Obama and Obamacare
Health care reform and Obamacare is really all about numbers. This has been pointed out several times in the past.
Health care reform is a necessity in the United States. America spends about 19% of its GDP on health care or about $2.97 trillion dollars annually. France is the next most expense at 11.6% of its GDP and it has universal coverage. America’s population is aging. Right now the a median age in the US is 37, expecting to rise to 38.7 over the next 20 years as Baby Boomers age. With that aging comes increased health care costs. US GDP expenditures on health care will continue to rise to well over 20% unless something is done. Thus, reform of health care was a major priority for Obama. If we could achieve near universal coverage and cut health care spending even to the level found in France (a one-third reduction in spending), that would free up near one trillion dollars per year to invest in the economy or simply to save.
For Obamacare to work one needed to achieve near universal coverage by getting many young healthy people otherwise not insured into the health care market. Increase the insurance pool of those healthy and the insurance markets set up with the health care exchanges will work.
Yet all of this is now falling apart because of other political math. The federal health care exchange web site is a mess, producing confusion and too few people who have signed up. Additionally, after candidate Obama promised the American public if they liked their health care plan they could keep it, millions are receiving notice that their current plan is being cancelled. The president’s approval rating is falling, over 50% think he is not trustworthy, and his own Democrats in Congress are worried about 2014 and want to act. Thus, last week Obama issues an executive order asking insurance companies to keep their old policies in effect for one more year. In essence, Obama is delaying by one year requirements for Obamacare, similar to requests pressed by Republicans only a few weeks ago during the shutdown.
Here is the math rock and hard place Obama is behind. First, the request to the insurance companies is merely a request and not an order. Second, how will cancelled policies be reinstated? Third, the request is only for a year, thereby pushing the cancellation problems into the center of the 2014 elections. Thus, the order to delay Obamacare is the product of political necessity but it solves little. Morever, by pushing the delay it potentially upsets the actuarial numbers that insurance companies need to make the policies work at their current rates. If people keep their current policies then those enrolled in the new health care exchanges may see their rates go up even more.
Finally, Obamacare was originally supposed to increase coverage by several millions. Best estimates by the Census Bureau (as I discussed recently in a blog) are that the numbers of people who will actually gain coverage will be far less than thought and because so little thought was given to increasing the supply of doctors and health care providers there are indications that costs will increase over time. Bottom line: there is little evidence that Obamacare will trim health care expenditures, bend the cost curve, or really lead to a dramatic increase in the numbers insured, beyond certain populations.
Okay so here is one last number and thought. What do we do in a post Obamacare world if the Affordable Care Act collapses on itself? What if one had simply taken the original 2,000 page law and instead did three things: 1) Allow young adults to stay on their parents policy until age 26: 2) bar denial of coverage for pre-existing illnesses; and 3) Allow anyone to enroll in Medicaid and pay for its benefits? My guess is that this legislation would have totaled about 100 pages and achieved far greater results than Obamacare.
Ranked Choice Voting
RCV in Minneapolis was all about math too. Some numbers to consider.
First, had the rules of ballot access been that one needed 500 or more signatures to appear on the ballot for mayor then (based on the final votes on election night) only ten individuals would have qualified as candidates. Something needs to be done to ensure that only serious candidates who have some support appear on the ballot and many cite the $500 ballot access fee in St Paul as an example. However, that $500 fee may be unconstitutional. The Supreme and other courts have struck down excessive ballot access fees as unconstitutional. Most jurisdictions do fees with alternative signature requirements. This is the better math for Minneapolis–$500 or 500 signatures.
Second, at 11 PM on election night it was clear that the bottom 29 or 30 candidates mathematically could not win the mayor’s race. This means that had city charter allowed for it, one could have simply eliminated them on the day after the election, transferred their votes, and the race would have been called then.
Third, the reason there are no voting machines to do the automatic tabulation is also a product of math. No two cities seem to run RCV the same way, precluding vendors from making machines that can be approved by the Department of Justice for use in elections.
Overall, do the math! Politics is often about numbers that do or do not add up.
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