Congress Will Go to the Head of the Line on Obamacare
Back when Congress was debating the Affordable Care Act, Republicans slipped in an amendment requiring members of Congress, and their staff, to buy their own health care on the exchanges. The provision was meant as a poison pill, but there is a logic to it: Members of Congress should be willing to eat their own cooking, shouldn't they?
Ryan Cooper argues that this will eventually have a salutary effect on the health-care system, as congressmen find out just how bad things are for ordinary Americans:
This sort of experience is unvarnished good news. Finally, wealthy members of congress are getting a tiny, tiny taste of how the healthcare sector actually works. Five decades of skyrocketing health price inflation didn't inspire so much as a peep when Republicans held all three branches of government. But now that Republicans have derped themselves onto the exchanges, they're shocked, shocked at how expensive things have gotten.
A fairer and more substantive complaint is that apparently the D.C. exchange has some glitches, and while it seems to be working well for most people, some staffers might have to get a delay in their purchase mandate. But while this complaint is easier to sympathize with, it also means that it will likely get fixed much, much faster. Congress pays a lot more attention when they are directly affected by some problem -- remember how fast they exempted air traffic control from the sequester?
Now that Members of Congress are having bad health care experiences, D.C. will probably have one of the best exchanges in the entire country. When it comes to health insurance, Congress and regular people will be at least within shouting distance of each other.
Color me skeptical. Congress is not going to get the same service that other people do on the exchanges. Obamacare will seem to them to be working much better than it is.
If you write about Detroit at all, you'll hear one story over and over. As the U.S. automakers began their long decline, senior auto executives were mystified. Various reports showed consumers complaining about the reliability and quality of their cars, but they drove those same cars every day, and they were fantastic. They couldn't figure out what their customers were complaining about.
Of course, you know the answer: Those executives were not driving the same cars that ordinary Americans drove. Plant managers made sure that a car destined for a Detroit senior executive was earmarked from the moment of its creation for special treatment. Exquisite care was taken with its construction, and little extras were added -- more insulation to cut down noise, perhaps. The car that was driven off the grounds and onto an executive driveway was the finest Detroit could make. But it was not what they were making for their regular customers.
If Detroit executives had just been buying cars like regular people, they would have comparison shopped at dealers, and quickly found out why people were flocking to foreign cars. But they "ate their own cooking" and as a consequence, they were actually more disconnected from the experience of ordinary customers.
Now, will buying health care on the exchanges actually make members of Congress more disconnected than they would be if they were still getting their insurance through the regular government system? It's possible, I suppose, but it doesn't seem likely. What does seem likely is that they will not have the experience that ordinary people have. For one thing, those who buy on the exchange are having their premiums heavily subsidized by the federal employment system. For another, as the New York Times reports, whatever exchange they're on will make damn sure that whatever the problems regular folks encounter, Congressmen and their staffers get taken care of.
Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.
That is true. As long as their constituents have access to "in-person support sessions" like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number -- a "dedicated congressional health insurance plan assistance line."
And then there is the fact that lawmakers have a larger menu of "gold plan" insurance choices than most of their constituents have back home.
It is simply very difficult to ensure that senior, important people have the same experience as normal people. Even if congressmen and staffers are scrupulous about never calling the political office to inquire about why their health care plan seems to be so screwed up -- and I suspect that many of them won't be -- any insurer with enough sense to come out of the rain is going to be assiduous about ensuring that its congressional clients have a great experience with their health insurance. And that goes double for exchange managers, who are, after all, political appointees.
I once sat in a seminar with various Canadian political folks of a more or less libertarian persuasion. One of them complained about limits on doctor's visits; another one argued that it was not that bad, because you could always get around them. To which the first rejoindered that of course you could, if you worked for a member of parliament, or were close friends with a doctor. But most Canadians do not work for an MP, or necessarily know doctors socially.
I say this not to revive tired arguments about Canadian versus American health care, but simply to point out that even in a system with a much firmer nominal commitment to equality than ours, "some animals are more equal than others." You can try to fight that, but we shouldn't fool ourselves that the rich and powerful can easily have the same experience as regular people. Obamacare may have changed a lot of things about the American health care system, but it hasn't changed it that much.
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Megan McArdle at firstname.lastname@example.org