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Is Obamacare Working? The Affordable Care Act Five Years Later

2015-03-24 · explainer · John · 7:28 · watch on YouTube

Topic: US politics & society · mode: News analysis · tags: timely hook, civic or action cta

John argues that five years on the Affordable Care Act is working insofar as it insures people who lacked coverage without disturbing others, but, not being radical, it leaves US health care spending unsustainable; fixing that means facing messy trade-offs.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Greeting; yesterday was the ACA's five-year anniversary, so John asks whether it has worked

00:00:13 — Summary: the US spends more public money on health care than Japan, the UK or Australia yet still lacks universal care; pointer to Healthcare Triage

  • ★★ John says that in 2009 more of his US tax dollars went to health care than would have in Japan, the UK or Australia, yet the US did not get their universal health care. — 00:00:13 · United States, United Kingdom, Australia
  • ★★ John says that in 2014 the US spent about the same share of GDP on health care as in 2009 and still lacks universal health care, but has "less un-universal" care. — 00:00:28 · United States
  • ★ John points viewers to Healthcare Triage for better information and more health care videos. — 00:00:39

00:00:41 — The pre-ACA system in 2009: Medicare, Medicaid, 44 million uninsured, costs shifted to others, 17% of GDP, pre-existing conditions (Henry Reich), job lock

  • ★★ John says that before the ACA, in 2009, the government insured the elderly through Medicare and some poor people through Medicaid, others got insurance through jobs or bought it, and 44 million people were uninsured. — 00:00:41 · United States
  • ★★ John says uninsured people's unpaid hospital care was absorbed by everyone else through higher prices or taxes, so the US had only an emergency-care kind of universal health care, not real universal care. (playful) — 00:00:59 · United States
  • ★★★ John says the US spent more than 17% of GDP on health care, while Canada, France, Australia and the Netherlands spend under 10% with similar or better outcomes. — 00:01:38 · United States, Canada, Australia
  • ★★ John says that in 2009 insurers could deny coverage for a pre-existing condition, a phrase so broad it covered nearly everything; big-company jobs were the only way around it. — 00:01:54
  • ★ John says Henry Reich of MinutePhysics was once denied insurance for the pre-existing condition of tinnitus. — 00:02:04
  • ★★ John says tying insurance to big employers pushed people into big companies when they might otherwise do other work, such as making MinutePhysics videos. (playful) — 00:02:17

00:02:24 — What the ACA sought and how: exchanges, Medicaid expansion, employer requirement, cost controls and new taxes

  • ★★ John says the ACA aimed to make the labor market less "bananas", cut health-related bankruptcies (the top cause of US bankruptcy), insure the 44 million uninsured and, over time, lower health spending. — 00:02:24
  • ★★ John says the ACA created exchanges where private insurers compete but cannot discriminate by gender or pre-existing conditions, and expanded Medicaid to more poor people. — 00:02:41
  • ★★ John says the ACA requires companies with more than 50 employees to provide affordable insurance or pay a gigantic penalty. — 00:02:55
  • ★★ John says the law was to be paid for, hopefully more than paid for, by cost controls (Medicare fraud, readmission incentives) plus a tanning-salon tax and a higher Medicare payroll tax on income over $250,000. (hedged) — 00:03:01

00:03:20 — Has it worked? Yes and no: rollout disaster, exchanges now work, 12 million enrolled, premiums, labor market, uninsured rates; but underinsurance and 17% of GDP remain

  • ★★★ John's verdict: the ACA has worked insofar as things are better than before, and not insofar as the US is nowhere near sustainable health care spending. — 00:03:20 · United States
  • ★★ John says the ACA phased in slowly, its core starting in 2014; the late-2013 exchange rollout and healthcare.gov were a disaster, though buying private insurance before was arguably worse. — 00:03:31
  • ★★ John recalls that trying to sign up for exchange insurance in the early months was truly awful; now it is easy, and he is among those insured through the exchanges. — 00:03:53
  • ★★★ John says the exchanges now work well: more than 12 million Americans have signed up, premiums rise more slowly than before, and more insurers participate. — 00:04:01
  • ★★ John says the law is costing less than expected because fewer employers than expected dropped people from their insurance. — 00:04:17
  • ★★ John says the ACA does not seem to hurt the job market and has brought labor-market freedom: Sarah Green could leave her insurance-providing museum job to start an art show with PBS Digital. (hedged) — 00:04:22 · Sarah Urist Green, The Art Assignment
  • ★★★ John says predictions of health-system collapse and "death panels" have not come true; US uninsurance rates have dropped dramatically and early signs show the law improving health in some sectors. — 00:04:44 · Death panel
  • ★★ John says many millions remain uninsured and underinsurance, where insured people still get unaffordable medical bills, is a huge problem. — 00:04:58
  • ★★★ John says US health cost growth has slowed but spending is still over 17% of GDP, while most developed countries spend far less and their citizens live longer, healthier lives. — 00:05:08 · United States
  • ★★ John rejects the idea that Americans' worse outcomes come from eating, drinking or smoking more than British people. — 00:05:21 · United Kingdom

00:05:34 — The ACA is not radical and grew on top of the old system; real change needs radical options; Aaron Carroll: trade-offs are messy; make politicians acknowledge it

  • ★★★ John says that if nothing changes, health care costs will still crush the US in the long run, because the ACA is not particularly radical. — 00:05:34 · United States
  • ★★ John says the 12 million who got insurance through the exchanges are less than 4% of Americans, so for most people little, including the underlying problems, has changed. — 00:05:41
  • ★★★ John says the US spends far too much and gets too little; taking that seriously requires radical change such as price controls, a single-payer system, or a truly free market that denies care to those who cannot pay. — 00:05:53 · United States
  • ★★★ John says the old system was not working; the ACA works insofar as it insures the uninsured without disturbing most people's insurance, growing on top of the old system rather than replacing it. — 00:06:11
  • ★★ John says insurers adding plans to the exchanges indicates the ACA will probably keep working, unless the Supreme Court eviscerates it in a few months. (hedged) — 00:06:27
  • ★★★ John says the ACA has not and will not solve the long-term health care spending challenge, nor would repealing it; the problem was worse before Obamacare. (hedged) — 00:06:37
  • ★★★ John says that instead of endless repeal-or-defend debate, Americans should be frank about the choices before them. — 00:06:46
  • ★★★ Aaron Carroll (quoted): Aaron Carroll, as quoted by John: health care trade-offs are messy; cleaner reform risks the private market, cheaper care needs more regulation, covering more people for less needs more tax dollars. — 00:06:52
  • ★★ John says health care policy experts across the political spectrum seem to acknowledge this complex reality of trade-offs. (hedged) — 00:07:10
  • ★★ John says it is now our job to make politicians acknowledge these trade-offs too. — 00:07:15

00:07:19 — Pointer to Healthcare Triage for more health care videos

00:07:23 — Thanks Hank for last week's crowd video; sign-off

In the description and comments

  • ★★ John writes that the law does seem to be improving health, at least for young adults and in colonoscopy screening rates, but much is still unknown. (hedged) — video description
  • ★ John writes that 44, or maybe 46, million Americans were uninsured in 2009. (hedged) — video description
  • ★ John explains that many of his sources are New York Times pieces because they do far more data analysis and reporting on health care than anyone else he has found. — video description · The New York Times

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Affordable Care Act · health care prices in the United States · Health insurance marketplace · United States · universal health care

Also: People: Aaron Carroll · Charlie McDonnell · Finn Harries · Henry Reich · Jack Harries · Sarah Urist Green

Projects: Healthcare Triage · The Art Assignment

Organizations: PBS Digital Studios · Supreme Court of the United States

Terms: doobly-doo

Concepts: free market · job lock · opportunity cost · pre-existing condition · price controls · underinsurance

Places: Australia · Canada · France · Japan · Netherlands · United Kingdom

Policies: Medicaid · Medicare

Memes: Death panel

Only in the description or credits: colonoscopy · The New York Times

Also centred on Affordable Care Act: Adorable Puppy Explains Health Care Bill · Bigger Pizzas: A Capitalist Case for Health Care Reform · The Lowdown on the Shutdown · Applying for Health Insurance: Then and Now · Understanding Donald Trump and Hillary Clinton's Health Care Reform Proposals · Why Can't America Have a Grown-Up Healthcare Conversation?

Also centred on health care prices in the United States: The Political Situation at the County Fair · Health Care Reform Thought Bubble · The 1200% Increase in my Prescription Drug Costs · Question Tuesday! Paula Deen Riding Me (and critical reading) · Why Are American Health Care Costs So High? · Understanding Donald Trump and Hillary Clinton's Health Care Reform Proposals

Also centred on Health insurance marketplace: Applying for Health Insurance: Then and Now · New Album, New Channels, New Fabric, New Internet Thing!

Also centred on universal health care: Ranting and Giving Stuff Away · Health Care Overhaul Summarized Via MASSIVE PIG · Health Care Reform Thought Bubble · Health Care Reform: The Hank Factor · Adorable Puppy Explains Health Care Bill · I OWN WARNER CHILCOTT!

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