Jamelle Bouie writes for The Daily Beast that, if the Affordable Care Act had existed in 2008, Breaking Bad character Walter White "wouldn't have had to cook meth for money."
That's wrong. The ACA would likely have done nothing to help Walter White. And that's actually a feature of the ACA, not a bug.
Remember, White (on the show, a high-school chemistry teacher who became a methamphetamine producer to pay his cancer treatment bills) had health insurance. He didn't incur enormous out-of-pocket costs because his plan had a high deductible or a low benefit limit. He incurred them because his family pressured him into getting treatment from Dr. Delcavoli, a superstar oncologist who didn't participate in Walt's HMO.
The ACA would not have forced Walt's employer to offer a more comprehensive provider network. In fact, though people like Walt with employer-provided coverage probably won't see the breadth of their provider networks affected by the law, people buying insurance through the Obamacare exchanges are likely to find themselves in Walt's shoes.
Insurance companies have been responding to pressure to keep exchange premiums down by excluding expensive doctors and hospitals. For example, none of the plans that will be offered in California's insurance exchange will include Cedars-Sinai, a top Los Angeles hospital; only one insurer will include UCLA Medical Center.
That is, one of the key ways the ACA controls costs is by boxing out doctors like Delcavoli.
Bouie raises the topic of lifetime benefit limits, which Obamacare has prohibited since 2010. But even if Walt had been running up insurance-eligible bills within an HMO network, he likely wouldn't have been affected by a lifetime limit. As of 2009, 69% of workers covered by large employer HMO plans had no lifetime benefit limit, and another 25% had a limit of at least $2 million.
Where the analogy breaks down is that a lot of people in situations unlike Walter White's stand to benefit a great deal from the ACA. People who currently lack health insurance will be better off with it, even if their insurance plans have limited provider networks. Some people really were hurt by lifetime limits.
But the failure to help Walter White also reflects one of the policy successes of the ACA. Helping people get highly cost-effective medical care is an excellent policy goal. We don't want people failing to manage their diabetes or walking around with joint injuries because they can't afford physical therapy. The ACA will do a lot to serve this goal.
Helping people get astronomically expensive hail-mary treatments for late stage cancer is a much more dubious policy goal; we shouldn't necessarily expect the law to help people get the sort of treatment Walt had to go to such great lengths to obtain.
There is a voice for this idea on Breaking Bad: Walter White himself, who initially resists his family's pleading, arguing that treatment is likely to be expensive and unpleasant and ineffective. Of course, on the show, the treatment ends up greatly extending Walt's life span, because "Man gets expensive cancer treatment, becomes too sick from chemotherapy side effects to run his meth lab, dies anyway, and leaves his family penniless" is not a very interesting television plot.
But back in the real world, trying to ensure that every late-stage cancer patient can get in front of the equivalent of Dr. Delcavoli for expensive and painful long-shot treatment is not a very good way of spending health care dollars. The ACA wouldn't help Walter White get treated—nor should it.
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