The so-called raging success and/or failure, depending on who you ask, of the Affordable Care Act passed by President Barack Obama is often stated as such without question in right-leaning and left-leaning echo chambers of the politisphere. The right has deemed it as a colossal deficiency or a strain on the United States, while the left has deemed it a progressive triumph for the very same country.
It goes without saying that all government operations have their fair share of faults, but the Affordable Care Act included a section beyond the normal text and into the fine print that, when implemented correctly, achieved what it set out for, but caused a reaction that any intellectual could have foreseen from a mile away.
The HospitalReadmission Reduction Program portion of our country’s healthcare alteration allowed the government to levy penalties on companies offering Obamacare policies who’s readmission rates soared after the passing of the ACA. A patient who is readmitted, classified as someone who is granted assistance within 30 days of the previous discharge of that very same hospital, will be denied service.
If the service is not denied and the company performs the necessary treatment, the federal government penalized said companies to an unaffordable degree. In just one year after the passing of this amendment, the New York City Presbyterian Hospital lost$1 million after readmitting patients with heart attacks, congestive heart failure, and lung infections.
This particular example is indicative of the ACA hitting the bull’s eye of the wrong target. While readmission rates have decreased, a clear correlation of mortality rates of citizens relying on Obamacare has increased at a troubling rate. Post-discharged patients with pneumonia and heart failure mortality rates steadily increased in the cited investigation monitoring patients over periods of time after admission. Death rates of those who were denied service raised “0.27% from period 1 to period 2”, then “0.49% from period 2 to period 3”, and finally “0.52% from period 3 to period 4”.
This is not to dismiss the successes of Obamacare, as to do so would be ignorant and refusing to acknowledge that the DNC has done something noteworthy in the past 5 years since the ACA’s passing. The uninsured rate declined from 17.3% in 2013 to 10.8% midway through the year of 2016, reported by a Gallup study. The decrease in the previously stated statistic rations out to roughly one million more people insured that the top 3 cities in the US combined (NYC, Los Angeles, and Chicago). However, with that being said, nothing is ever perfect, most certainly when it comes to government-run entities and programs. When the effects of such mishap result in easily-preventable deaths, feedback and outcry of the public is necessary to demand change in Washington.
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The Koch Brothers have found themselves in the news again recently, this time by once again distancing themselves from one of the biggest policies that have defined the Trump Presidency: his support for protectionism through tariffs. The Koch brothers differ from Trump on this issue because they believe in the elimination of tariffs. President Trump sees tariffs as a necessity to compete with strength in the global economy. Due to this difference and their belief that the party has drifted more towards economic nationalism and right-populism in the age of Trump, they have threatened to not support Republican federal candidates who agree with the President on the issue of trade.
Many in the media have pointed to this conflict as one of the many examples of disillusionment between Trump Republicans and ‘libertarian’ Republicans. The Koch brothers are widely regarded as two of the biggest and most influential small-l libertarians in the country. Why are the Koch brothers so widely regarded as libertarian and do all of their political activities and money spent towards specific issues align with their libertarian beliefs?
One of the things the Koch brothers do that earns them the approval of libertarians is their involvement with the Cato Institute, the biggest libertarian think tank in the United States and arguably the second largest right-wing think tank in the country. Charles Koch was among one of the founding members of the institute, along with libertarian activist Ed Crane and the founder of the anarcho-capitalist school of thought Murray Rothbard. There’s no denying that the Cato Institute, since its founding, has done inspired work in making the case for limited government, individual liberty and non-interventionism through policy studies and libertarianism in the United States through intellect and reason. Through the institute, The Kochs have pushed for many libertarian policies such as lower taxes, privatization of government services, civil liberties, gay marriage/marriage privatization, criminal justice reform, marijuana legalization, and much more.
Additionally, David Koch founded Citizens for a Sound Economy, which has since split into two organizations: FreedomWorks and Americans for Prosperity. FreedomWorks is a conservative and libertarian advocacy group that supports like-minded candidates for office and produces a scorecard which grades Congressmen on how often they vote in line with the libertarian principles FreedomWorks embodies. Americans for Prosperity serves much of the same purpose as FreedomWorks – electing like-minded liberty-friendly candidates – but is under different leadership.
Furthermore, they’ve also voiced their opinions and spent money towards fighting legislation like the Patriot Act, in which they gave an amount of money Reason Magazine declared to be around $20 million to the ACLU to promote opposition to the Patriot Act and government surveillance in general (to be completely fair, in an update to the article, Reason announced they were unable to confirm the amount the Koch Brothers gave to the ACLU, or that it existed). They were also one of the biggest vocal opponents of the Affordable Care Act and promoted a free-market approach to health care, in which they used their funds towards Americans for Prosperity to run anti-Obamacare ads worth around $3 million.
Based all of this, I’d say it’s fair to come to the conclusion that their political activities within their supported organizations have done much good for the cause of liberty and limited government, and it’s great that libertarianism has such powerful allies in that sense.
But what about the thing you hear in regards to the Koch brothers the most – their involvement in elections and their support of a plethora of Republican candidates? Based off everything else I’ve written so far, you might assume that the Kochs have a strict qualification for candidates and only support those who consistently align with their views of limited government and philosophical libertarianism, but that’s not always (and not usually) the case.
Most the money the Kochs spend in elections goes towards supporting establishment-friendly mainstream Republicans. According to the website OpenSecrets, the top 10 candidates for election in 2018 that have received the most money from the Koch Brothers are Marsha Blackburn, Orrin Hatch, Lee Zeldin, Ron Estes, Karen Handel, Patrick Morrisey, John Barrasso, Ralph Norman, Claudia Tenney, and Mimi Walters. All of these ten candidates, besides perhaps Morrisey, are establishment-backed Republicans who are nowhere close to representing the libertarian values the Koch Brothers hold dear.
To their credit, I have to note that the Kochs do also support and have donated to the very few libertarians in Congress like Rand Paul, Justin Amash, and Thomas Massie, but there’s no doubt the money they’ve given to establishment big government Republicans outnumbers the money they’ve given to true small-l libertarians. Even when America had the chance to elect Rand Paul, who no doubt represented libertarian the best in the Republican primaries, they decided not to get involved whilst stating they had a favorable view of Rand as well as Ted Cruz and establishment favorites Jeb Bush, Marco Rubio, and Scott Walker (whom many speculated was their preferred candidate, even over Rand).
One thing is clear from all this: they’re not interested in electing liberty candidates, they’re just interested in electing Republicans. They support Republican leaders such as Paul Ryan and Mitch McConnell many of whom are to blame for the scope of government still getting bigger even under a Republican president and a Republican majority in Congress.
The issue I find with this is that if we keep electing the type of Republicans the Koch brothers have shown the most support to, how will we ever get the country to become more libertarian as the Kochs apparently obviously desire? They’re supporting the same wing of the Republican Party that have advanced authoritarian big government policies such as unnecessary wars overseas, the Patriot Act, big spending bills, and the war on drugs. It is a fair argument that voting isn’t the best ways to change society’s outlook on government and certain issues, but in my opinion, to not focus on elections is wasting an opportunity to see liberty in our lifetime.
If we look at legislation that’s in favor of big government, some Koch-backed candidates have often sided with raising the scope of government instead of the positions the Koch Brothers take on limited government. 3 of the Republicans who voted against the partial repeal of the Affordable Care Act in 2017 which the Koch Brothers enthusiastically supported, have received funding from the Koch Brothers in the past: Dean Heller, Shelley Moore Capito, and Rob Portman.
Another piece of legislation that raises the scope of government that has been enacted under the Trump administration was the $1.3 trillion omnibus spending bill passed with some Koch funded candidates backing it in the Senate such as Majority Leader Mitch McConnell, Orrin Hatch, Marco Rubio, Rob Portman, Tim Scott, among many others (you can see how everyone in the Senate voted on it here). Instead of putting their efforts towards recruiting candidates who actually align with libertarian values and want to shrink government and end the wars, they’ve spent money on candidates like those I mentioned who want bigger government almost as much as the Democrats do.
The Koch brothers have done a lot of good for libertarianism by funding institutes and organizations that promote the idea of liberty. Rand Paul declared “The Koch brothers’ investment in freedom-loving think tanks will carry on for generations”, this is true and while libertarians should be grateful for their contributions in that regard, their involvement in the American election process and candidates they’ve thrown their support behind could be so much better for the cause of liberty, but we’ll see what’s more effective long-term in making our country freer.
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Perhaps my problem is that having just spent seven years in Canada, single-payer universal healthcare ruined any possibility I would ever accept the Obamacare model. Be that as it may, after just a few minutes reviewing my employer’s healthcare package, I couldn’t help but feel I would be better off financially going without coverage in the US, at least in the short-term.
Paying $256 a month for a high deductible plan means that during the four months or so we have left until hopefully returning to Canada, we will need to spend more than $3,000 on healthcare before most services either my wife or I could possibly need even begin to receive coverage. For insurance to kick in for both of us, we must meet the family deductible. This pushes our total figure to somewhere just north of $5,000. Welcome back to the United States, where healthcare costs and in network/out of network headaches just might cause more strokes and heart attacks than the system prevents.
Even if we were staying full-time in the US, our plan would be a disaster. With it, our annual healthcare spending would have to be extraordinary for it to make any sense. We are unlikely to reach the $2000 individual/$4,000 family deductible alone, never mind the $5,000 to $7,000 in health related costs we would need to incur over the course of the year before this insurance plan finally began saving us money (deductible plus nearly $3000 in premiums). As people are fond of saying when stark financial realities confront them, just do the math.
In addition, it’s important to keep in mind the expenses described above represent a huge percentage of annual income for anyone doing the job I’m currently doing. Because we don’t plan on remaining in the United States for long, I haven’t sought jobs in my field here. I’ve just taken a temporary job at a convenience store to hopefully save up a little money before returning north. At that point, I will pursue a master’s degree and permanent residence in Canada. However, for many of my co-workers, the job is much more vital in both the near and long term.
I suppose some would say I should feel lucky to have any insurance at all under the circumstances (a very American response). As you might expect, working in retail doesn’t pay well. Frequently, it doesn’t come with any benefits at all.
I would argue that for all practical purposes, my job still doesn’t come with benefits. The insurance premiums alone knock roughly 15% off the earnings of a typical convenience store clerk. If that clerk or a family member were to experience serious health issues, the $2000 minimum they will have to pay out of pocket before the insurance even begins to provide some relief will quickly bump the cost of this “insurance” into the 25% of annual income range. This amounts to an extremely regressive tax on low income workers. There’s nothing economical, let alone right, from either an individual or social perspective about any of it.
Obamacare provides health insurance subsidies to those purchasing individual coverage through the marketplace created by the Affordable Care Act (ACA), but not to those receiving health insurance through their employer. It did, however, require people to sign up for their employer’s insurance to avoid paying a tax penalty. However, even taking the tax penalty into account (about $695 in our case, assuming we’re in the US all year), the hit to a low income worker, making what I earn, is far greater. Regardless, the so called “affordable” plans offered via the ACA tend to also have high deductible policies. It’s difficult to justify huge government subsidies for plans that don’t really provide true coverage.
As was the case with the uninsured before healthcare reform, high deductible plans still often leave low-income workers choosing between food, shelter, and healthcare. No one in a nation as wealthy as the US should have to face those kinds of decisions. Medicaid might pick up some of the slack in many cases, but this imposes yet another layer of bureaucracy onto American healthcare that the poor are required to navigate and that healthcare providers must bill. This alphabet soup of private and public plans is primarily responsible for the high administrative costs of the US healthcare system. Yet, it just leaves patients feeling frustrated and confused.
Before my employer took it over, health coverage in Canada for my wife and I totaled $135. Enrollment, as I recall, involved a single double sided page of paperwork. Then, we got the same healthcare card that everyone gets, rich or poor. We also got the same benefits. There was no monthly, quarterly, or annual renewal. Our healthcare provider just swiped the card at the front desk and that was that.
Our monthly premium was high by Canadian standards. Because we lacked permanent residency or citizenship, we didn’t qualify for lower cost options. However, we did still qualify for Pharmacare, a benefit which reduced the expense of Canada’s already relatively cheap prescription drugs. Supplemental insurance, provided through my job, picked up whatever drug costs that remained.
As for hospital bills, while living in Canada I paid three visits to the emergency room and never saw a single bill. My wife had a specialist to help facilitate the best management of her Type I diabetes. We likewise never had to pay a dime for her doctor visits. In other words, that $135 a month was for a zero deductible plan, which is the only plan in Canada.
I did have to pay $80 for one ambulance ride, the maximum that a hospital can charge for this in British Columbia. It took them six months to get around to sending that bill, and there appeared to be no urgency on their part about seeing it paid. That said, we were happy to pay, given that we knew a similar ride south of the border would likely run over $1000.
For obvious reasons, and contrary to popular belief, Canadians aren’t exactly flocking to the US for non-essential services they might have to wait a little longer for at home. Even the single-payer system’s harshest critics estimate that only tens of thousands off Canadians come south to receive treatment. This amounts to a fraction of 1% of the entire Canadian population. Of course, no critic of the single-payer model ever cites the number of Americans that have moved to Canada at least in part because they find its system of universal coverage far preferable to the balkanized and expensive US alternative.
Regardless, virtually every Canadian we spoke with about healthcare during our time in their country could not grasp why so many Americans favor the right to go without health insurance altogether. It’s possible some of them insist on that right for the same reasons we’re exercising it, but most seem opposed to health insurance mandates on ideological grounds rather than out of financial necessity or practical budgetary reasons. Canadians, in our experience, were equally puzzled by the apparent willingness of so many of their southern neighbors to pay so much for coverage that provides so little in return. Indeed, government has told us the plan we’re being offered is “normal” both in terms of monthly premiums and benefits received in return, and that we should accept it. Again, having experienced Canadian healthcare, normal to me has become something quite different.
Sometimes it was necessary to explain what a co-payment was to our friends up north. The whole idea of networks was something of an enigma to them as well, given that Canada as a whole is just one big healthcare network. Explaining the benefit of a healthcare network to a Canadian is like trying to explain the benefit of a fish tank to a creature that’s spent their entire life swimming in the ocean. Why you and your neighbor should each have to choose different doctors because you have different insurance plans makes no sense at all from a Canadian perspective — or really from any serious perspective for that matter.
For all the talk about maintaining the right to choose your own doctor in the United States, it’s in America, not Canada, where your choice of doctor is limited by your insurance provider. In fact, unless you’re buying individual coverage, even your insurance provider is likely to have been chosen by your employer instead of by you. In other words, among the world’s developed countries, America probably offers patients the least freedom of all when it comes to choosing a physician.
So, it’s official: we’ll be keeping our fingers crossed until we return to our adopted home and resume following our chosen path to permanent residence and ultimately citizenship in Canada. It simply makes no financial sense to pay an arm and a leg for both health insurance AND visits to the doctor at the same time. As with millions of other Americans, the healthcare options for us seem little changed since our initial departure in 2010 before Obamacare had taken effect. Given the kind of choices US health policy still forces tens of millions of citizens to confront daily, I’ll take the “lack of choice” Canadians enjoy any day and look forward to getting back to not having it again very soon.