The Median Voter, the Marginal Patient, and ObamaCare: Why No Politician Competes for the Votes of Patients with Bladder Cancer
On October 30, President Obama gave a now infamous speech celebrating the going out of business of so-called “bad apple” insurers.
According to the President, “before the Affordable Care Act, these bad apple insurers had free rein every single year to limit the care that you received or used minor pre-existing conditions to jack up your premiums or bill you into bankruptcy.”
Only a few days later, Edie Sundby of San Diego wrote a heartbreaking op-ed in The Wall Street Journal describing how ObamaCare had forced her health insurer to cancel her policy, which had already spent $1.2 million on her treatment for a rare cancer. She may well go into 2014 without health insurance.
Much has been written about Ms. Sundby’s tragedy. John Goodman has used the case to explain the basic economics of health insurance.
This article will attempt to explain the political science behind the crisis. First, when President Obama asserted that insurers’ could “jack up” individuals’ premiums based on individual health status, he was absolutely wrong. Every state guarantees renewability of premiums for each beneficiary at the same rate as everyone else in the risk pool.
This is why Ms. Sundby was happy to keep her policy. Her insurer did not “jack up” her premiums when she was diagnosed with bladder cancer. Her premiums increased at the same rate as the thousands of other beneficiaries enrolled in that risk pool, most of whom remained healthy.*
One remarkable characteristic of President Obama is that he remains blissfully ill-informed of how health insurance worked before ObamaCare. Since his 2008 presidential campaign began, he has described the market for individual insurance wholly inaccurately.
And yet he has not suffered for it (until now). I think the explanation is that the median voter, whom every successful politician seeks, is also ill informed about individual health insurance. This is what we call rational ignorance: Most Americans (especially those who vote) have expected health insurance as a job-based benefit, so they do not bother to educate themselves about individual health insurance.
So, a politician can say whatever nonsense he wants about it, with little risk of being called to account by those whose votes he seeks. But the campaign for the median voter also bears a human cost: The median voter does not have stage IV bladder cancer. He or she is largely healthy — maybe concerned with blood pressure, cholesterol, or a little overweight, but not thinking about serious, catastrophic illness.
This also explains why it is impossible for politicians to design health insurance that operates as real insurance: covering expensive accidents or life-limiting diseases. It simply would not bring in the votes. So, they emphasize preventive care: free prescriptions or birth control.
There are a lot of things that politicians should not be in charge of: Health insurance is near the top of the list.
(*Technical note: This is not a perfect solution. In any risk pool, there will be tendency for beneficiaries who remain healthy to drop coverage and opt into a new policy with a different design. This leaves the sicker beneficiaries in the old risk pool, causing premiums to increase at a higher rate. Insurers stop marketing the old policy. In insurance economics this is known as the “closed block” problem. There are various ways to address it. In California, once a block is closed, an insurer must allow all the remaining beneficiaries to enroll in one of the two most popular individual policies that they are offering, without underwriting. Of course, the best solution would be a market for insurance against being re-underwritten, which is described in John Goodman’s Priceless.)
“One remarkable characteristic of President Obama is that he remains blissfully ill-informed of how health insurance worked before ObamaCare.”
He even said in his speech the other day, “What we’re discovering is that insurance is complicated to buy”!
There must have been a mass facepalming
Had to have been, I am in complete disbelief
There seems to be difficulty grasping the fact that Health care and health insurance are 2 different things. You can provide health care without necessarily having insurance, this has been done for years for the uninsured and underinsured. It’s not a great solution but it can be done, and there are ways to set up health care for the needy without disrupting the whole system.
Does that system need rehabilitation? Yes, because the opposite is now not necessarily true that you can get health care (or good or better health care) with insurance.
“This also explains why it is impossible for politicians to design health insurance that operates as real insurance: covering expensive accidents or life-limiting diseases. It simply would not bring in the votes. So, they emphasize preventive care: free prescriptions or birth control.”
Exactly! And this is why socialized medicine inevitably results in covert if not outright rationing. The sick will always be a small minority at any given time so their voices will always be drowned out by the majority–(except if they are the “victim” of private health insurers) . And, once government becomes the face of healthcare, it has an incentive to pad its numbers, suppress negative information and propagandize its results just as the run up to Obamacare relied upon demonizing and distorting the current private healthcare system while trumpeting Medicare. And you can bet our sycophantic media will always give cover.
Government and health insurers know the real cost drivers of medical care are this small slice of the population. 5% of the population consumes 50% of healthcare costs. This is the target–the sickest, the most debilitated, the elderly. So while they conspire to ration care to this group, they ingratiate themselves to the healthy masses with “free” stuff that amounts to peanuts within the aggregate of healthcare costs. It will not be until these folks find themselves in need of expensive medical care that their blissful ignorance will be hit with reality.
“There are a lot of things that politicians should not be in charge of: Health insurance is near the top of the list.”
So true. I just hope enough people realize that and see that this ObamaCare failure is not unique to ObamaCare, but is representative of what happens when the government intervenes in the market like it has done here.
Sorry but you are giving Barack Obama the benefit of a doubt he does not deserve. Either he was also the worst son ever known (and didn’t help his terminally ill mother when she asked for help on her insurance) or he knew exactly how health insurance worked and then lied about its relation to his mother’s terminal illness in order to get elected and to get the Patient Protection and Affordable Care Act (both those bastions of conservative journalism — the Washington Post (see the Washington Post — http://www.washingtonpost.com/blogs/post-politics/wp/2012/09/06/fact-checking-joe-biden-did-obama-fight-his-mothers-insurance-companies/ ) — and the New York Times — http://www.nytimes.com/2011/07/14/us/politics/14mother.html).
“This also explains why it is impossible for politicians to design health insurance that operates as real insurance: covering expensive accidents or life-limiting diseases. It simply would not bring in the votes. So, they emphasize preventive care: free prescriptions or birth control.”
Bingo.
yet they keep trying to get their hands into things that don’t matter
Rather, into things they shouldn’t