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The drumbeat about "Obamacare" has nothing to do with the Affordable Care Act (ACA) or even with fiscal conservative values. If your friend or neighbor has been watching too much Fox News, here are ten reasonable retorts to the paradoxes of the Radical Right that they use to hook the Obamacare-obsessed.

1. The Private Sector Paradox - The ACA is based entirely on the blueprint created by the ultra-conservative Heritage Foundation for a private national health insurance system. The same Heritage Foundation who now opposes it. The Heritage Foundation's current leader, Jim DeMint, when he was a U.S. Senator, backed both what became known as "Romneycare," after the Massachusetts implementation of the law, and Romney in his first presidential bid. Advocates at the time touted using the private sector to solve the healthcare crisis. There are no government insurance companies involved. This isn't Medicare. The exchanges refer people to private insurance companies.  The only major change to the ACA is that a black president embraced a conservative concept, and conservatives have been washing their hands of it ever since.

2. The Food Stamps Paradox - Republicans rail at SNAP, the Supplemental Nutritional Assistance Program because supposed "welfare cheats" and "loafers" aren't paying their own way, yet they have no problem with healthcare cheats and loafers not paying their own way for their own health care. They resent paying for other people's food out of their tax money, but they seem to have no problem with those not paying their way with their medical bills clogging up ERs, driving up prices of health care, etc.

3. The Selfishness Paradox - Obamacare-obsessives don't want to pay for anyone else's health care with the partial government subsidies. Paying for them through higher insurance premiums and the whopping increases in hospital costs that cover the cost of saving the lives of the uninsured seemed to work just fine for them.

4. The Transparency Paradox - Fox News pundits will scream transparency all day long to wipe out demon Obamacare, but how transparent is the system that they want to maintain? Funding for the poor and those with some ability to pay refusing to take health insurance by way of those elevated hospital bills is hardly transparent.  Covering the poor under Medicaid, and making everyone pay their fair share of their healthcare costs is far more accountability, which Republicans have historically supported. The ACA requires greater transparency from both insurers and the medical industry about costs, access to particular benefits, and what elements of providing quality care affect the cost of operation of health systems.

5. The Affordability Paradox- Republicans tell anyone who will listen that "Obamacare" is going to send costs skyrocketing, but any insurance actuary could tell you that increasing the pool of insured people, more people paying into the system, reduces overall costs and improves risk spreads for private insurers.

6. The Corporate Socialism Paradox If you believe the daily spew of Republican congressmen and their radio and television propaganda wings, government socialism is evil. Yet corporate socialism is generally acceptable. A key tenant of GOP-think is that the private sector can always outdo the government in the solution of a problem. We'll recall that this was blown out of the water by what would have been a domino-effect collapse of the private insurance industry which had been speculating with billions prior to the 2008 Great Recession, but let's work with their fantasy. Modern reporters, clever little people that they aren't, seem to fail to ask the obvious question: If the private sector solves all, then why isn't the ACA, which gives a massive windfall to corporate insurance companies, a big win for the GOP and its dogma?

7. The Bureaucracy Paradox - Republicans rail against the wasteful government bureaucracy but the bureaucracy of private health insurance is staggering, and adds enormous costs to health care as doctors and hospitals wrangle with literally thousands of plans. U.S. News in 2012 found more than 1200 plans per state. Those plans add huge bureaucracy and cost on every end of the healthcare system, from the bloated bureaucracy of the insurance companies which administer the plans to the large staffs of hospitals and doctors who must wade through the nuance of the rules of myriad different plans.  As for accountability, the government has procedures and rules, and you can always complain to your local elected official. If an insurance company screws you, suing them, and the years thousands of dollars in legal fees that a civil action takes, may be your only recourse.

8. The Death Panels Paradox - Sarah Palin and her lot bogeyman the ACA with "death panels" scare tactics, but insurance companies have had their own "death panels" for decades.  Pre-existing condition limiters, and denial of care by insurance companies for people with insurance, and lifetime caps on payouts to people with chronic illnesses and birth defects have been death sentences. More than 105 million people are benefitted by the ACA's end of pre-existing condition limiters and lifetime caps.

9. The Jobs Paradox Mr. Boehner's much ballyhooed cry of "Jobs! Jobs! Jobs! in the private sector hasn't materialized into real employment, but implementation of the ACA means thousands of new jobs added at the private insurance companies as they hire on more people to take care of all of those being added to the private insurers' rolls.

10. The Pills and Pillows Paradox- Improving access to healthcare increases its use. That means more goods and services being used by healthcare providers, more money flowing to pharmacies and pharmaceutical companies, manufacturers of healthcare equipment, linens, surgical suppliers, and many many more. For conservatives who believe in "trickle down" economics, increases in delivery of goods and services at lower costs should be a win-win.

The truth is that a small handful of very wealthy people who are old-school John Birch Society Libertarians oppose the ACA. It is their hundreds of millions pitted against the millions of Americans. Up until they infected the system with their selfish billionaire bile, the majority of fiscal conservatives could have reached consensus on the ACA, and drowned out the dittohead drumbeat and the paranoids pablum dished up by the flame-fanners of Fox News.

My shiny two.

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Comment Preferences

  •  Tip Jar (25+ / 0-)

    "There are two types of people in this world: Those who like delis, and those with whom you should not associate." - Damon Runyan

    by Brian Ross on Tue Oct 22, 2013 at 07:11:42 AM PDT

  •  good list. I've used many pieces here on FB (4+ / 0-)

    recently, but always end up using something like this (which someone recommended here in some comment a while ago):

    'don't take my word for it, or listen to the e-mails and FB posts you get - check it our yourself!  go to healthcare.gov or just check the (calculator) (i insert link to kaiser fdn calculator)'

    I also have provided sample figures for the ridiculous scenarios they are trying to pose.  e.g. yesterday, my cousin said that her kids can't afford $600 a month.  Her oldest child is 33, then 30, and the other 2 are under 26.

    so i did the calculator for a 33 yo in suffolk county, ny making 35,000 (her son is not making near that) - $270 per month.

    I also use the line a lot that anyone that already has insurance is exempt from the ACA (in response to all the stupidity that Obama has exempted himself and/or congress) and i take the opportunity to say "except that they will benefit from.... and list stuff like no lifetime caps, free preventive care, limited out of pocket....

    I THINK I am reaching some people, time will tell.

    "Don't Bet Against Us" - President Barack Obama

    by MRA NY on Tue Oct 22, 2013 at 07:23:37 AM PDT

  •  my guess is that (0+ / 0-)
    The ACA is based entirely on the blueprint created by the ultra-conservative Heritage Foundation for a private national health insurance system.

    if one compared the ACA with the Heritage plan that one could spend all day listing the differences between them.

    I doubt the Heritage plan was over 2000 pages long.

    for example "All citizens should be required to obtain a basic level of health insurance." sounds like catastrophic care coverage and not what the ACA requires people purchase.

    Or was there an employer mandate in the Heritage plan?

    Or was there  medicare expansion in the Heritage plan?

    •  Heritage came up with the core concepts (2+ / 0-)
      Recommended by:
      Catte Nappe, Eyesbright

      I don't know that they ever had a real, hard-copy bill that actually made it out of committee.  Usually once the rubber hits the road in real bill-writing, a lot of things get added and tweaked and massaged, and that adds to the complexity and length.

      It's the difference between pitching a movie concept to a movie company versus actually having to sit down and write out the actual screenplay.

      •  so the two share (0+ / 0-)

        some concepts. Not "The ACA is based entirely on the blueprint" since you suggest Heritage never had a blueprint.

        I wonder how many of the features of the ACA can trace back to heritage.

        Simplistic talking points that ignore the complexity of a situation are an irritation to me. They obscure truth rather than reveal it.

        •  It's worth noting (1+ / 0-)
          Recommended by:
          Eyesbright

          that the ACA is based largely on Romneycare, which in turn took it's core concepts from the Heritage proposals.  It might be more accurate to say that the ACA was based on the blueprint of Romneycare.

          •  OK (0+ / 0-)

            so what is the same betweent them and what are all the differences?

            iirc, the ACA bill is ten times the size of the Romneycare bill. Not counting whatever regulations had to be written to support them.

          •  have been looking at this heavily and there (1+ / 0-)
            Recommended by:
            Eyesbright

            Were two plans originally chafee which got 20 republicans on board and abother 1994 proposal which also used a mandate,the 1994 one required a 1000$ catastrophic deductible or something like that there is a link to the heritage analysis by the creator of the mandate I give for the 94 plan it also had a state program but it was later pulled  

      •  Still... (0+ / 0-)

        The producer is responsible for the big picture, and they painted that picture.

        "There are two types of people in this world: Those who like delis, and those with whom you should not associate." - Damon Runyan

        by Brian Ross on Tue Oct 22, 2013 at 08:26:32 AM PDT

        [ Parent ]

        •  I mean it still a moderate plan maybe not (0+ / 0-)

          Conservative or Ultra conservative but it is definitely a centrist proposal I think the chafee bill was more generous and similar ro obamacare though they are complicated

  •  Excellent diary. (0+ / 0-)

    "A typical vice of American politics is the avoidance of saying anything real on real issues." Theodore Roosevelt.

    by StellaRay on Tue Oct 22, 2013 at 07:31:10 AM PDT

  •  #7 missing some text? (1+ / 0-)
    Recommended by:
    Brian Ross

    Seems to just cut off mid-sentence.

    Otherwise, great list.

  •  isn't a primary goal of the ACA (0+ / 0-)

    5. The Affordability Paradox- Republicans tell anyone who will listen that "Obamacare" is going to send costs skyrocketing, but any insurance actuary could tell you that increasing the pool of insured people, more people paying into the system, reduces overall costs and improves risk spreads for private insurers.

    ---

    to provide affordable insurance for people with medical conditions that prevent them from buying it. So adding people whose expenses are expected to be much higher than their premiums will make it cheaper for everyone else?

    that is a paradox

    •  http://www.heritage.org/research/reports/1994/06/R (0+ / 0-)

      That the link it long though

    •  Two thoughts on this (2+ / 0-)
      Recommended by:
      Catte Nappe, Eyesbright

      First, adding more of the well along with those with pre-existing conditions does still balance things out. They make a lot of money off of millions of health Americans, and pay out far less than they take in (hence why they compensate their executives for record profits).

      Second, most pre-existing conditions are not terribly expensive, and quite often the premiums paid in over a lifetime more than adequately cover them.  The 25% upcharge I pay for allergies, for example, never is a cost to Blue Cross of Florida because they hit me and my family with a $14K deductible, and only give "discounts" until I reach it. I have paid enough in the last two years of premiums for otherwise healthy people to cover my allergy medication for the next 15 years!

      "There are two types of people in this world: Those who like delis, and those with whom you should not associate." - Damon Runyan

      by Brian Ross on Tue Oct 22, 2013 at 08:35:42 AM PDT

      [ Parent ]

      •  but wouldn't it be necessary to charge more for (0+ / 0-)

        People with pre existing conditions a little like maybe 100 extra or would the costs really be balanced our by a larger risk pool of young healthy people who may just pay for a High deductible cheap plan the heritage founder seems to agree with you that it will balance

        •  In California (0+ / 0-)

          Years ago, someone sued Blue Cross and said that the individual buyers made up the largest pool in the state. The Supreme Court of California agreed. Simply rerating the "group" of individuals sent premiums and copays and everything tumbling, based on the system in which they did it. So yes, once you have a large enough pool it all averages out. Even current "pre-existing conditions" claims by the insurance industry are a joke. Look at their profit margins and they're huge.

          "There are two types of people in this world: Those who like delis, and those with whom you should not associate." - Damon Runyan

          by Brian Ross on Tue Oct 22, 2013 at 11:23:06 AM PDT

          [ Parent ]

  •  EXCELLANT! (0+ / 0-)

    A To Do diary.  Always the best..

    Thank you, will tweet far and wide today.

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Tue Oct 22, 2013 at 07:49:24 AM PDT

  •  Arguments like this aren't going to get (1+ / 0-)
    Recommended by:
    smokeymonkey

    very far, I think.  These are mostly conceptual concepts, and don't address the direct impact of the ACA on people's lives.

    The truth is that before the ACA, the majority of people had health insurance, and a majority of those who did were satisfied with their health insurance. See the summary of the polling here, where it says that an average of all the polls show about 87% of the people who had health insurance before the ACA were satisfied with it.

    The question is going to be whether those 87% see the ACA as helping or hurting their own personal situation.  Absolutely, the people who did not have insurance in 2009 and who are able to get it now will be happy.  But that's not going to shape the majority of public opinion.

    Here's the issue:  The President sold this to the country as a plan where all these uninsured people would get covered, and there would not be any detriment, or downside, to those 87% who were satisfied with the insurance they had before the ACA.  Remember the repeated "If you like the insurance you have, you can keep it"?  The sales pitch was that we could add coverage for millions and there would be no down side for the 87% who liked what they had.  Those people conceptually don't have a problem with a plan to expand coverage to those who didn't get it.  However, if it had been sold honestly -- i.e., yes, those who now can get insurance and are satisfied with it are going to have to see changes in their OWN insurance situation to accomplish that -- I'm not sure it would have gotten the support it did.

    So, having sold it as "we can insure all these additional people and there's no real downside to those of you who are satisfied with the insurance you have,"  I think satisfaction with the ACA overall is going to rest heavily with the experience of those who were satisfied with their insurance before the ACA.  If they are equally as satisfied after the full rollout of the ACA as they were before, the ACA will be a success.  

    However, if those 87% perceive that the ACA was a detriment to their own  situation, all of these conceptual arguments aren't going to make any difference.  

    •  will the premiums of healthy young people (0+ / 0-)

      Particularly college educated midfle class there are going to be a lot of sicker people put on the insurance market and sense the premiums will probably be roughly the same rate AD insurers can't charge 500$ or more a month and discriminate premiums of others might go up especially if the pool isn't large enough like how many employer premiums are. It might start looking bad and it will be tough to call for a tax increase on upper middle class people to subsidize the people with rate increases but probably necessary

    •  Not quite right... (4+ / 0-)

      The 87% who had insurance still benefit from the ACA. Pre-existing conditions alone save both individuals and employers who were hit with the premiums a lot of money.

      Lifetime caps issues save the 87% lots of money.

      Perhaps the other thing the 87% should think about, what with 2009 and all, is if they lose those wonderful jobs providing insurance, as we've witnessed with 800,000 people the last bubble pop, is that they can get affordable, and possibly even subsidized health insurance rather than the venomous COBRE policy while they are looking for the next company to employ them.

      "There are two types of people in this world: Those who like delis, and those with whom you should not associate." - Damon Runyan

      by Brian Ross on Tue Oct 22, 2013 at 08:39:43 AM PDT

      [ Parent ]

      •  Being able to extend coverage (3+ / 0-)

        for children up to age 26 helps a LOT of college students...

      •  If this is true, the ACA will ultimately (0+ / 0-)

        be very popular.

        The 87% who had insurance still benefit from the ACA. Pre-existing conditions alone save both individuals and employers who were hit with the premiums a lot of money.
        If the 87% of people with insurance before the ACA who were satisfied see some of those benefits, it will ultimately be hugely popular.

        If that group does not see those benefits, and -- even worse -- if they perceive a down side (like significantly higher costs), the ACA will be very unpopular.

    •  the underinsured (0+ / 0-)

      Those who previously had plans so bad they must be discontinued under ACA will probably pay more.

      It is a version of the individual mandate:  If you are uninsured, you are required to buy insurance.  If you are uninsured, you are required to buy real insurance.

  •  THE EXAGGERATED PROBLEM OF ADVERSE SELECTION The N (0+ / 0-)

    THE EXAGGERATED PROBLEM OF ADVERSE SELECTION The Nickles-Steams bill has attracted strong criticism from advocates of managed com- petition, as well as from a group of conservatives, in part because it contains a provision that would allow Americans to switch health plans easily if they were dissatisfied with a plan's level of service or wished to obtain a plan with different benefits. Under the bill, insurers would not be permitted to take health risk (that is, pre-existing conditions or fam- ily medical history) into account when setting premiums. They could set rates only based on age, sex, and geography (with discounts available for group purchases and healthy life- style), a rating system known as "limited underwriting." Other features of the bill, includ- ing tax reforms, would ease the after-tax cost of insurance and out-of-pocket medical costs for millions of Americans. Thus, under the Nickles-Steams bill, if the wife in a family developed breast cancer, the family could switch to a plan with more extensive or better quality cancer treatment without a premium "penalty" for the wife's health status. Similarly, a young couple who conceive a child and then discover the fetus has a severe abnormality would know that they could obtain insurance coverage for their future child at reasonable cost. They would not face the horrifying choice between an abortion or full risk-based insurance that might take most of their available income. Thus, unlike today, or under estimated risk rating, a higher-risk family could always count on obtaining the coverage they need under Nickles-Steams without their medical condition making the price prohibitive. Managed competition advocates argue that this freedom of choice in a competitive in- surance market is inherently unstable. According to Stanford Professor Alain Enthoven, one of the architects of managed competition, there are two related and fatal problems. One is adverse selection, in which sicker people would gravitate to the plans offering the best coverage, thereby driving up their costs and making them uneconomic. Mean- while, insurers would try to "cherry pick" as they market their plans-that is, avoid high- cost individuals. The result, he says, would be an unstable market. The second pattern, which Enthoven argues would compound this problem, is"market segmentation." This means insurers would offer a combination of benefits designed to appeal only to a dis- creet, profitable share of the market. Enthoven raised these objections against the Nickles legislation, as well as the FEHBP, in recent congressional hearings. Said Enthoven: One problem is adverse selection, the good risks and the bad risks. The other problem is what is called segmenting the market. It is something we teach in business school. That is, if you do not want to compete you find a little niche where nobody else is and you get in there and make your product and you jack up your price. And if we as public policy people are trying to make the market competitive, then we want to combat market segmentation.... Plan A has wonderful vision care and no podiatry; Plan B has wonderful podiatry and no vision care. And that is anti-competitive because -those people who have bad eyes and good feet, they do not say "Am I going to join Plan A or Plan B based on price..." They just say, "This is the plan that covers my problems of bad feet and good eyes," or vice versa. 7 Enthoven maintains that allowing such competition would lead to what he graphically calls a "death spiral" of adverse selection within the insurance industry. This is the basis of his objection to the Nickles-Steams Consumer Choice Act. Like other supporters of managed competition, he proposed to deal with adverse selection and market segmenta- tion by limiting consumer choice to a range of plans with precisely the same services (all with eye care and podiatry-or none with these services), with these plans competing solely on price and quality. Some conservative scholars raise exactly the same objection. Echoing Enthoven, they maintain that if insurance companies cannot charge enrollees a premium fully in line with the anticipated cost of covering the individual, the market is unstable. 8 They say that such an unstable situation would occur if plans are "community rated" (that is, required to charge exactly the same price to all in an area, irrespective of any risk factor) or even if plans were prohibited only from including health factors in premium-setting, such as in the Nickles-Steams bill. Their argument is that relatively sicker people would cost the insurer more than the pre- mium it could charge in a competitive market if medical condition must be ignored in set- ting price. A competitive plan could not charge a healthy person significantly more in pre- miums than he would expect to use in services, or the person would switch plans or drop insurance. So to avoid heavy losses, there would be a remorseless incentive for compa- nies to try to avoid loss-making sick customers, drive down the quality of care for such customers on their books, and seek out profitable healthy customers. Meanwhile, sicker families would seek out the plans with the best services, causing these better plans to be swamped with costly enrollees and either to fail in the market or to cut quality and serv- ices in order to drive away people who need expensive care. The argument is identical to Enthoven's. and paints a bleak picture of insurance market chaos.  Doesn' obamacare use a community rating and not allow discrimination based on anything?                                                                                                                                                                              

    •  Please use paragraph breaks (1+ / 0-)
      Recommended by:
      CuriousBoston

      There very well may be something valuable in your comment but with no paragraph breaks in it, it becomes a miserable assault on a reader's eyes.  Please learn to use paragraph breaks.    As it stands, I suspect very few people will subject themselves to the pain and struggle to read it and try to make sense of it.

      If you're not sure of the exact place to put a paragraph break, just pick a spot and do it.  Few people will fault you if it's not the perfectly grammatical spot; that's the least of your worries.

      If people have trouble reading what you wrote, you've wasted your time in writing it.

      It's not a question of whether our founding fathers are rolling in their graves but rather of how many RPM they're clocking.

      by Eyesbright on Tue Oct 22, 2013 at 11:28:23 AM PDT

      [ Parent ]

  •  On #9 (1+ / 0-)
    Recommended by:
    Eyesbright

    There is a potential positive effect on jobs as those who have been captive to their employers for the sake of insurance coverage are now freed to follow their dreams to start their own businesses - some of which will no doubt succeed and create new jobs for others.

    “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

    by Catte Nappe on Tue Oct 22, 2013 at 10:36:22 AM PDT

  •  nice... but 7 is truncated (0+ / 0-)

    Thump! Bang. Whack-boing. It's dub!

    by dadadata on Tue Oct 22, 2013 at 02:26:54 PM PDT

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