Obamacare's shocking premium hikes: Mastio & Lawrence

Jill: As usual, bad news is giving conservatives an excuse to use health policy as a weapon of political war and once again call for the electric chair for the 2010 law with two unfortunate names.

I’ve said before that it was political malpractice for the Obama administration to allow the name Obamacare to take hold. In hindsight, and even at the time, it was also ridiculous for Democrats in Congress to call their bill the Patient Protection and Affordable Care Act. The title was always going to be shortened, likely to something unpleasant. And no matter what it costs, health care is never going to be considered affordable.

What we have here is akin to a clash of civilizations: Liberals who believe health care is a right and a public good that shouldn’t hinge on private insurers trying to remain profitable, and conservatives who believe the free market and canny individual shoppers can drive down costs. From those starting points, the two sides have been trying to either make the law work or do what they can to make sure it doesn't.

I bought health insurance twice under this law, so I know it better than most Americans. There are a few key points that should not get lost in the furor, including that 20 million people have gained insurance under ACA; that Republicans have not offered plans on a similar scale; and that we can fix much of what’s wrong if we all take a few steps toward the middle ground.

David: I am glad you acknowledge that bad news is the “usual” for Obamacare. Let’s dispense with this 20 million number first. The majority of those who gained health insurance coverage were added to Medicaid. That's not health care “reform;” it is spending. The second largest group, as many as 6 million, are young adults now covered under their parents’ plan until they turn 26. That is just cynically telling young people they are getting something for free when everyone else with insurance is paying for it.

So it is not a surprise that the price of the benchmark Obamacare insurance plan is jumping an average of 25% nationwide.  For the millions of Americans getting their insurance through the Obamacare marketplaces, that’s a disaster even though the blow will be cushioned by federal subsidies. And it is just an insult that Obamacare architect Jonathan Gruber has gone on CNN to opine, “There’s no sense in which (Obamacare) has to be fixed. The law is working as designed.”

Apparently, the law was designed so that one in five Obamacare “beneficiaries” have exactly one insurance carrier to choose from for 2017.

In any case, the law is not working anywhere close to how it was sold. The Democrats made promises for health care reform that were widely known to be laughable. Now the inevitable consequences of promising people free ponies and complimentary fairy dust are arriving. To give cut-rate insurance with multiple thousand dollar deductibles to a few million people, Democrats have messed with the health care of every American, and 25% annual rate increases are just a taste of what is to come if this foolish scheme isn’t abandoned.

Jill: So many points to argue, so little space. Expanding Medicaid has given millions access to health insurance and services, many of them children and people with jobs. To me that’s wonderful. The same is true of making it possible for children to stay on their parents’ plans until they’re 26 (and not for free, you have to pay extra). That’s a safety net for young adults who can’t find jobs, whose jobs don’t offer health insurance, or who want to start their own businesses. It’s also a way to broaden the pool of insured to include generally healthier young people.

Democrats have not “messed with” the health care of millions. They are trying to fix what insurance companies, doctors, hospitals, drug companies and everyone else has spent decades messing with. They have not messed with nearly half the country that gets coverage at work, whose family premiums rose about 3% from 2015 to 2016. Or the 36% that get coverage through government plans such as Medicare and Medicaid.

Only 7% of the country buys insurance through the ACA marketplaces. It is hugely complicated. The first time I bought a policy, I had to ask a friend with a Ph.D. in health economics to come over and sort out my options. It was very expensive. I didn't qualify for subsidies, and under ACA insurers are allowed to charge me three times more than a younger person. And my choices were constricted — because Congress vetoed a public option health plan and an option to buy in to Medicare (either of which I would have done in a heartbeat) and because I live in Washington, D.C., which is a small market that attracted very few companies.

And yet, before the ACA, insurers could charge whatever they wanted based on age, gender or health status. They could also restrict, cancel or deny coverage to anyone they wanted, on grounds of pretty much any pre-existing condition. Up to two-thirds of the whole country have such conditions, a government study found, and at a certain age it’s probably closer to 100%. I can assure you I would never have been able to get insurance — and the peace of mind that comes with knowing you can go to your doctor and weather a medical crisis without bankrupting your family — except for the ACA. It needs to be fixed, and there are ways to fix it. But first we have to agree that we need this law.

David: I feel your pain. I have gone without insurance when I was between jobs. I have paid out of pocket for prescriptions. If ever there was an industry that deserved the regulatory hammer, the health care industry is it. I am about to have my fourth kid but only just wrapped up the last nagging bill dispute over kid 3.

The problems don’t come from a free market gone wild. They come from 75 years of increasing government interference that have made health care costs opaque to Americans with insurance. As health care costs became invisible, pressure to keep prices down disappeared and health care inflation got out of control. More government rules, like the 1,000-page Obamacare legislation, won't fix that.

And Obamacare doesn’t simply regulate the 7% of Americans who get their insurance through government marketplaces. It is reshaping directly and indirectly the health insurance all of us receive. And while you are right that family premiums for employer-based insurance went up slowly last year, the costs that employees are paying for health care went up faster. Since Obamacare was signed into law, the number of insured employees with deductibles north of $1,000 has doubled to 51%. Last year, the average deductible went up 13%. When government regulation squeezes one place, inflation just pops out in another.

The examples abound. Obamacare is pushing insurers to narrower networks of health care providers,  which puts people in a new bind: Consumers can keep their doctors or risk a disruption in their care when they change plans. For those with serious health problems, that can be huge. If Republicans came up with a scheme to foist this choice on the sick or push poor people into subpar Medicaid plans, Democrats would be outraged. But as Democrats make all Americans' health care more and more like Medicaid, we’re supposed to celebrate and ask for more.

President Obama has already signed 14 laws passed by the Republican Congress intended to fix aspects of Obamacare. There is no magic cure to our health care problems, so anyone who is promising that a new round of tighter rules will fix things is selling snake oil.

David Mastio, a libertarian conservative, is the deputy editor of USA TODAY's Editorial Page. Jill Lawrence, a center-left liberal, is the commentary editor of USA TODAY. Follow them on Twitter @DavidMastio and @JillDLawrence.

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