Paul Krugman seems very optimistic about Obamacare. I hope he’s right but I think he’s far too sanguine about the pitfalls. In fact, I don’t think he’s right about the potential problems:
What can still go wrong? Well, Obamacare is a complicated program, basically because simpler options, like Medicare for all, weren’t considered politically feasible. So there will probably be a lot of administrative confusion as the law goes into effect, again especially in states where Republicans have been doing their best to sabotage the process.
Also, some people are too poor to afford coverage even with the subsidies. These Americans were supposed to be covered by a federally financed expansion of Medicaid, but in states where Republicans have blocked Medicaid expansion, such unfortunates will be left out in the cold.
Still, here’s what it seems is about to happen: millions of Americans will suddenly gain health coverage, and millions more will feel much more secure knowing that such coverage is available if they lose their jobs or suffer other misfortunes. Only a relative handful of people will be hurt at all. And as contrasts emerge between the experience of states like California that are making the most of the new policy and that of states like Texas whose politicians are doing their best to undermine it, the sheer meanspiritedness of the Obamacare opponents will become ever more obvious.
If Massachusetts is any guide, it’s not just the poor that will be hit–it’s the next two fifths as well. The data from Massachusetts are clear: having health insurance is better than not having it. But better than is not the same thing as good. In Massachusetts in 2008, forty percent of those who made between $39,000 – $63,000 reported skipping needed medical treatment due to costs.
Again, that’s better than the fate of the uninsured. But the issue isn’t the premiums, it’s the deductibles and co–payments. Paying low monthly rates and still getting hammered on the copays can actually leave lower-middle class households worse off–they don’t qualify for Medicaid, but they can’t afford deductibles.
Like I mentioned, I hope Krugman is right, but he really doesn’t seem to understand how healthcare costs hit moderate income families. This is an improvement, but that might not be good enough for millions of people–that’s not bureaucratic problem but a policy one.
At least, he’s now calling it a conservative plan…