By Lambert Strether of .
This short post is a series of [head, desk] moments from at The Times, where (highly credentialed) reporters Reed Abelson and Margot Sanger-Katz together with the editors exhibit about as bad a case of market fundamentalism as ever I’ve seen, but I can’t think of much more to say about it than “[head, desk]”.
Let’s start out by defining market fundamentalism. From Michael Hudson:
Market fundamentalism: The belief that the optimum common interest is only achievable through a market equilibrium resulting from individual decisions by market participants seeking to maximize their own private gains. Epitomized by Margaret Thatcher’s declaration that there is no such thing as society, its policy conclusion is that “free markets” should not be distorted by public regulations enacted in the name of the common good. Hence, it has become a synonym for rentier economy, in contrast to progressive economic policy. (See Chicago School and Deregulation.)
To the Times piece, whicn is a transcribed conversation between , who “currently covers the health care business, focusing on how financial incentives affect the delivery of medical care,” and , who “writes about health care for The Upshot, the Times site about politics, economics and everyday life.” The editors introduce the story this way:
News About Obamacare Has Been Bad Lately. How Bad?
Ever since passage of the Affordable Care Act, a fierce debate has been waged over whether the law would work as advertised. While advocates promised that the design of new insurance markets would transform the way consumers buy health insurance, critics warned that the new market would never succeed. Reed Abelson and Margot Sanger-Katz have had front-row seats to the debate, and the two reporters took a few minutes to discuss when — and if — .
So “how the new market” is working is the essential frame for news about ObamaCare; this despite having a reporter whose beat is “everyday life,” and who hence might be expected to weigh in on how
consumers citizens actually experience ObamaCare, what with its , , , by age, jurisdiction, and income, and . (I’ve added links to comments at the Times with the usual harrowing stories.) But no! Since “the optimum common interest is only achievable through a market equilibrium,” the central focus of the story must be, and need only be, the market.
Here are the central exchanges between Abelson and Sanger-Katz (emphasis mine throughout). This is a bit long, but you can see that at every stage, while the Times reporters occasionally evince some concern for ObamaCare users, they always return to the condition of the market. That is their chief concern.
SANGER-KATZ: … It seems clear that some insurers just made pricing mistakes. I’d include a lot of the nonprofit co-op plans that have gone belly up in that category. United may fall in that category, too, in some places. That doesn’t seem to me like a permanent problem. If everyone priced too low, they can just raise their prices in future years, and it’ll be O.K. , but most people in the exchanges won’t notice a difference because of the way the subsidies work.
than some insurers expected….
ABELSON: But isn’t it a vicious cycle? unless they can attract enough customers to make it worth their while. Those who say Obamacare is doomed argue that the premiums are just too high for people who don’t qualify for a subsidy. If you are insured and relatively healthy, you may not feel as if the coverage is a good deal. The deductibles are steep, meaning you end up paying for a lot of your care before you see the first dollar of coverage, and you can’t always see your choice of doctor.
and therefore too volatile to attract mainstream insurers like United.
… to keep prices low… : California, Vermont, Washington. Those state exchanges made some different regulatory choices early on that got more people into the new markets right away, so their more quickly. ….
ABELSON: It’s easier to smooth all of this out if you insure more people. I know insurers in the early years suffered when some states allowed people to keep their existing plans. Those plans that were grandmothered, as it is called.
SANGER-KATZ: My sense from talking to folks in the industry is that the grandmothered plans really wrecked their early calculations. The Obama administration, responding to a political freakout about people whose plans were getting canceled in 2014 [the ingrates!], let states keep them for a few more years. The result was that healthy people tended to hold onto their old, cheaper plans, while sick people went to the exchanges. [even if some people stayed financially stable and other people got heatlh care].
… [O]bamacare has been much less disruptive to the status quo than many people thought. But it also means that .
Wait, what? You mean this is a problem in political economy?
SANGER-KATZ: It’s such an interesting question.
It would be even harder if you had any, er, skin in the game.
Every time I write a story about the health law, I get comments and emails from people just above the income cutoff for subsidies. These are the people who have been most hurt by the health law. Plans on the exchanges are just really expensive for them, and often come with big deductibles, too. And if premiums keep rising, they’ll keep getting squeezed. Analysts from the Urban Institute have done the math and found that some of them are paying more than 25 percent of their income on health care now. Still [nice transition],
Well, it certainly won’t get any easier to imagine after articles like this.
Hillary Clinton has some proposals about affordability, but they don’t include expanding subsidies.
ABELSON: One of the strengths of the law, and its main weakness, is its emphasis on keeping the status quo. While President Obama may have overpromised when he said you can keep your plan if you like it, the insurance isn’t radically different. The only way companies can seem to bring down prices is by narrowing networks of hospitals and doctors or hiking deductibles. …
— some real change in how care is delivered that is much less expensive or at least more effective.
SANGER-KATZ: This is the thing I say whenever anyone asks me what I think about the health law. It basically baked in all of the complexity and dysfunction of the pre-existing American health care system.
But we should also look at what happens with some of the newer players, like Oscar, the for-profit company in New York that has a lot of capital. And I know that some of the big health systems — I’m thinking of another hometown player, Northwell Health, formerly North Shore-LIJ Health System — have started offering plans. Some of these systems, like Northwell, have had some success in attracting customers and think they can make a go of it.
And we should watch the Department of Justice. If it approves some of those big health insurance mergers like Anthem and Cigna and Aetna and Humana, .
At the beginning, Sanger-Katz urges market competition as the solution. Through a series of seamless transitions, we arrive at the end, where Abelson urges market concentration as the solution. Because markets.
Well, that’s that. I’m sorry it was so ugly. Oh, and readers are invited to consider contextualize the reporting in terms of “Neoliberalism as Lived Experience” here. It was fascinating to watch the reporters approach the human consequences of our health care policies, and then veer away into considering the “health” of the market.
 Of course, if insurance companies are minded to deny people care (as they are) and the system is complex enough to allow them to do so (as it is) then a phishing equilibrium will arise, where insurance companies scam their policy holders. This topic isn’t part of polite discourse, and so the only way to uncover it would be to, well, do some investigative reporting and collocate the common experiences of many ObamaCare buyers. Here again, market fundamentalism prevents that, a priori. No need to talk to those pesky rational agents; we need only examine the health of the market!
 One might argue that this was an editorial constraint, but a headline like “News About Obamacare Has Been Bad Lately. How Bad?” permits a broad variety of topics.
 Like taking the profit out of it?