Michael Matthew Bloomer, October 2, 2013.

The Republican howling about ‘Obamacare’ continues with little change in emphasis, although their Obamacare-driven government shutdown qualifies as a change in emphasis. Predictions of increased insurance premiums, one of the more strident and emotional outcries since the unveiling of the Affordable Care Act, have framed this concern in Republican terms.

Lying by omission, the GOP Obamacare attacks fail to lay out the historical context of premium increases. It would maim their argument if they did. For working Americans, premiums rose 172% in the 13 years from 1999 to the end of 2012. There was little sign of abatement, and much of the increase was in profitability. Simultaneously, until 2009 worker income rarely rose above the inflation rate, while the opposite happened to workers’ contributions to premiums which in 2009 rose above the rate of increase in premiums. Oh, and health insurance companies’ profits have soared.

Among other reasons, the Affordable Care Act’s passage set off a significantly greater year-to-year increase. However, the ACA’s state insurance exchanges opened for business just the other day, and, remember – even though Republicans are tight-lipped about this – for most Americans, tax credits will largely or wholly offset premium increases, thereby reducing health insurance costs. Who benefits? Incomes from 100% up to 400% of the poverty level (about $24,000 to $94,000 per year for a family of four in 2014). That’s no small number. [See this Kaiser Family Foundation report]

That sleight-of-hand alone is a huge GOP talking point omission. Nevertheless, for a moment let’s assume this Republican argument true. How is an ‘Obamacare’ increase in premiums unusual? As you can see in the chart, it’s not a rare event under the present system. Premiums rose 172% from their 1999 base. And most importantly, the ACA brings with it greatly expanded coverage. Here are three notable examples,

the end of preexisting conditions disqualifications, preventive health care services, and coverage of children under 26 years old on their parents’ health insurance.

The One-Entry Accounting Republican Mind. Accounting takes note of both costs, revenues, losses, gains, and when available, profits. The GOP mind consistently takes note of only one side of the accounting equation, costs. So they fight the ACA based upon the costs their imaginings, their lies, or their obfuscations. They fail, for instance, to assess the gains to be had from the improved health care system the ACA was designed to deliver, and will deliver, in large part, although the GOP’s dishonest and insincere meddling at every governmental level makes the task more difficult.

A one-entry mind, if given physical form, would look like a fishing net with a mesh size designed to filter out all but the bigger fish. They aren’t really fishing at all, they’re predating, they’re only interested in one or two species. For true fishing boats that’s essential to their livelihood; for politicians, that’s a recipe for gridlock and complete intransigence. They will not let much in to their minds.

The roll-out of the ACA insurance exchanges yesterday puts single-entry accounting minds on display. For example, people like Ted Cruz point to the increased premium costs that accompany ‘Obamacare.’ Leaving aside for a moment their judgment is wildly premature, let’s again assume they are correct and premiums rise in some markets. Yet, cost alone does not define the success or failure of the ACA.

For perhaps the best example, let’s consider that insurance providers disqualified those with preexisting condition for coverage. Pre-ACA that was the standard health insurance standard. It was a policy responsible for untold suffering, mentally, physically, and financially since few, even the moderately wealthy, could afford the full cost of care for most chronic conditions. And if one wants to address one of the bedrock Republican concerns, the cost to our workforce in lost or reduced workforce productivity was likely large, and outside the ambit of a single-entry mind that considers costs in one direction only, out-of-pocket.

The ACA’s preexisting condition provision that ends exclusions will extend and save many lives, restrain co-morbidity, and reduce the ultimate dollar costs of health care for a significant portion of the workforce, and, consequently, for their employers. So to will the ACA’s emphasis and coverage of preventive care. It will identify illnesses in their early stages, especially chronic illnesses like type-2 diabetes, and the systemic problems it brings with it. Any premium cost increase, should it develop, will likely be minimal, and given the gains to follow, will be well worth the increased costs. On a societal level, the gains will overwhelm on the good side the aggregate cost, unless one sees good in many people dying earlier and in maximum mental, physical, and financial distress, both for themselves and their families.

Sadly, stupidly, the ACA’s gains go unnoticed by a GOP that still rides on its big kahuna wave of its imaginings of 18th century political ideology. Their political philosophy often resembles that of late 18th century French revolutionaries. In the House especially, they’ve waged a legislative reign of terror, threatening to undo the very concept of the general welfare. Yet, confused as they are, they also court those who would crush any true revolution, those very counter-revolutionary 1%ers, especially the one-tenth of that one-percent.

So it will continue ever on in its not-very-stealthy pace. Republicans will do anything to prevent this remarkably fair program’s success, today, tomorrow, and right up until the time when the ACA operates smoothly and effectively. Just as they’ve always been hunting Medicare, Medicaid, and Social Security, the will always have their knives out for the ACA.

Don’t any of these people have any family member who benefits from these established programs? Do they even care?

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For more on workers’ health benefits, see this Kaiser Family Foundation collection of graphs.

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