Obamacare's New Forgotten Man

October 30, 2013 Topic: EthicsPolitical TheorySociety Region: United States Blog Brand: The Buzz

Obamacare's New Forgotten Man

Once again, social reformers are showing little concern for collateral damage.


Writing amid the first stirrings of the Progressive movement in the United States, Yale sociologist William Graham Sumner argued that seemingly positive social reforms always had an overlooked cost:

A government produces nothing at all...the state cannot get a cent for any man without taking it from some other man, and this latter must be a man who has produced and saved it. This latter is the Forgotten Man....The type and formula of most schemes of philanthropy or humanitarianism is this: A and B put their heads together to decide what C shall be made to do for D. The radical vice of all these schemes, from a sociological point of view, is that C is not allowed a voice in the matter, and his position, character, and interests, as well as the ultimate effects on society through C's interests, are entirely overlooked....to lift one man up we push another down.

Sumner’s Forgotten Man concept isn’t perfect. Any technocrat today will eagerly assert that not all government activity is strictly zero-sum, that some forms of spending stimulate more economic activity than their own value. And Sumner deployed the concept as part of an extremely grim view of human society:

A drunkard in the gutter is just where he ought to be, according to the fitness and tendency of things. Nature has set up on him the process of decline and dissolution by which she removes things which have survived their usefulness.

Yet Sumner had an important point. Those who seek to improve society can develop a laser focus on those they want to help, losing sensitivity to the interests of everyone else. And so they sometimes make improvements at the expense of others.

The Affordable Care Act, popularly known as Obamacare, appears to have added a new wrinkle to the Forgotten Man idea. An NBC News investigation suggests that the administration “knew that more than 40 to 67 percent of those in the individual market [for health insurance] would not be able to keep their plans, even if they liked them.” This contradicts the president’s repeated assurances that “if you like your health plan, you will be able to keep your health plan.” The NBC report tells the stories of multiple people on the individual market who did not get to keep their health plans:

George Schwab, 62, of North Carolina, said he was "perfectly happy" with his plan from Blue Cross Blue Shield, which also insured his wife for a $228 monthly premium. But this past September, he was surprised to receive a letter saying his policy was no longer available....The best option he’s found on the exchange so far offered a 415 percent jump in premium, to $948 a month. "The deductible is less," he said, "But the plan doesn't meet my needs. It's unaffordable."

And a new mother who received a cancellation notice from her insurer told NBC that

she supports the new law and is grateful for provisions helping folks like her with pre-existing conditions, but she worries she won’t be able to afford the new insurance, which is expected to cost more because it has more benefits. "I'm jealous of people who have really good health insurance," she said. "It's people like me who are stuck in the middle who are going to get screwed."

These people “stuck in the middle” are the new Forgotten Men of Obamacare. But unlike Sumner’s Forgotten Man, whose resources or liberties are taken for the benefit of another, Obamacare’s Forgotten Man has his health insurance taken away for his own good. Igor Volsky of ThinkProgress breaks out the apologetics, noting that many plans were cancelled because they didn’t comply with the new law’s tougher standards:

The goal...is to allow a consumer to keep their existing policies, while also ensuring that there are some basic patient protections built into these plans....Individuals can keep the plans they have if those plans remain largely the same. But individuals receiving cancellation notices will have a choice of enrolling in subsidized insurance in the exchanges and will probably end up paying less for more coverage. Those who don’t qualify for the tax credits will be paying more for comprehensive insurance that will be there for them when they become sick (and could actually end up spending less for health care since more services will now be covered). They will also no longer be part of a system in which the young and healthy are offered cheap insurance premiums because their sick neighbors are priced out or denied coverage. That, after all, is the whole point of reform.

Of course, some of Sumner’s Forgotten Man shows up explicitly—the “young and healthy” who once got cheap insurance are forgotten, for the benefit of “their sick neighbors.” (Some of those sick neighbors—such as the woman with the preexisting condition in the NBC story—are also among the forgotten, but let’s forget that.) Yet the new Forgotten Man is here, too, hidden behind Volsky’s hedge words: those who lose their policies can go on the exchanges and probably pay less thanks to subsidies; those who who don’t get the tax credits could end up spending less thanks to broader coverage. Implied: some who lose their insurance and go to the exchanges will pay more in spite of the subsidies; some who don’t get the subsidies will pay more in spite of broader coverage. And, if the reports are to be believed, some will simply lose their insurance altogether, as they’re no longer able to afford care under the Affordable Care Act. Volsky asks us to kindly ignore all these people, as they are not the law’s intended beneficiaries—and, moreover, he expects them to be grateful that they are no longer part of an unfair system. That’s a line the new forgotten men won’t soon forget.

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