The designers of Obamacare made wholly inaccurate assumptions about how uninsured and lower income people would respond to new healthcare options, and evidence from the troubled program's start-up should provide a lesson on the pitfalls of governing a socially and economically diverse nation, says Michael Barone.
"The evidence is not all in. But it seems that Americans are not behaving as Obamacare's architects — and many critics — expected," the syndicated columnist writes in The Wall Street Journal.
Barone, the senior political analyst for the Washington Examiner and resident fellow at the American Enterprise Institute, highlights three misguided assumptions
at the heart of the president's signature healthcare law.
For a start, he says, the authors of the legislation incorrectly assumed that everyone wants health insurance, and that if low-cost coverage was available for those with modest incomes, the uninsured would overwhelmingly take advantage of it.
The evidence so far, Barone says, does not bear that out. He cites low enrollment rates among the uninsured and a recent Kaiser poll
indicating the program's unpopularity among that group.
"One reason may be that Obamacare requires policies to cover not just the expenses of catastrophic illness — the sort of thing auto and home insurance policies cover — but routine medical expenses and procedures that many individuals will not need," Barone writes.
"Apparently many of the uninsured aren't interested in prepaying for health insurance any more than they are interested in prepaying their credit cards."
Barone says a second assumption was that health insurance would make people healthier. He points to evidence from a two-year Oregon health study that showed there was no significant difference between the health of those who received Medicaid compared to those who were eligible and didn't have Medicaid coverage.
Barone adds that the Oregon study also debunks the assumption that those with health insurance are more likely to go to the doctor rather than the emergency room: in the study, those with Medicaid were 40 percent more likely to go to emergency rooms than those without insurance.
None of these three assumptions has been conclusively disproved, Barone says. But, he contends that the discrepancies between what policymakers expected and the behavior of Obamacare's intended beneficiaries highlight evidence of sharp differences in behavior between the bottom 30 percent of white Americans and the upper 20 percent.
Lawmakers, he says, tend to come from the latter group, and the failures of Obamacare suggest that they are out of touch with the desires and behavior of those in the lowest income classes, the very group the policy was intended to help.
"The trouble that has resulted — from the architects' apparent failures to anticipate the behavior of fellow citizens who don’t share their approach to the world, and the architects' determination to impose their mores, such as contraception coverage, on a multicultural nation — is a lesson to national policymakers, conservative as well as liberal," Barone writes.
"Govern lightly if you want to govern this culturally diverse nation well."
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