The ever-failing-upwards Megan McArdle, also known as McMegan or Buffy the Bechamel slayer, has been called in to consult on the patient known as the Affordable Care Act which has been coughing and wheezing since its birth last week and after a cursory glance Dr. McMegan has decided to probably pull the plug on the ACA because it is never ever ever going to get better so; pillow placed firmly on the face time.
Oh, Obamacare, we hardly knew ye.
It seems that the ACA, which McMegan has never approved of because she is well paid by wealthy people to appear unconvinced and perplexed by the very concept that poor people need anything more than stiffer spines and a better work ethic, is already in its death throes so McMegan thinks we should start planning to death panel the shit out of it right now before people start to get too attached to it like it’s Ole Yeller and you have to take it out behind the barn and (spoiler!) shoot it and then everyone is sad sad sad, as well as still being unhealthy because the people who oppose the Affordable Care Act have offered no alternatives other than The Indifferent Hand of the Free Market or “Well, did you ever stop to think that maybe Jesus wants little Timmy with cancer to come to Heaven right now? No, you didn’t now, did’ya? I didn’t think so. ”
(Pause here to take a breath after that sentence lest someone think you have an incurable lung disease and then it’s lights out for you too. … Better now? Okay, proceed)
After pointing out that some people think the exchanges won’t be working totally cool beans until after Dec 15, “although that view is not universally shared”, McMegan says:
Time to panic? No. But it’s time to prepare to panic. It sounds like the earliest anyone is projecting fixes is sometime in the middle of November. That’s the time when it absolutely has to work — and if it doesn’t, we should panic.
If this piece doesn’t work, then most of the Patient Protection and Affordable Care Act doesn’t work.
So there you have it: the ACA is just about as dead as Bob Dole’s dick so you should probably stock up on Bactine and chewable Flintstones vitamins because The Plague Years are nigh upon us because all the machines and the nerds who work on them will have failed us. Which is also why we don’t have flying cars.
Of course McMegan never explains why most of the ACA will be a big fat failure because she has moved on to pointing out that a crippled ACA will only attract, well, let’s call them ‘undesirables‘:
If it were impossible, then we could all just agree to move to Plan B. And if it were as easy as everyone expected, well, we’d see if the whole thing worked. But what we have now is a situation where only the extremely persistent can successfully complete an application. And who is likely to be extremely persistent?
- Very sick people.
- People between 55 and 65, the age band at which insurance is quite expensive. (I was surprised to find out that turning 40 doesn’t increase your premiums that much; the big boosts are in the 50s and 60s.)
- Very poor people, who will be shunted to Medicaid (if their state has expanded it) or will probably go without insurance.
Oh, yuck. Those people. They just ruin it for everyone with their not-healthiness and pre-existing conditions. And they have all the time in the world to waste on getting possibly life-altering help for their icky icky lives. But, wait, where are the young healthy people who will help dilute this pool of pestilence by signing up for health insurance in case they get something stuck in their butt after too many Saturday night strawberry-mint mojito appletinis?
Meh. Too much trouble:
The exchanges were also broadly understood to be needed to get young, healthy people into the system. Somewhat naturally, almost every story you’ve seen about a new enrollee — including those told by the president this morning — has focused on someone who couldn’t buy insurance before, or who had very expensive insurance. But it’s not surprising that those people are fighting through the system to get coverage; they would pull themselves to the top of Mount Rushmore using only their teeth if that’s what it took to get a cheap insurance policy. What we need to know is what is happening among the people who didn’t need Obamacare to help them buy insurance, because insurers would be perfectly happy to sell them a policy without it. Those are the folks whose premiums will cover treatment for the rest.
As Yuval Levin says, “The healthy young man who sees an ad for his state exchange during a baseball game and loads up the site to get coverage — the dream consumer so essential to the design of the exchange system — will not keep trying 25 times over a week if the site is not working. The person with high health costs and no insurance will.” One might add that he’s probably not going to call into the call center, wait three weeks to get his PDF application mailed to him, review it and send it in, wait another week or two for notification about his subsidy eligibility, and then (finally!) call back yet again to check out his policy options. Some will, of course. But at every tedious step, you will lose people.
McMegan is right! When young people want something they want it RIGHT NOW. Even if it means camping out overnight like, oh, I don’t know:
So I’m currently waiting outside the Apple store in Arlington waiting to purchase an iPhone. Megan McArdle is my line buddy for the evening, but, perhaps not surprisingly, we managed to run into a Cato intern as well. This may seem odd, but in my experience, it’s almost impossible to avoid Cato interns during the summer (and no, I don’t, and haven’t ever, worked at the glass cube on Mass. Ave).
Anyway, we used Megan’s laptop to take some video of the line a few hours back, which I then awkwardly edited it in iMovie. I’d never used the program before (I’m a longtime Premier man), and I found it pretty non-intuitive.
We couldn’t figure out how to make Megan’s laptop record sound, but if we had, you might’ve heard conversations about how Best Buy sucks, Robert Nozick and veganism, and contained atomic reactions.
People are starting to go to sleep. The guy in line next to me is snoring at comically high volume, like a Merry Melodies cartoon. I’ll report back later.
Sure that sounds like youthfull hijinks, but over-nighting just so you can be the first one your block to get the new iPhone is very much like being a war refugee:
Early this morning, the Apple folks appeared with water for the needy liners.
I imagine this is what it feels like to be a refugee–you sleep outside, and then smiling people in uniform hand you supplies whether you ask for them or not.
So, you see, there are some things that are worth fighting for.
Just not health care for other people.
Bonus graphic because , who could have predicted?: