What ACA/Obamacare Reveals

Over the past weeks and months, I’ve encountered more and more examples of people either losing jobs or having their working hours cut so that their employer would not have to pay health care benefits as a result of the requirements of the Affordable Care Act.  And like many people, I’m beginning to get outraged – but not at the ACA. I’m outraged for another reason, one based on the interplay of economics and human nature.

Let us assume you have a business, one with employees, and that you provide a service or produce some physical goods, or perhaps both.  To be successful, any business must bring in more income than what it costs to provide the goods and services that generate that income.  Those costs include what you pay for raw materials, equipment, office supplies, heat, power, rent or mortgage payments for whatever property you need, parts, taxes, permits, fees for accountants, legal services …and wages and possibly benefits for employees.

If a business owner needs a lawyer or an accountant, the owner is going to have to pay more for someone with those skills and credentials.  If the business needs a mechanic, the same is true.  The only levels of employees whose wages are not “protected” in some way are those whose skills do not require specific training or credentials or those who are professionals in fields where there are substantial numbers of unemployed individuals, such as graduate academics. No one protests, or not too loudly [and if they do, few listen] about what it costs to hire a lawyer, a plumber, an accountant, a computer programmer.  But almost every business owner I know complains about the costs of lower-paid individuals, and they complain even more when the government raises those costs, through either the minimum wage or something like ACA/Obamacare, and all too many of those same business owners do everything they can to keep wage costs low for those individuals.  The same is absolutely true of state colleges and universities, with their reliance on low-paid clerical and security staff, and poorly paid teaching assistants and adjuncts.

What this shows, quite clearly, is that, at least in the United States, a sizable chunk of business, higher education, and at least certain parts of government are quite willing to squeeze everything they can out of those employees lowest on the totem pole, whether by hiring double the number of part-timers, or avoiding providing the benefits paid the higher-compensated full-timers, all the time protesting that paying living wages and health insurance for those lowest-paid employees will put them out of business, yet expecting someone else to provide health care, either government or other employers and workers [through higher health care premiums]. And, again, for the most part, those who complain the most are those most insulated from the lack of affordable health care, which, like it or not, translates into the availability of insurance for those low-paid workers.

Yet at the same time, we, as a society, make no distinction between those individuals who work hard and cannot afford health care and those who hardly work.  As a society, we have effectively determined that no one can be denied health care, even those individuals who are clear and total freeloaders.  Is that willful blindness… or hypocrisy… or some combination of both?

Interestingly enough, I also don’t see anyone asking questions on the other side of the issue.  Why should we have any interest in preserving businesses and institutions that can only survive by exploiting people who are working hard to that degree?  Or is it that we all want everything so cheaply that we don’t really care about those people?  And why do so many people vote for politicians who support that view?

14 thoughts on “What ACA/Obamacare Reveals”

  1. Kathryn (@Loerwyn) says:

    To go off the second paragraph, the way a system like ACA would have to work is that it provides a basic level of care to everyone for free (or for a very small fee). There is no reliable way to distinguish fairly between those who ‘hardly work’ and those who cannot work. After all, many disabilities are invisible, and any crackdown on ‘those who hardly work’ (which, it must be said, is something people think is more prolific than it truly is) will disproportionately affect those who are disabled.

    That is something that’s happening over here in the UK. There’s been a massive crackdown on ‘benefits fraud’ by the government, despite the fact that there’s one job vacancy for something like every five people, and the unemployment figures are being skewed by exploitative free labour (Workfare, which is not work nor fair), and by the government increasing the number of unemployed people by kicking numerous disabled people off their disability benefits. Do you know what the independent projected figure for benefits fraud is? This figure goes over ALL UK benefits, by the way, so working tax credits, pensions, etc. It’s 0.7%. A massive crackdown that has destroyed or hurt the lives of many disabled people, over 0.7% fraud rate.

    That’s what happens when you try to prove the unprovable, when you try to tackle a problem that is either not truly there, or not exactly the biggest problem.

    So I take the point of view that any healthcare bill has to apply equally to every single citizen of that country. I don’t care whether these people are disabled, able-bodied and healthy, white, black, foreign nationals with citizenship, gay, straight, transgender, parents, surrogates or anything else. The basics of any healthcare system should apply equally to everyone who is a citizen. It shouldn’t be denied to those who aren’t citizens – health isn’t something that waits – but perhaps at a higher cost. Lazy, hard-working, young or old. You should have the same basic access to healthcare as anyone else.

    I also take the point that if businesses paid their taxes like they have a civic duty to (and this extends to the UK, too), then just maybe these budget issues wouldn’t be there. But as for the payment of the healthcare, perhaps something like in the UK would work. We have National Insurance (which you automatically pay once you’re sixteen and earning over a certain amount), which goes into a big pot which goes towards everyone’s healthcare. So you’ll “technically” be paying for someone’s chemotherapy, someone else’s mobility aid or someone’s childbirth, but those same people will also be contributing to any healthcare you need.

    Last point: It’s the duty of any government to look after its citizens. That should include looking after their health, and making sure the vast majority of treatments are available, of high quality, are *safe* and are easily accessible, and if need be – fairly priced.

    I apologise for the haphazard thought-stream, it’s just how I operate.

  2. R. Hamilton says:

    How did people survive 50 or 100 or 10,000 years ago, without having their needs guaranteed regardless of their level of participation in their outcomes? And for those that didn’t, why should we be under some new obligation to keep them alive today? The loss of freedom under the burden of ENFORCING such obligations exceeds the dubious value of the lives of all the minimally productive on the planet. Which is not to say that were such obligations taken on in small parts by many people acting VOLUNTARILY, most needs couldn’t still be met without any such loss of freedom.

    If we won’t do it willingly, then I guess if we do it unwillingly and get underperforming mediocrity in return, that won’t be on our consciences instead? Nonsense. Either you do something yourself, or you’re at fault for not having done it, but the fault is not society’s, it’s individual, as is all fault and virtue. That’s what matters, not the body count or lack thereof.

    We’ve become a defectively weak species if we think we can’t get by without guaranteed outcomes. We’ll all die in the end anyway, so why not just be responsible for ourselves and those closest to us until then? And let someone else do likewise for others, or not, as they wish.

    Perhaps having some few able people care about us is also a survival skill; and without either that or one of the more usual survival skills, what point living anyway? Isn’t that how it used to work – children and family being one’s old age insurance?

    (PS, I have no kids, so I expect to croak alone, and that’s my problem, not the government’s.)

  3. People survived through cooperation, and the more cooperation the more likely they were to survive. The lack of large scale cooperation was likely a significant factor in the die-off of Neandertals. The most deadly large predator as a single individual is the tiger. It’s also endangered and will not survive without the cooperative efforts of human beings.

    1. Kathryn (@Loerwyn) says:

      Exactly. As I think you said in a podcast (Writing Excuses), or at least implied, you don’t have to have a direct hand in creating something you need. I think you said a community has to make more than they need to live in order to survive – something about subsistence, right?

      That applies to the world. Should the artist starve because he doesn’t produce food? Should the craftsman be unable to feed their family because he creates benches, and doesn’t bake? Of course not. It is, like you say Mr Modesitt, a cooperative relationship.

      And that is the basic level to which we should work. Everyone – independent of their career choice, able-bodiedness, etc. – should have the ability to have a basic level of food, water, shelter and healthcare. You can’t have a workforce without those things. Your workers are useless (or operate at a lesser capacity) if they’re not fed, not watered, don’t sleep or are sick.

      Maybe that means I’m some weak-willed socialist or something, I don’t know, but I don’t get why it’s so hard to see that ACA/Obamacare is a *positive* thing, at least in theory. A healthier country is a more productive country, and the current state of US healthcare is not helpful. It punishes the poor, it withholds treatment from the sick and so forth. This is not a good thing. At all.

  4. AndrewV says:

    –I don’t know, but I don’t get why it’s so hard to see that ACA/Obamacare is a *positive* thing, at least in theory. —

    That is the problem, Kathryn. The ACA is positive in theory. In reality, it is an awful piece of legislation that does more harm than good.

    The US Healthcare Industry is sort of like having a large town with several roach or rat infested homes. The ACA is like saying, “Gee, we have some infested homes in the town. Let’s all take steps to kill off infestation.”

    To continue the analogy, we could have sent in exterminators (small, low cost efforts) and then took necessary steps from there but instead a group of townspeople decided to launch cruise missiles (flashy, expensive, and with lots of collateral damage) without caring that the other townspeople thought that was a bad idea.

    Remember, the President asked for Republican input on the ACA but Rahm Emanuel famously opined, “We have the votes, f*ck ’em.” And so they did.

    The intent of the ACA was noble and I wish it had no negative consequences. But wishing doesn’t change the negative affects hitting our economy. Watching my friends and family members get laid off is not worth it. “Well, it was a positive thing in theory” does not put food on their table.

    Mr. Modesitt, the reason why businesses large and small “complain” about the cost of labor is because for most businesses it is the largest cost on their Income Statement (besides, maybe, Cost of Goods Sold). A business is not a charity, it is a profit machine. When the profit machine is running well all employees benefit, when it does not, everyone suffers. The ACA makes the machine run poorly, period.

    Also, why doesn’t anyone understand that capitalism is simply cooperation on a massive scale? Everyone does something of value so that the entire economy benefits. That’s the very definition of cooperation!

    In our system some people’s contributions are more valuable than others, and while some claim that’s not fair it’s also an unchangeable reality. Now I would agree capitalism hardly perfect, but given that all other options tend to lead to human misery on a massive scale I’ll take ‘hardly perfect’ over ‘millions of graves.’

    1. Ryan says:

      It seems to me that the whole healthcare debate comes down to two questions:

      Does everyone deserve healthcare?

      (if so) How do we implement it?

      I would argue that aside from the obvious moral argument, the Declaration of Independence says that the rights to life and liberty are unalienable. Additionally, one of the stated aims of the Constitution is to promote the general welfare. Obviously there are people who disagree with the idea that everyone deserves healthcare, and I’m fairly sure that this is the real argument that nobody wants to argue, at least from one side, in public.

      As for the implementation, there are really two ways to try and deal with the situation:

      work within the current system (capitalism)
      completely rework the system (social medicine)

      Arguably there are several options for working within the current system, but what a lot of people who disagree with the ACA fail to mention or perhaps realize is that the ACA is an attempt to work within the system, and not an attempt at social medicine. In fact, the basis of the ACA is actually something that conservatives came up with, as an alternative to social medicine.

      The alternative, social medicine, is enjoyed in most first world countries aside from the USA, where per capita healthcare costs are lower, and outcomes are generally better. Equating social medicine with “Millions of graves” goes beyond overstatement.

  5. jeanR says:

    So AndrewV my sister is schizophrenic. Under your oh-so-empathetic world she should then be thrown out on the streets like a piece of garbage. She isn’t productive so she doesn’t get food, water, a safe place to live, much less healthcare. Should we maybe exterminate her like a rat because she doesn’t contribute to society? And who should make that decision. You perhaps? But would we then have to pay you for your expertise on who is productive and who is not? And wouldn’t we then have to pay a doctor to verify your decision? And wouldn’t we then have a Disabled Euthanasia Oversite Committee. Oh wait, ACA might be cheaper!

  6. Rehcra says:

    Good thing the Republican agenda… I mean Obama made the Republicans shut-Down the government so we couldn’t fund ACA.(Funny how the defense never worked for me as a kid!) There is nooooooooooo waaayyyyyy that is going to be bad for the economy. Although, I guess ACA wasn’t threating to make our currency no longer considered the world currency but ehhh; I am sure if that happens ObamaCare will be to blame some how. But at least peoples Health didn’t get in the way of the economy this time.. cause it’s always better when its the other way around.

    p.s. On the part time worker problem, Simple solution would be for employers to have to pay a equal percentage based on the hours, 100% being the minimal hours to enter into it. Even if the employees are not covered it would no longer allow for the part time worker loop hole. Business wise it does seem a little harsh but equally harsh to all businesses I can live with.


  7. Ryan says:

    Also: in response to the statement that some people’s contributions are more valuable than others I would like to point out a few things.

    First, you link contribution with economy, which is not a link that necessarily exists. Science moves forward slowly, with small contributions from scientists all over the world. Occasionally one may land a lucrative patent, but inventions are built on knowledge, and the builders of knowledge as a whole are under rewarded for their contributions.

    Really, in capitalism, the people who are rewarded most are not the people who make the largest contributions to society, but those who are best at making money.

    Also, your statement that capitalism is cooperation just isnt true. Everyone doing something with the entire system benefiting is socialism or communism.

    Capitalism is the survival of those best able to compete in markets, which is usually done by reducing overhead. Because of this, an unregulated or under regulated free market only has as much morality as it’s least moral component. Examples include third world sweatshops and poisonous Chinese toothpaste.

    Or, relevant to the current discussion, are the owners of Walmart, who take places 4, 7, 8 and 9 on the list of the most wealthy Americans. Historically Walmart has provided the bare minimums when it comes to insurance, and recently changed their healthcare policies so that people working under 30 hours a week will not be eligible for health insurance, because they are paying them so little that they will qualify for the expanded medicaid under the ACA.

    But really none of this has any bearing on the healthcare discussion, because capitalism and social medicine can coexist.

  8. J. Mai says:

    I very carefully read the responses to Mr. Modesitt’s post, and again reviewed them to be sure that I was not about to launch onto a tirade that missed points raised as I’ve seen so ignored in all of the replies to this same post.
    I’ve seen a plethora of talking points regurgitated over and over again, as well as the accompanying counter points to those talking points, and not one individual who seems to understand what Mr. Modesitt is speaking of.
    I am one of those whose hours have been cut nearly in half by the results of the Affordable Care Act, in effect, I’ve lost my job.
    There is no way that I can continue to pay my bills on half the income that I was earning before my employer decided that it was far cheaper to replace me with two or even three people. it was far more cost effective for them to dispose of me, my experience, my years of service, that it ever would be to insure me.
    All I see here is a vague disdain for current policies, and a weak reaching out to attach said policies to some other policies that might have some other form of relevance to other polices that have also failed.
    I do not care what the current policies are, I am not in the slightest concerned with who links what with what concept,here, and I could care less with what, from what I’ve read, noting but random and opinionated posts about what is actually happening to me and millions of others. and I absolutely could care less with who is to blame for all of this.
    Because of the government actions, and allow me to be clear here, I could care less about which branch it is, Republican, Democrat, Tea Party, or the President, I only know that the nation that I grew up in is not the country that my father taught me it was.
    I know that because of the decisions of my leaders, I’m out of work.
    Their choices lead me into a position where I am an expendable person, someone whom is regarded as a resource to be utilized only and as so much as it suits the organization that I work for.
    When the moment comes that I cost to much to maintain as an asset, why then other assets are easy to obtain, for far less cost.
    All of your talk of incipient socialism or your pseudo intellectualism has no bearing upon the reality of what is happening to millions of people right now.
    Millions of people are right now trying to figure out how they are going to eat this afternoon, because a noon meal means that those few dollars might cost them the next months rent.
    You actually ask if everyone needs health care, you post in written words a question inquiring if everyone really needs health care.
    No, of course not, nobody needs health care, I’m perfectly happy getting sick for weeks on end, with no income forthcoming, I’m perfectly happy having not even so much as sick leave when I come down with an illness, I’m delighted to sacrifice myself for some undefined and greater good.
    I’m pleased to find myself dying of some totally and easily correctable condition, it’s a damn shame I didn’t have the money to keep me alive, but my sacrifice will never be in vain will it?
    This is all total nonsense, I can see it, I can read it in your posts, I can see the nuttiness that you present here, I can see the madness that you insist is reality, I can see that every single word you type is something that you wished to say, but I can not ever see what you mean unless you are honest with your words.
    If you state that the above was your honest words, why then, I can only express my appreciation for your steadfastness.

  9. ryan says:

    I’m sorry you’re having trouble.

  10. R. Tavares says:

    Mr. Modesitt

    Your essay paints business owners as somewhat out to get “the little people” and I have no doubt at all that most are like this. Just to put a specific example out there: A group of Anesthesiologists that I work with have had their insurance premiums increase by $300 per family per month effective 11/2013. I have three friends in TN, premiums went from $265/biweekly to $480/biweekly with an actual decrease in coverage.

    Other comments have pointed towards “civic duty to pay taxes.” I wholeheartedly agree that there is a civic duty to pay the dues needed to fund the constitution-derived nation of ours… but can you honestly express to me that it is my civic duty to fund Pakistan, Military equipment and aid to Egypt (or to fund the messes that created this need), How about that patient I took care of last month that is on disability for addiction to narcotics?

    What this commentor refers to is “blind obedience” not “civic duty.” What about the military which got a 1.3% pay raise this year but a much higher jump in tricare costs and a decrease in coverage as well as a vast decrease those covered at the same time Big business, Unions, and Congress get a pass on the impending “universal” mandate.

    I’ll pay my taxes happily, when my tax money is spent wisely.

    Soap box: I pay the same rates for insurance (very fit 34 year old, nonsmoker, nondrinker, no medical history) as do several coworkers that are obese, cardiac disease, diabetes, etc. Yes, I’m oh so thrilled with universal healthcare that fails to require individual responsibilities.

  11. Ed says:

    For whatever reason (Maybe it’s because I’m a capitalist and not a socialist) I see it differently. A business needs to be profitable and competitive to survive. A “Business” doesn’t need healthcare, -an employee does. Your personal health is your responsibility. The arguments I read further up this thread presuppose some kind of “moral” obligation on a business to provide endless welfare to its employees. Next you’ll be saying your employer should pay for your license plates because you have to drive to work. Or give you free daycare for your kids. I suggest you budget for what’s important to you and stop trying to get in your employer’s pockets. It’s a free country people. Go start your own business and lavish all the perks you want on your employees, no one’s stopping you. I get really nervous when I hear talk about spending someone else’s money.

    1. Ryan says:

      Healthcare began being linked to healthcare during WW2, when wage increases were frozen to try to combat inflation. It makes no sense for healthcare to be linked to wages, it was just a way for employers to raise wages without raising wages.

      if they had just been allowed to raise wages at the time, who knows how our healthcare would work.

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