The biggest of the many big lies about Obamacare is that it’s a “government takeover of health care.” In reality, it leaves the toughest work in health care – restraining costs without compromising quality – solidly in the hands of private health care providers and private health care insurers. Its big idea is that by realigning the incentives, it can make the free health care marketplace work better.
In a meeting at our offices in Framingham yesterday, Robert G. Romasco, the president of AARP, described Obamacare as a “watershed moment” for health care.
Up to now, he explained, insurance companies have made their money by collecting as much as they can in premiums, and paying out as little as possible to providers. They tried to insure the healthy, less expensive, people, while avoiding having to insure the unhealthy people. They shifted costs, discounting premiums for large employers and negotiating lower prices from providers, then making up for it by overcharging in the individual and small-business markets. Hospitals and physicians made their money by performing more services on patients. Nobody made money for keeping people healthy.
Obamacare changes that, Romasco explained, by “making the insurance companies the good guys.” Now they have to cover everybody, and they can’t drop clients who get too sick or cost too much to treat. So they make money by working with providers to reduce the need for expensive services – by keeping people healthier.
Figuring out how to do that is the job of insurance companies, hospitals, physicians and the rest of the medical establishment, not “big government.” Republicans supported the ACA model for decades because it’s a market-based system that doesn’t replace the insurance industry with government bureaucrats. The health care sector of the economy is healthy and competitive, with lots of innovation going on. Obamacare keeps it that way.