Paul Krugman Explains Obamacare

On July 10, the failing New York Times ran “Three Legs Good, No Legs Bad” by Paul Krugman who asserted that the reason “Republicans can’t come up with a non-disastrous alternative to Obamacare [is] because you can’t change any major element of the Affordable Care Act without destroying the whole thing.”

Krugman then informs us that ObamaCare is a “three-legged stool.” The first leg requires “that insurers offer the same plans, at the same prices, to everyone, regardless of medical history,” which “deals with the problem of pre-existing conditions.” The second leg is the individual mandate, which requires (some) Americans to buy health insurance. And the third leg of Krugman’s stool is subsidies for those who can’t afford to comply with the mandate; i.e. expanded Medicaid and tax credits to buy private health insurance. “The key point is that all three legs of this stool are necessary. Take away any one of them, and the program can’t work.”

But if ObamaCare really is a three-legged stool, then that’s a major design flaw. Why wasn’t ObamaCare designed to be a four-legged chair? Many animals are quadrupeds, and can still get around if they lose one leg. Redundancies and backups are built into everything nowadays. Jetliners are designed to be able to fly on one engine. So was the stool deliberate, or are the architects of ObamaCare just doofuses who shouldn’t be allowed anywhere near public policy?

Krugman’s problem is that he won’t admit that ObamaCare has more than three legs, even though he writes: “you need to realize that as written (and interpreted by the Supreme Court), the law’s functioning depends a lot on cooperation from state governments.” What Krugman calls “cooperation” was actually force, and the high court held that, “as written,” ObamaCare’s expansion of Medicaid in the states was unconstitutional. If ObamaCare “depends” on the states, why are the states not a fourth leg?

Medicaid’s expansion has still not expanded to the entire nation. Medicaid is becoming so costly that it’s a major item in the budgets of many states. What if the states rebelled and told the feds to handle Medicaid themselves? Then we’d be back to three legs, and Krugman’s metaphor would still stand.

Another leg Krugman fails to recognize is the risk corridors, which are bailouts of insurance companies. (Find recent court cases here and here.) Republicans are now calling the risk corridors “stabilization funds.” Senator Rand Paul objects to these funds, because they’re taxpayer funding of private insurance companies. But the risk corridor funds were a part of the original ObamaCare, so we got another leg here. Then there’s the bailouts known as “Net Worth Sweep,” Yet another leg. Maybe ObamaCare is really a chair or a table, or maybe even a credenza.

ObamaCare is an ungainly creature propped up by numerous legs all held together with duct tape, bailing wire, snot, and lies. Krugman isn’t a true “leg man,” as he can’t see all the legs. Or maybe metaphor isn’t Krugman’s métier.

But what do we do about “the disaster known as ObamaCare”? Sen. Paul is showing us the way by objecting to the insurance company bailouts. But it’s the entire subsidy program that needs to be deleted, and Republicans are keeping it. Instead, Congress should accept responsibility for poor folks in the subsidy program who have pre-existing conditions and put them into Medicaid. That should cost the taxpayer less than the ObamaCare subsidy program. The subsidy program was a new entitlement, when we couldn’t even pay for the old ones. End the subsidy program and there’ll be no need to borrow another $180B to stabilize a defunct program. That should go far in getting Sen. Paul onboard.

So we’ve dealt with the problem of pre-existing conditions. Now, what do we do about the issue that cost the GOP the votes of the lady senators: i.e. Medicaid? To get these ladies’ votes, the repeal and replace bill should leave Medicaid alone. Medicaid needs top-to-bottom reform, but the current bill is not the place to do it. Leaving Medicaid unscathed for the time being might rile certain Freedom Caucus members. However, everyone who cares about spending and deficits realizes that Medicaid must be reformed, and soon. So save Medicaid reform for later, because repeal and replace needs to be kept simple.

Having taken care of his third leg, what do we do about Krugman’s first and second legs? Well, we saw them off. We allow insurance companies to formulate whatever policies the market calls for, and charge whatever prices the market deems fair, because the feds will be getting out of the insurance market. And we end both the individual and the business mandates to buy insurance. I’ve already urged the repeal of McCarran-Ferguson, so we’ll have a national health insurance market. Let’s try free-market capitalism for a change. Hoorah!

What I’m proposing is full repeal, but with one addition: putting into Medicaid the patients in the individual market with pre-existing conditions. And it should go into effect on January 1, 2018. The only reason Republicans would want to delay implementation of the replacement is because they want to continue with the Democrat’s rotten idea of the tax credit subsidy program, which is one of the worst ideas of ObamaCare. The subsidy program is why we have the dang bailouts.

At 4 percent of the population, the individual market was the smallest non-VA insurance cohort before the advent of ObamaCare; it was 7 percent two years later. It was to those in the individual market that Obama made his dishonest pitch about how premiums would go down by $2,500. The opposite has happened. It is folks in the individual market who have been hurt the most by ObamaCare. Because of the harm done to it, the repeals that affect the individual market should happen immediately; i.e. the end of mandates and uniform policy requirements.

Why did the Democrats foist the ultra-expensive patients with pre-existing conditions into the tiny individual market, rather than accepting that responsibility themselves and putting them into Medicaid in the first place? Why did the Dems infect the smallest cohort with the sickest patients? It’s because Democrats want control. It’s the same reason they require uniform policies, and uniform prices, and uniform Americans. It’s their lust for power. Democrats must pay for the all the damage they’ve caused by reversing the ObamaCare now.

In 2015, former Health and Human Services Secretary Sebelius made statements similar to Krugman’s. She said that Obamacare was so “intimately entwined” into the healthcare system that we couldn’t go back. Indeed, there was nothing to back to. I responded with “Are We Really Stuck with Obamacare?” It may not be a three-legged stool, but I think it still stands up; you might give it a look.

Jon N. Hall of Ultracon Opinion is a programmer/analyst from Kansas City. 

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