DOUTHAT: But what if Obamacare actually works?

Keywords Forefront / Opinion
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Ross DouthatIt’s likely that HealthCare.gov will be fixed by Thanksgiving and millions of Americans will (finally) be able to get a real look at what Obamacare is selling them.

What will they find? One way to understand what is being offered is to think in terms of three “mores:” more expensive, more subsidized and more comprehensive.

Some of the state-level exchange websites are working well enough to enable illuminating window shopping.

Take my native state, Connecticut. There, the “more expensive” part of the new regime is readily apparent. If you look at Connecticut insurance prices for 2013—that is, pre-Obamacare—on the online clearinghouse eHealthInsurance, monthly premiums for a 30-year-old in good health can start below $100, and under $300 for a healthy 60-year-old.

On the state’s new Obamacare-compliant health care exchange, by contrast, the lowest priced (“bronze”) plan for a 30-year-old Connecticut resident has premiums starting at $224 a month; for a 60-year-old, the cheapest plan starts at $537.

However, there are subsidies. If our hypothetical 30-year-old makes $30,000 a year, he or she would be eligible for credits that lower the actual cost of the cheapest plan to $115 a month. A hypothetical 60-year-old making $30,000 would see the cost of the cheapest bronze plan fall to zero.

Overall, the premium increases only really bite as subsidies phase out—at incomes above $45,000, or about $62,000 for a family of four.

They bite, in part, because insurance companies now have to take customers with pre-existing conditions, which drives everyone’s rates up. But they also bite because buyers are getting more insurance than the older system’s cheapest plans offered.

If we ever get beyond the follies of HealthCare.gov, the politics of the rollout will probably be defined by how (and how vocally) middle-class Americans just above the subsidy threshold react to this “pay more, get more, subsidize other people” deal.

Will they be grateful for more comprehensive coverage, even though it’s being forced on them and has higher premiums attached? Or will they feel they were misled by the president’s “if you like your insurance plan, you will keep it” rhetoric, and drive a further backlash against the law in 2014 and beyond?

Where the underlying policy debate is concerned, meanwhile, what you think about the three “mores” basically determines whether you belong on the left or on the right. To liberals, more is simply better, and the disappearing low-cost plans deserve to vanish, because they left purchasers potentially exposed to way too much financial risk.

Conservatives agree that these cheaper plans create more risk. But they also create a sensitivity to price— and with it, a curb on cost growth— that’s rare in a system where third-party payment has made prices opaque, arbitrary and inflated.

And for a society that pretty clearly spends far too much on health care, sticking with catastrophic coverage frees up money—thousands for individuals and families, billions for the government—to spend on something other than the insurance-medical complex.

This is why the law’s critics believe Obamacare might be a long-term failure even if it survives its launch troubles and works on its own terms for a while. It’s not about the good things the reform delivers: Those are real enough. It’s about whether there are too many other goods, for too many people, that the law’s three “mores” end up crowding out.•

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Douthat is a New York Times op-ed columnist. Send comments on this column to ibjedit@ibj.com.

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