Obamacare, Crazy Healthcare Policy and the Revolving Door

The revolving door is part of the Obamacare story. Former employees of Congress and various government departments that were involved in drafting the Affordable Care Act and all of the various regulations like exchange rules that go along with it have moved into lucrative roles with health insurance providers.

Liz Fowler, well known as the architect of President Obama’s Affordable Care Act, never really left the healthcare industry. Before and after working as chief health policy counsel for Sen. Max Baucus (the position from which she drafted Obamacare), Fowler worked for the nation’s largest health insurance provider Well Point. She was then appointed by Obama to oversee the implementation of her Obamacare legislation and now, as Glenn Greenwald flagged Wednesday, will be taking up a senior position with Johnson & Johnson.

According to the Wall Street Journal, healthcare insurance CEOs earn more than telecom CEOs and even oil & gas CEOs. And that was before all of these exchanges started being set up, which will earn decent margins from people made to purchase health insurance through them or for whom health insurance is paid for by their employer by way of one of these massive exchanges.

The US approach to healthcare is best described as completely insane. There are so many different rules and regulations, complicated by the clear incentives to engage in rent seeking behaviour on the part of the medical profession and insurance companies, that making any policy changes is bound to result in trade-offs that look really stupid when you think clearly about them.

For example, coming out of the Great Recession, people need to work more hours to catch up for the labour income they didn’t earn if they were under-employed or unemployed. But the 30 hour a week threshold for compulsory health insurance is punishing low income workers twice – their hours are cut because the marginal cost of that additional hour could be thousands of dollars for their employer – and their income is lower because of health insurance costs that they could be rationally avoiding because they’re too poor to afford health insurance and would prefer to put food on the table.

For all of the complaining that some people have about ACC and the public health care system in New Zealand, at least it is not completely insane and riddled with stupidity. If you can afford private healthcare, you’ll take the option if that’s your preference but I think any issues with healthcare here are a whole order of magnitude below those in the US.