The perfect and the good, benefits and harms

A good friend of mine listened to a recent talk on health care reform from a well-known political figure, and was telling me about it. This figure disapproves of the Affordable Care Act, and was explaining why it needed to be repealed. His most salient point was that companies exist which would drop health insurance for their employees since the penalty would be less expensive than providing the insurance.

I don’t think this argument is factually incorrect. And so I agreed that he was likely right in his assertion.

Too often, however, when I agree that those I am arguing with have a point, they throw up their arms in victory and think they’ve “won”.* I don’t understand this mentality. If we want to be totally honest, yes, companies exist which will do this. There are likely some large companies that are giving their employees bad insurance, or none at all, and they won’t want to be faced with the new costs. Companies likely exist who will drop some employees to part-time in order to avoid having to pay for either insurance or the penalty. Companies likely exist who will find loopholes to get under the cap of a “large business”.

Some bad things will happen to some people under the law. When did we become a country of people who only expect that purely positive things ever happen?

When I hear that companies will drop insurance, I nod and say that their employees will go to the exchanges. When I hear that this will increase the cost of the law because of increased subsidies, I nod and say yes, I think it’s worth it. I say that because I live in the real world where sometimes good things cost money.

When Medicare was put in place, I’m sure people and businesses didn’t like the Medicare tax. They adjusted. When social security was put in place, I’m sure they felt the same way about the social security tax. Whenever we do something good (or even bad), we all pay for it somehow. If you don’t believe that’s so, you’re in denial.

So if tens of millions of people get insurance who did not have it before, if tens of millions of people with chronic diseases are assured they will always be able to get insurance, if tens of millions of people are given financial help to buy insurance, if tens of millions of seniors have an easier time buying drugs, if millions of young adults can get on family policies, if millions of people are protected from annual or lifetime caps, and if some steps are taken to try and curb costs, then I can live with covering the cost difference between the subsidies these employees will receive in the exchanges and the penalties companies will pay for sending them there when they drop coverage.

Of course there will be some negative outcome from the Affordable care Act. But if you think any negative consequences means we should do nothing, then we might as well close up shop now. This type of magical thinking is killing our discourse.

I can find fault with your plan, and you can find fault with mine. That can’t be the end of the discussion; it has to be the beginning. For me, it’s not that negative consequences don’t exist, it’s that the benefits outweigh them. You may be able to find a salient flaw in the law, but if all you’ve got is repeal, then you need to convince me that this flaw is worse than doing nothing. I can come up with reams of data to show that our health care system costs too much, covers far too few people, and is shockingly lacking in quality. I think that health care reform under the Affordable Care Act is far from ideal, but I also believe it does more good than harm.

You can’t just talk about the bad stuff. You need to explain why the bad stuff overwhelms the good stuff. Otherwise, you’re just letting the perfect be the enemy of the good.

*My friend did not do this, of course

UPDATE: Julie Rovner reports that Employers May Not Rush To Drop Health Coverage After All. This still doesn’t change my main point.

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