This powerful piece in Forbes, of all places, deconstructs this week's announcements from some big insurers that they intend to retain some of the more popular provisions of the ACA, no matter what its fate.
I have often suggested that I suspect the Republican leadership in Congress of going to sleep each night secretly praying that Obamacare will survive the Supreme Court test. The leadership knows very well that, as much as the American public says they dislike the Affordable Care Act, there is little desire to see some of the more popular elements that have already taken root vanish into the legal ether...
If you consider returning to a system where fifty million Americans remain uninsured, this might be your happy ending. If you've pleased that babies born with a serious medical condition will, once again, be unable to receive health insurance -- thereby dooming the parents of these children and, ultimately, the children themselves to financial ruin because of their bad luck -- it's all good. If you're okay with the demise of the medical loss ratio requirements, allowing the insurance companies to once again decide how many of your premium dollars they wish to spend on actual health care while pumping ridiculous sums into marketing and administrative overhead, sums that you and I pay for via our ever rising premiums, then you've got yourself a victory for free enterprise.
Me personally, I'm starting to suspect that the organized right has been taking advantage of a huge misunderstanding on the part of some of its less-privileged supporters. I think there are people who believe that the GOP wants to give Americans (white Americans, anyway, who live in real American places) free health care with no strings attached, but that Obama and his Socialist friends cooked up this One World atrocity called "mandates" to make them pay for it -- and are making it really expensive by requiring Catholics to use expensive birth control. This is sarcasm, of course, but I am genuinely baffled as to how so many people who claim to have so much admiration for the free enterprise system can have so little understanding of how risk pools work -- and that they can fail to see that for-profit insurers already have de-facto death panels that pass judgment on sick people every day.
As a student of secret societies, I know that many of them were conceived as occasions to sell insurance -- they're risk pools, but tarted up with all the rigamarole of fellowships. The Oddfellows, for example, provided burial insurance to its members; the Woodmen of the World was (and I believe still survives as) an insurance company. You can buy medi-gap insurance from B'nai B'rith. The KKK, which was very much a for-profit organization in its second incarnation in the teens and '20s, sold life insurance. In my book Cults, Conspiracies, and Secret Societies, I quote an initiation oath from the Ancient Order of the Foresters, circa 1907:
It has been truthfully said that nothing is more uncertain than the proportion of sickness and death which falls to the lot of the individual, but that nothing is more certain than the percentage of sickness and death among a multitude of men. As a multitude of men, seeking to help each other, and to bear one another's burdens, the Ancient Order of Foresters exists and has existed from time immemorial. It assumes the individual's inevitable liability for sickness and death, and distributes it among a number of his fellow members, who willingly bear their share, knowing that their own turn will come in time.
This, then, is Benevolence: the refined robbery of Robin Hood. The word "Benevolence" is derived from two Latin words signifying good will, and is synonymous with bengnity, humanity, tenderness, and kindness. It does not mean charity: for charity, while a worthy virtue, and the corner stone of many societies, has no place in the Forestric vocabulary. We do not dispense charity. Whatsoever our members may receive, they obtain as a matter of right, for which they have paid, and for which they are expected to pay.
I'm one of those dreary progressives who thinks that Obama should have staked everything on a single-payer system. I'm sure it would have failed, but at least he would have made a point. Turning as it will on legal arcana, the seemingly inevitable failure of Obamacare will be much harder for future reform-minded presidents to parse.
Rereading that Foresters oath, I wonder if the problem with Obamacare was that it just wasn't enough fun.