The horizon is not so far as we can see, but as far as we can imagine

Obamacare Failures Are by Design

Look, this is not a mistake by Obama. This is how Obamacare was designed:

for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”

Obamacare was a way of bailing out insurance companies and for providing catastrophic insurance coverage, which is meant to protect hospitals. If someone requires many thousands of dollars of care in one go, the hospital doesn’t have to eat it.

Meanwhile the high deductible, plus the relatively low percentage of premiums which the plan should be designed to pay out, are intended to keep insurance companies in business, as they were becoming less and less profitable.

In-network vs. out-of-network rules and deductibles also make the insurance hard to use in many parts of the country, and, again, this was by design.

Obamacare was never designed to make sure everyone had health care, it was designed to help insurance companies and hospitals—to get money to  people who matter.

I strongly suspect it was also intended to preempt the logical plan of simply extending Medicare to everyone. Obama went out of his way to make sure there would be no public option, as well, trading it away right at the beginning.

Obamacare is a corporate subsidy. Some ordinary people get helped, but that is a side-effect.

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  1. Roman Berry

    As we used to say over at the late, great Firedoglake, the ACA plan is for “junk insurance”, and the reason it’s “junk insurance” is that the people who it’s supposed to help can’t afford to use it because of those high deductibles (which oddly enough is a feature — as in “high deductibles are supposed to make consumers make better choices in health care” — and not a bug.)

    The ACA was always a “health insurance” plan rather than a health care plan. And you are exactly right when you say that the ACA is a bailout of insurers. Not too many businesses I can think of where the federal government guarantees you a minimum of 20 percent off the top. (20 percent was supposed to be the ceiling, but there’s this thing in the law called waivers which apparently just about every insurer has applied for and been granted which makes a joke of even that 20 percent.)

    Late stage “capitalism” is in the process of eating itself alive. The end game, when it comes, is going to be very, very ugly.

  2. Mary McCurnin

    I knew we were in trouble before Obama was elected the first time since he voted for the FISA extension. Having already gone through the disappointment of the first Clinton, I could easily see where Obama was headed. Universal health care made way too much sense. And Obama has cut back medicare.

  3. different clue

    Obamacare could be considered the legislative version of what Wikipedia calls a “stub”. Part of the purpose was a bailout for Big Insura. Part of the purpose was to poison the well around “health care reform” so thoroughly that the issue of Single Payer CanadaCare for America will not be revisited for decades to come. And the “stub” part of the purpose is to have it in place for Obama’s successors to refine it into the pure Heritage Care which would not have passed if offered in the pure form.

    (Also it is a toilet into which Medicare, Medicaide and VA Medicine are meant to be flushed and privatised over time).

    Obama hopes to become America’s first Billionaire ex-president.

  4. The Tragically Flip

    This is what they mean by that awful orwellian “bending the cost curve” thing. Wow, use of health services is down when people have to shell out $3K just to get them? You don’t say!

  5. The Tragically Flip

    Should also mention the decision not to pass Obamacare under reconciliation which would have greatly strengthened the hand of the bulk of the Democratic caucus in passing a better law without having to keep the likes of Lieberman & Nelson on board since that meant it could pass with 50 + Biden. The budget rules for 2010 included provisions to allow a health care law. Sure, it would have meant the law had to be renewed in 10 years, but if it worked, that would be no problem.

    I can’t recall there being anything like a satisfactory explanation for not doing this under reconciliation rules.

  6. Christopher Fay

    Bill/Hillary are the first billionaire ex-presidents. They just have it in the inconvenient form of various trusts. But they live/act like billionaires.

  7. Oaktown Girl

    Here’s another affordability nightmare: In California, you don’t qualify for “Covered CA” (CA’s version of the Affordable Care Act) if you have insurance through your employer, and your employer is paying your monthly premiums. But here’s the kicker: yes, my employer was paying my monthly premiums, but my deductible before my insurance could even BEGIN to kick in was $4,000. What was I making? $11.00 hour. So yes technically I had coverage, but I could in no way afford to use it.

    I tried to get Covered CA on the grounds that my “coverage” was unaffordable, but the rules of Covered CA had me (and everyone like me) screwed. As long as my employer was paying my monthly premiums, I couldn’t qualify for Covered CA, and it didn’t matter that I had a 4K deductible on $11.oo hr wage. In addition, I was not legally allowed to “refuse” my employer’s coverage so I could get Covered CA instead.

    So then I was “lucky” enough to get a job with a more affordable health plan. But I absolutely hate the job, and I know it’s shortening my life. 90% of my working life (all in the U.S.) has been wasted at jobs I hate just so I can get health insurance. I’ll stop there because anything more I write is even more depressing.

  8. EGrise

    Sorry to hear all that, Oaktown Girl. I’m in much the same boat, stuck in a crummy, stressful job because I need the health insurance. Almost like this was part of the plan, isn’t it?

  9. Steve

    I was on several different Obamacare plans for about 2 years in 3 different states, and I can attest that these policies provided basically no assistance. I found plans with much lower deductibles (I’m young and healthy) than quoted in these articles, and they still were not what anyone would consider affordable.

    It does feel like a tax.

  10. Oaktown Girl

    @Egrise – thank you, sincerely. Yes, it does feel like a tax, and that’s putting it kindly.

  11. Greg T

    The Affordable Care Act was a mandate to purchase junk insurance. As Ian writes, its primary goal was to keep the health insurance industry profitable, and take cost pressures off hospitals. Obama managed to bailout three major industries during his first term; the automobile industry, the TBTF banks and the health insurers. These industries cannot exist without government support. In a sense, he is a socialist, though his socialism is quite selective. The national government guarantees the profits of preferred industries, while society pays the costs. That’s rich man’s socialism.

    Customers are realizing that Obamacare isn’t such a great deal. Even subsidized premiums don’t cover theses high deductible plans. In some cases, customers have to come out of pocket 10-12 K before insurance even kicks in. That’s really a catastrophic care policy, and It doesn’t solve the adverse selection problem. Only sick people will enroll in the plans. Healthier people will forego the coverage and pay the tax.

    Watch the penalty tax be increased. In 2018, the so-called ” Cadillac Tax ” will apply to employment insurance plans. This gives incentives for employers to terminate employee health coverage, and throw everyone to the exchanges.

  12. ProNewerDeal

    At the current time, do you feel the ACA is a overall net positive or net negative over the pre-ACA status quo? I honestly do not know.

    I also wonder if the 0bot opinion of “the ACA is a good 1st step towards Medicare For All”, or if commenter Different Clue is correct, and ACA is a 1st bad step into crapifying Medicare/Medicaid into ACA.

    If this CO Medicare For All 2016 Ballot initiative has a real chance of passing, perhaps it could be 1 genuine sign of hope that Barbaric USA could possibly take a baby step towards CAN-style Medicare For All. I imagine the CO activists will face massive anti-ballot lobbying attacks & propaganda. I’d be scared that 0bama or other right-wing DLC Dems or Rs will try to kill CO’s plan if they can. If CO Medicare For All is enacted, will they face a risk of adverse selection, with some of the seriously sick USians from the 320M in the other 49 states moving into the “mere” 5.4M state of CO. But I hope my fears are overstated, & the CO’s Medicare For All is enacted, this would be True Hope & Change, not that garbage 0bama sold me & some others of us that were excessively naive in 2008.

  13. ProNewerDeal

    Was Glen Ford of blackagendareport correct, & 0bama is The More Effective Evil? Is 0bama Even Worse than Bush43?

    0bama’s negative policies include the negative parts of the ACA including
    1 the unaffordability given the high deductible mentioned in this article,

    2 the ACA Individual Mandate legally establishing the concept of forcing a consumer to purchase a crapified service from a private oligopoly,

    3 the Nastradamusing of predicting one’s work income 1 yr in advance in an job-insecure, mass-layoff, gig-job economy for the ACA private oligopolist insurance subsidies, & if you guess wrong, you owe the IRS + interest.

    other 0bama negative policies include
    4 TPP horrible trade agreements

    5 repeated Grand Ripoff attempts to slash/crapify Soc Security & Medicare

    6 establish “normalcy” of US President openly dictator-murdering USians that are not physically in the US (like say in Yemen) sans any judicial process.

    Meanwhile Bush43
    1 0.6M private sector job loss over 8 yrs despite population growth, an outlier crappy job record. By comparison 0bama has ~10M (albeit mostly crappy) added private sector jobs

    2 Bad regulation of 2B2F Banks, & derivatives, led to the 2008 GFC

    3 Sep11 attack which killed 3K USians, likely due to Bush43’s incompetent inaction despite intelligence analysts’ repeated warnings of a likely attack

    4 Iraq & Afghanistan Wars, sold to USians based on a lie of “WMD”. The wars cost $3T+ counting veterans’ benefits, and led to ISIS being able to gain power years later.

    I’d guesstimate that 0bama is even worse than Bush43. The scary thing is, that H Clinton is likely to be as bad as 0bama if not worse, & the Repubs are likely Even Worse. B Sanders seems clearly actually good, if he can somehow overcome the Rigged Dem Primary, where Hellary’s hack lackey DNC Chair D Wasserman-Schultz is simultaneously & absurdly the Primary Referee.

    What do yall think, is 0bama Even Worse than Bush43?

  14. Christopher Fay

    Bush44 worse than Bush43. If Hillary then Bush45 worse than Bush44 than Bush43.

  15. kj1313

    @Roman Berry FDL and NC did some great analysis when the ACA was taking shape.

  16. To be honest, the low premium-high deductible plans were already there. Obamacare just forced thousands to buy into it through the law or face fines. Many who can barely make the premium payments but simply will never have the amounts needed to pay the deductibles.

    It would be interesting also to see the numbers Obamacare did help who could afford such high deductibles but were not previously able to even get this insurance because of a pre-existing conditions

  17. Z

    The Tragically Flip,

    Obamacare ended up being at least partially passed via Reconciliation. After the Obama administration had originally denied that it was a viable option in defending why they wouldn’t use it to include a public option in the bill, they were forced to resort to it to get the bill passed. Once that happened, Obama rushed in (after sitting on the sidelines for a long time and allowing the bill to be weakened) to wrap it up before public pressure could be re-organized to push the Congressional democrats for a public option again.


  18. different clue


    I am not prophetic enough to know whether Obamacare will in-the-end lead to single payer CanadaCare for all. But I am smart enough to know that one of the long-range GOALS of Obamacare IS to deSTROY Medicare, Medicaide, and VA Medicine and privatise/profitise the wreckage and revenue streams. Its part of what Obama expects to be paid hundreds of millions of dollars for after he leaves office.

    I believe he expects more than well-paid speechgiving opportunities. He expects to be placed on corporate boards, be made a member of the Carlyle Group, be set up in a lucrative foundation like the Clintons, etc. etc.

  19. Notbuyingit

    Before Obamneycare, at least the available catastrophic plans were affordable. I had a plan with a $5000 deductible, less than Obamacare, but it cost under $100 a month, while now I would have to pay over $300 for a plan with a higher deductible. Obama is all for socialism for the corporations and the same old predatory capitalism for actual humans.

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