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The Parable of the Blind Men, the Elephant and Obamacare

From the moment the Affordable Care Act was but a gleam in Barack Obama’s eye, the parable of the blind men and the elephant has seemed particularly apt.

On the most literal level, Obama points to the blind and afflicted as people who, if a catastrophic accident caused their condition wouldn’t be bankrupted by it, and if it was a pre-existing condition, wouldn’t be denied coverage. Opponents, meanwhile, portray the elephant, who, delightfully enough is the Republican Party’s symbol, as shooing off hordes of the needy with its trunk, carping, “Hey, you afflicted! Get your hands out of my pockets!” (Yes, I’m aware that elephants don’t have pockets. Do you know how hard it is to come up with perfect analogies?)

But the parable, which epitomizes the limited perspective with which different parties view the big picture, has driven the Obamacare narrative since Day One.

Virtually every facet of it has been attacked and defended using the same facts. Spokespeople are recruited to show how it has harmed/helped them, and the opposing side points to those same people to prove the reverse.

The maxim that statistics can be used to prove anything? ACA is Exhibit A.

The latest blind men/elephant evaluations were galvanized by a report from the Centers for Medicare and Medicaid Services, which reported that approximately 2/3 of small business employers will pay more for health care insurance to cover their employees, and only 1/3 will pay less. Remarkably, not a single small business will be paying the same as before, according to these stats. Large companies won’t feel much of an impact either way, according to the CMS’ Office of the Actuary.

The actual numbers involved are relatively small, with 11 million small business employees expected to see their premiums rise, as opposed to 6 million who will benefit from a decrease.

So, of course, Republicans and other anti-ACA parties have jumped on this report to crow about the utter failure of Obamacare. Democrats and other supporters cite the report as good news.

That’s because the numbers are kind of useless without providing context and enumerating the numerous caveats, such as:

  • Insurance premiums for small businesses have already almost doubled from 2009-2014, which, of course, almost exclusively covers the pre-ACA period. According to the Department of Health and Human Services, since the inception of ACA, “premiums are growing at less than one-half the pace seen a decade ago.”
  • CMS officials admit to “a rather large degree of uncertainty associated” with their estimates, as they didn’t take into account factors like tax breaks for small businesses, how the new online insurance portals will perform, or other unknowns including “the mix of firms that decide to offer health insurance coverage.” In other words, the CMS’ report offers a limited perspective, much like… much like…. blind men touching an elephant!
  • Obamacare aims to even out the premium discrepancies businesses pay to cover their employees, disregarding factors like gender/age/ and the health risks associated with the industry. So “low-risk” businesses will naturally see rising premiums and “high-risk” ones will benefit from lowered costs.
  • OK, a little “weed-wading” here: that “2/3 pay more” number gets skewered by the fact that “low risk” businesses were previously more likely to offer insurance to their employees in the first place. And, while these companies were paying less than the average for insurance, they weren’t paying as “less” as the “high-risk” businesses with older, less healthy employees were paying “more.” This analysis comes by way of Jonathan Gruber, an M.I.T. health economist who was cited in the above report, and who concludes, “So what that means is that while the cheaper firms will lose, they will lose by less than the most expensive firms gain. The 65/35 is still consistent with the overall roughly net zero result that the Congressional Budget Office, myself, and others have estimated.”

In other words, things are going about as planned, it’s much ado about literally nothing (well, unless you’re the employer paying the higher premiums), etc.

The report further dissects the numbers into “on the one hand, on the other hand” distinctions, but frankly, my head is starting to hurt. The point is, whatever your position is on Obamacare, the report supports it!

And both sides use the numbers to blind us, beneath a big pile of elephant dung.

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