de jure versus de facto: the mirage of Obamacare

Under the terms of the Affordable Care Act, insurers cannot refuse us coverage for a precondition, cannot kick us off a health plan, and cannot impose lifetime limits on coverage. This is the situation de jure.

But the de facto situation is something quite different: premiums are higher, doctor networks are limited, deductibles are unaffordable, and (now we are being told) important classes of drugs are not fully covered.

So, it turns out in the real world that the wonderful health insurance plans peddled to us by Obama and the rest of the Dems aren't so wonderful and unlimited after all. The American people are finding out, as Nancy Pelosi said they would, what is in the law.

If, de facto, an individual finds premiums and deductibles too high or cannot see his doctor or cannot afford the drugs the doctor prescribes for him, it hardly matters if, de jure, he has a right to "health insurance."

The insurance companies have a million different knobs and levers that they can operate to dial down their costs and subvert all the lofty promises of Obamacare. Obama has been duped. This should come as no surprise, given the fact that the insurance companies underwrite insurance policies and process claims every day, whereas people like Obama, Harry Reid, and Nancy Pelosi are rank amateurs in the insurance business (as they are in the website development business) and really have no idea what they are doing.

What it's beginning to look like is that the status quo ante Obamacare has not changed at all. The promise of Obamacare is a mirage. Even if millions of people sign up on healthcare.gov, the insurance policies being sold there will turn out to be no better (in their own way) than the policies that were available in the individual market before Obamacare, and which the Democrats so roundly criticized as "junk policies" over the last couple of months. And again, this should come as no surprise, since the terms of the policies in the individual marketplace before Obamacare were dictated by economic reality, and President Obama, as much as he may think he can do things like stop the rise of the oceans, cannot suspend economic reality. There simply ain't no free lunch. People, like Obama, who think otherwise are just idiots.

Years from now there will still be millions of people who, de facto, will not be insured (or adequately insured), regardless of the situation de jure.