Jonathan Sumner Evans
Sumner Evans
Software Engineer at Automattic working on Beeper

Analysis and reflections on "The Obamacare marketplaces aren't in a death spiral"

Written by Human, Not by AI

I recently read an interesting article from FiveThirtyEight about the state of the Obamacare marketplaces. You can read the article here.

I have compiled a list of my thoughts on the subject. Many of these are not particularly related to the article, consider this a brain-dump. I quote from the article for context, so I recommend that you read these articles somewhat simultaneously.

Article Analysis

83 percent of the people currently using the markets receive subsidies to help pay for their plans

  • To say that ObamaCare does not create entitlements is denying the facts. Obamacare creates a new entitlement: healthcare; and subsidises the market to ensure that everyone receives it.
  • I note people on the Left calling healthcare a right. I think this comes from a fundamental disagreement on the definition of right. I believe that all rights come from God. We have the ability to delegate those rights to other institutions. For example, all humans have the God-given right to defend themselves and their families from people who want to cause them harm. Most people have delegated this right to institutions such as the police and the military. God did not give me the right to force people to pay for my health issues (he did give me the right to convince other people that paying for my health issues would be a good idea), thus I believe that it is not something that I can delegate to the government.

The problem with Obamacare, Laszewski believes, is that it prioritized lower-income people over those with more moderate incomes. But he said the GOP bill to repeal and replace parts of the ACA, which narrowly passed the House earlier this month, falls into a similar trap: It prioritizes middle-income people over the poor. He sees this as a result of both parties looking out only for their own voters, in both cases creating an unbalanced marketplace.

  • This is why I don’t think that either party is any good.

Map: Insurers are leaving the ACA marketplace
Map: Insurers are leaving the ACA marketplace

  • I find it fascinating to see that the places that experienced the largest reductions in healthcare options were the places that Trump carried by the most surprising margins. Take for example Pennsylvania, Iowa, Florida, Michigan, Ohio, Indiana, Arizona, and Wisconsin: all states that were either part of Hillary’s firewall or states that would have effectively ensured that she would win (if she had carried Florida, for example, she would have won).

    Also interesting is the South. Before election night, pundits were speculating that Republican strongholds like Georgia might be in play. It is obvious that this was not the case. The delta-map would predict high margins of victory for Trump in the South, and that is the was indeed the case.

    When making a rough visual inspection of the delta-map and the electoral college map for 2016, most of the states with the highest negative delta in healthcare options are also states that Trump carried.


Like the author of the FiveThirtyEight article pointed out, there is no easy political solution to the healthcare problem. I believe that the entire debate over government healthcare is completely superficial and does not come close to the root of the problem. My next argument will take some time to build up, so please bear with me.

I believe that there are three main institutions established by God for Man: family (Gen. 2:24), the Church (Matt. 16:18), and government (John 19:11). (Note I am no theologian and these verses are not great for this argument, but they were the first ones to come to mind.) It is the responsibility of the Church to take care of the sick, and the poor. We establish this by first looking at the example of Christ, as he himself healed the sick and cared for the poor. Additionally, he commands us to care for the poor, and the sick multiple times. In Luke, he commands us to share with the poor in our prosperity (Luke 14:13) and in Matthew 25:35-36, Jesus tells his disciples that whenever we help those in need, we do it unto him meaning that whenever we help people in need, we glorify God, which is our entire purpose in life.

I believe that the entire healthcare problem is a direct result of decades of 1) family members who are able to help other members of the family neglecting their responsibility to care for their needs and 2) the Church neglecting its responsibility to care for the people who’s families either cannot or do not properly care for them.

At this level of analysis, it is clear that the government cannot solve the healthcare problem because it is a much deeper societal problem. The problem is that because the family and the church have neglected their responsibilities, the government has had to intervene. In effect, healthcare has gone from being a family and church responsibility to being a government responsibility. Human nature is to outsource as much personal responsibility as possible, and once outsourced, is is painful to take back that personal responsibility. Thus it is not at all politically expedient to propose more personal responsibility in this matter.

I don’t have an answer for the healthcare problem, but I do know that the answer is not the government.