Yes, Obamacare Critics, Health Insurance Does Make You Healthier

Michael Barone and Charles Krauthammer have some medical advice for you: Don’t get health insurance, they say. It won’t make you healthier. It’s a waste of money.

Obamacare Enrollment SurgeThey must be desperate. They don’t want to admit that they’ve run out of criticisms of Obamacare. The website is working, enrollments are surging, and millions of Americans are getting affordablehigh-quality health insurance. They couldn’t deny these facts, so they needed a new argument to discredit the law — and they found it tucked away in the New England Journal of Medicine.

In 2008, Oregon conducted an experiment. They held a random lottery. They picked 20,745 names out of a waiting list of 90,000 low-income adults who wanted to sign up for Medicaid. Of the winners, half received Medicaid, and half did not. After two years, they compared the two groups to see if the ones who had Medicaid were any better off.

Barone and Krauthammer claim that the Medicaid group did not have better health than the uninsured group, proving the futility of health insurance, but their conclusion is based on a very narrow, selective reading of the evidence.

It’s true that the individuals on Medicaid did not fare any better than their uninsured counterparts on blood tests for cholesterol, blood sugar, and blood pressure. But it’s also true that the Medicaid patients scored higher on the mental quality-of-life test, experienced significantly lower rates of depression, and reported that they felt healthier.

The Medicaid patients also experienced significantly less financial strain. They were 25 percent less likely to have an unpaid medical bill sent to a collection agency.

In other words, health insurance has significant mental and financial benefits.

In this study, the physical benefits are less clear, but that’s not surprising, given that it only lasted two years and it only measured three simple blood levels. Fortunately, other researchers have measured more than just cholesterol.

A 2008 study in the prestigious medical journal The Lancet, for example, revealed that uninsured patients were significantly more likely to develop advanced-stage cancer because they didn’t receive early screening to detect it.

A year later, Harvard researchers published a study in the Annals of Surgery showing that uninsured patients who arrived at the emergency room with traumatic injuries were almost twice as likely to die in the hospital as patients with insurance, even if they had the same race, gender, age, and severity of injury. Later that year, a similar study was conducted at the Boston Children’s Hospital and published in the Journal of Pediatric Surgery. It found that uninsured children were more than three times as likely to die from traumatic injuries as children with commercial insurance.

And if all that wasn’t enough to convince you, the American Journal of Public Health published a study that same year comparing the death rates of the insured and the uninsured when they had the same education, income, weight, rates of smoking and drinking, etc. They concluded that 44,789 Americans die every year simply because they don’t have health insurance.

That is the bottom line we should be talking about.

If the Oregon experiment were carried out beyond two years, the differences between the insured and the uninsured would accumulate. They found that the Medicaid patients were 70 percent more likely to visit the doctor, 20 percent more likely to have their cholesterol monitored, and for the women, 60 percent more likely to get a mammogram. Those kinds of preventive measures don’t make a huge impact in two years, but in the long run, they can mean the difference between life and death.

Health insurance is so beneficial to your health, in fact, that its effects spillover and benefit those of us around you. Studies have shown, for instance, that companies that offer health insurance are more productive because insured workers take 52 percent fewer “sick days” than their uninsured co-workers.

I have to wonder if Barone and Krauthammer have ever even met anyone on Medicaid. I wonder if they know the terrible fear that uninsured Americans feel when they get sick and they’re forced to choose between astronomical medical bills and untreated illness.

I think they should find out. If they’re so confident that health insurance doesn’t affect your health, then I would like to issue this challenge to them: Give up your own health insurance. Don’t waste another penny on it. Join the ranks of the uninsured.

If not, if they’re unwilling to follow their own advice, then they should stop giving it. They should stop spreading misinformation that can hurt millions of Americans who read their op-ed columns and who depend on the access to lifesaving medical care that only health insurance can provide.

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This op-ed was published in today’s Huffington Post. An abbreviated version was published in the South Florida Sun-Sentinel.

Does Obamacare Infringe on Our Liberty? Or Does It Give Us Even More Freedom?

What right does the government have to make you buy health insurance?

That’s the question that riles Obamacare critics the most. It’s not the premiums or the website or the dropped coverage. It’s the infringement on their liberty.

Does Government Threaten Our Freedom?You hear it all the time: “This is a free country!” That’s what everybody says. But what do they really mean? Do they know what freedom is?

It seems obvious at first. Freedom is lack of coercion. Therefore, anything the government makes you do infringes on your freedom.

But there are different types of coercion, and the government isn’t the only one doing the coercing.

Let’s say that you want your daughter to attend the best school in America. But you can’t afford the tuition. Do you really have freedom of choice? If you choose the school you want, they won’t let you through the front door. If you force your way in, they’ll arrest you.

So you “choose” a more affordable school. You wanted a better school, but they forced you to settle for a different one. Sounds like coercion to me.

Let’s consider another example. You want to retire at the age of 65. You’ve worked hard throughout your entire adult life. Unfortunately, wages haven’t risen, and the bills kept piling up. You saved as much as you could, but it’s only enough to live off for a couple years. Oh, and one more thing: Social Security and Medicare don’t exist.

If you “choose” to retire, you’ll go broke. You’ll go without preventive health care. Your chances of dying early will increase significantly.

So you have a choice: Keep working or die young.

In this case, you actually have less freedom because the government is less involved. Without Social Security and Medicare, you do not have the freedom to choose a long, healthy retirement.

Freedom requires more than the absence of laws and taxes. True freedom of choice requires the capability to make that choice — and the free market doesn’t always give us that capability.

Jobs are scarce. Most of us don’t have the freedom to work anywhere we want. We take what we can get. For many of us, that means working at a company that doesn’t pay for our health insurance. So we “choose” to buy insurance on the individual market.

Before Obamacare, the individual market charged really low rates to healthy people and really high rates to sick people. So the people who needed insurance the most couldn’t afford it. They didn’t have the capability — and therefore the freedom — to buy it.

Obamacare outlaws that kind of discrimination. It requires insurers to charge the same rates to healthy and sick people alike, and that means that healthy people will have to pay higher rates. Some of them won’t want to, so they’ll stop buying insurance. When they drop out, they leave behind the sicker people who are most costly to insure, forcing insurers to raise rates even more. It’s a vicious cycle, a “death spiral,” that results in almost everyone being priced out of the market.

Virtually no one will have the freedom to buy health insurance on the individual market.

And that’s why we have an individual mandate. If the healthy people don’t drop out, there’s no death spiral, and the insurance remains affordable for the people who need it the most.

The government gives them a freedom that the free market cannot. It gives them the capability to purchase health insurance.

If we choose not to buy insurance, we pay a penalty. As Supreme Court Chief Justice John Roberts has written, “it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income.” Those taxes pay for our roads and Army and Navy and Social Security and Medicare — and those things give us the freedom to live a life that we often take for granted. Without those taxes, without those government-funded investments, we could not call ourselves a free country.

In the same way, without Obamacare, without the government making us buy health insurance, we would be condemning millions of Americans to lives without health care. We would be restricting their freedom. And what right do we have to do that?

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This op-ed was published in today’s South Florida Sun-Sentinel and Huffington Post.

Do the Math: People Don’t Choose to Be Poor or Unemployed

Long-Term Unemployment HistoryGod, I wish I were poor.

And unemployed. That’s the good life. Poor and unemployed.

I mean, just look at all the cool stuff you get. Medicaid and welfare. Food stamps and unemployment insurance. And don’t forget public housing.

This stuff is so awesome that it’s like a “hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.” That’s what Paul Ryan says, at least, and as the Chairman of the House Budget Committee, he’s supposed to know these things, right?

According to Ryan and his fellow Republicans, if I have unemployment insurance, I’ll never want to work again. Senator Rand Paul says it will cause me “to become part of this perpetual unemployed group.” With an average benefit of $269 per week, I’ll be living on Easy Street.

This is a common belief. There’s an email making the rounds from a 54-year-old consulting engineer who makes $60,000 a year and has to pay $482 a month for health insurance under Obamacare, but that’s not his biggest complaint. He’s really upset that his 61-year-old girlfriend who makes $18,000 a year only has to pay $1 a month for health insurance.

He thinks she has it so easy that she can afford to pay more, but he’s wrong.

On average, Americans earning $18,000 a year pay more than $3,000 in taxes, so she really only has $15,000 leftover to pay her expenses. She lives in Monterey, CA, where the average rent and utilities add up to $15,000 a year. So, after paying taxes, rent, and utilities, she’s completely broke. She doesn’t have money for food, let alone health insurance.

The consulting engineer thinks people will choose her lifestyle over his. “Heck, why study engineering when I can be a schlub for $20K per year?” he asks. (Nice way to talk about your girlfriend, by the way.) To which I’d like to reply: If being a “schlub” is so attractive, why don’t you do it? Why don’t you quit your engineering job and join the “$20K per year” club?

For that matter, why don’t we all quit our jobs right now and start collecting unemployment insurance? How far do you honestly think we can stretch $269 a week?

I’ll tell you how far: It would cover less than half of the basic necessities for the average American family.

That’s why unemployment makes you more likely to have to borrow money from a friend, withdraw money from your retirement savings, and have trouble paying your medical bills, rent, and mortgage. It makes you more likely to have a stroke or heart attack, lose self-respect, have difficulty sleeping, and seek professional help for anxiety and depression. It makes you more likely to kill yourself, kill others, and drink yourself to death.

And if you’ve been unemployed for more than a few months, most employers won’t even look at your résumé. It doesn’t matter how qualified you are. It’s like you don’t exist anymore.

The last time it was this bad, with long-term unemployment close to 3 percent of the workforce, was the peak of the 1980-81 recession. Back then, the federal government kept extended unemployment insurance in place for almost two more years, until the long-term unemployment rate fell close to 1 percent. In fact, that’s been standard operating procedure for every recession in the modern era, including 1990-91 and 2001. But now, with long-term unemployment as high as it’s been since World War II, Republicans have killed the emergency unemployment insurance program, and they’re fighting Democrats’ efforts to restore it.

They don’t seem to care that there are 2.9 applicants for every job opening. They don’t seem to care that people on unemployment insurance actually spend more time searching for work than their fellow unemployed who are ineligible for benefits. They’re sticking to their story.

On the 50th anniversary of the War on Poverty, many Americans are still operating under the assumption that people choose to be poor and unemployed, that they’d rather be lazy than rich, that they can afford the basic necessities of life. But the numbers tell a different story.

I don’t wish I were poor. Or unemployed. And I sure don’t wish it on anyone else. If you did the math, neither would you.

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This op-ed was recently published in the South Florida Sun-Sentinel and the Huffington Post.

Good News: Obamacare Clearly Isn’t Stifling the Economy

Part-Time Employment Before and After ACA

The latest GDP numbers are bad news for Obamacare critics.

You’d think that everyone would be happy when the Commerce Department announced that our economy grew by a whopping 4.1 percent in the third quarter of this year. But according to the naysayers, that wasn’t supposed to happen.

One of their biggest complaints against Obamacare was that it would stifle the economy. Penalties and fines would raise the cost of doing business. High premiums would impoverish middle-class families. Forcing businesses to offer health insurance to full-time employees would make them switch to part-time employees — or stop hiring altogether.

And yet, the more of the law that’s implemented, the better the economy seems to perform. How can that be?

Well, for one thing, the cost of Obamacare has been greatly exaggerated. The law states that companies with more than 50 workers must offer health insurance to their full-time employees or pay a fine of $2,000 per employee. That may sound like a lot, but it’s a heck of a lot less than most companies are already paying for health insurance, which costs an average of $15,073 per worker.

“You’ve got 5.7 million firms in the U.S.,” says health economist Mark Duggan. “Only 210,000 have more than 50 employees. So 96 percent of firms aren’t affected. Then if you look among those firms with 50 or more employees, something on the order of 95 percent offer health insurance.”

When you add it all up, the “employer mandate” probably affects less than 1 percent of the workforce. Definitely not enough to make a dent in the economy.

So it shouldn’t come as a surprise that there is no evidence that Obamacare is turning us into a “part-time” economy. Since President Obama signed the law, the economy has added millions of full-time jobs, while part-time jobs have actually declined. A lower percentage of workers are part-time than they were under President Reagan in the 1980s. Over the past year, there has been a significant decline in the number of people working part-time “for involuntary economic reasons.” And when you look at the part-time definition of “less than 30 hours per week,” the number of workers who fall just below that cutoff has been growing slower than the number of workers just above it.

And it makes even less sense to argue that the employer mandate would cause employers to drop coverage. If they’re offering coverage, it’s because their employees want it, and they want to attract and retain good employees. They’re not going to stop just because the penalty costs less than the insurance. If they wanted to drop coverage, they could have done it before Obamacare, when there wasn’t a penalty at all. In fact, in the years after Massachusetts enacted an employer mandate, their employer-based insurance coverage actually increased while the rest of the nation’s decreased.

What’s more, those small businesses that do offer coverage will receive a sizeable tax credit. For the small businesses that already offer coverage, this is a huge windfall. For the ones that don’t, the tax credit may make it profitable for them to do so. And since they fall under the 50-employee cutoff, they won’t be penalized if they don’t offer coverage.

The only remaining question mark is exactly how the employer mandate will affect insurance premiums. Since it doesn’t go into effect until the beginning of 2015, we’ll have to wait until the end of 2014 to find out. Just like this year’s fiasco, there will probably be a lot of complaints about dropped coverage and raised rates, and then those complaints will fade away as people realize that most of them can get better coverage and, on average, rates are going down.

And, as an added bonus, those Americans who do lose their employer-based coverage now have the comfort of knowing that they won’t be denied coverage or charged discriminatory rates on the individual market, thanks to the individual mandate and the online marketplace that are now in place. They will get affordable insurance, and they will live healthier lives, and they will continue to contribute to the rising productivity that is making our economy grow so fast.

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This op-ed was published in the Huffington Post, and a slightly edited version was published in the South Florida Sun-Sentinel.

Looking Overseas Gives Us Reasons to Be Thankful for Obamacare

U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

This Thanksgiving, a lot of Americans will be giving thanks for Obamacare.

By the end of this month, HealthCare.gov will be able to handle 800,000 users per day, enough to enroll everyone who needs coverage by the end of the year. Meanwhile, the state-run exchanges are reporting “a November enrollment surge,” precisely as the Obama administration predicted. (Massachusetts also experienced a late enrollment surge when they adopted an individual mandate in 2006.) Everyday, we hear new stories about Americans who are saving thousands of dollars on their insurance costs, including House Speaker John Boehner, whose new Obamacare insurance will cost pennies on the dollar of his six-figure income.

And not a moment too soon. Earlier this month, the nonpartisan Commonwealth Fund published the results of their latest survey of eleven industrialized countries, including the United States, where they asked people about their experiences with the health care system in the past year. Their findings are a sad reminder of just how bad the status quo is — and why we demanded health reform in the first place.

Many Americans don’t go to the doctor when they’re sick because they can’t afford it. Many don’t go to the pharmacy or take their medicine. Add it all up, and 37 percent of Americans had some sort of “cost-related access problem” in the past year.

That kind of problem isn’t nearly as common in the Netherlands, where it only affects 22 percent of the population. Or France, where the number drops to 18 percent. Or Canada, where it’s 13 percent. Or the UK, where it’s 4 percent.

Fair enough, you might say. More people have more access, but they also have to wait in line longer, right? Not necessarily.

In fact, in most countries, the majority of the population could see a doctor within a day of their request. The United States placed second-to-last in this category. A quarter of our population had to wait six days or more — a little better than Canada, but far worse than Australia, France, Germany, the Netherlands, New Zealand, and the UK.

But that’s primary care. The United States is known for its specialists, where 76 percent of the population got an appointment in less than four weeks and only 6 percent had to wait two months or more. That’s a heck of a lot better than Australia, where only 51 percent got an appointment in less than four weeks and 18 percent had to wait two months or more. Or Canada, where the numbers are 39 percent and 29 percent, respectively.

But it’s about the same as the Netherlands, where the numbers are 75 percent and 3 percent. And the UK, where they’re 80 percent and 7 percent. And even Germany isn’t far behind, at 72 percent and 10 percent.

So it’s a mixed bag, but we’re certainly not in the lead.

In most countries, it’s a lot easier to get after-hours care than in the United States. Only 35 percent of American doctors have an arrangement to take care of their patients after the office is closed — by far the lowest percentage of all the countries surveyed. In Canada, it’s 46 percent. In France, it’s 76 percent. In Germany, the Netherlands, and the UK, it’s 90 percent or higher.

And the doctors have a lot more problems in the United States, where the paperwork piles up. One in three — 32 percent — reported significant paperwork or payment problems in 2013, compared to 23 percent in France, 17 percent in Germany, 15 percent in Canada, and 4 percent in the UK.

No wonder everyone else is happier with their health care than we are.

Only 25 percent of Americans think their health system works well. In the other countries, that approval rating ranges from 40 percent in France to 63 percent in the UK.

Whereas 27 percent of Americans think the health system needs to be completely rebuilt, that disapproval rating ranges from 12 percent in Norway to 4 percent in the UK.

That’s a lot of numbers, but they all tell the same story: The United States has the most complicated, most expensive, and most frustrating health care system in the industrialized world — and none of that is due to Obamacare, most of which took effect after the survey.

In fact, Obamacare is moving our system closer to our international counterparts. Based on these numbers, I’d say that’s definitely something to be thankful for.

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An abbreviated version of this op-ed was published in Friday’s South Florida Sun-Sentinel. This version was published in the Huffington Post.