Bryan Caplan  

Would Obamacare Have Saved Walter White's Soul?

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[Warning: Non-Finale Breaking Bad Spoilers]

The Daily Beast
's Jamelle Bouie claims that Obamacare would have ruined the premise of Breaking Bad:
Remember, the instigating action of the series is White's cancer diagnosis--in order to pay for his treatments and leave a nest egg for his family, he teams up with a former student to make and sell methamphetamine. The moral logic of this aside, it's not hard to see why he made the choice. Even with health insurance, courtesy of Albuquerque public schools, White had to make large initial deposits (in one case, of $5,000) and deal with expensive hospital stays. The surgery to remove cancer from his lungs cost nearly $200,000, an impossible sum for the vast majority of Americans, to say nothing of a public school teacher.
 

[...]

Breaking Bad begins in 2008. If it had taken place just two years later, White wouldn't have had to worry about lifetime limits. Under ACA provisions that took effect in 2010, just a few months after the law was signed, insurance companies are prohibited from imposing lifetime limits on benefits. If the series had started in 2014, the year Obamacare is fully implemented, White would have had few financial worries. Not only is that the year the law bans annual limits on insurance coverage, but it also puts a cap on out-of-pocket expenses for families and individuals. At most, the White family would have had to pay $12,700 for Walt's care. A large sum, but not so much that it makes sense to go into the meth-dealing business.

Josh Barro, however, knows better:

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.

[...]

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.

[...]

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.

Like me, Josh argues that the Breaking Bad character with the clearest understanding of the medical industry was none other than Walter White:

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.

In short, the show-ruining premise is not the ACA, but medical realism.  Thank goodness for suspension of disbelief!

P.S. If you postpone your viewing of critically-acclaimed shows until you know that they deliver on their promise, feel free to begin Breaking Bad's transcendent tale of hubris and corruption.



COMMENTS (8 to date)
Daublin writes:

Don't forget IPAB. On an Obamacare plan, you are subject to cost/benefit analysis for any treatment you get. If a treatment costs a lot and is unlikely to succeed, then IPAB will not allow it so as to control costs.

This is especially true for older patients. If you are 70 years old, then your expected healthy years, as the NHS puts it, are not as long as if you are 25.

I agree that this is a feature, and one well worth understanding. Any public health care system is going to work like that. As such, it is deeply misleading to talk about "free health care", because that implies that anything you want, you will get. It's a welfare system, and Obama wants everyone to be on welfare.

Hazel Meade writes:

Walt's motivation isn't really his cancer. It's his envy of his former business partner's success in life.

Peter H writes:

Walter White became a meth dealer due to lack of life insurance, not health insurance. In season 1, he explicitly is counting up the costs his family will need (college education, pay off mortgage, and living expenses), and comes up with a number for what he wants to get from meth cooking. None of his calculation includes health care costs. He ends up using a bunch of meth money on it, but that's not why he starts.

And yes, his motives change as the show progresses, but lack of life insurance is why he starts.

Jacob M. writes:

On a somewhat related note, I wonder how much of Breaking Bad's plot would have been averted if Silk Road had existed back in '07. Walt may have been able to avoid a lot of nastiness with various distributors had he been able to peddle his meth online.

Hazel Meade writes:

I like Jacob's point. Using Silk Road allowed small-time producers and consumers to connect in a safe, non-violent, environment, avoiding the dangers of interacting with drug cartels and gangs. It's also an example of the way in which ratings-based internet exchanges allow economic transactions to occur without formal contracting, obviating the need for courts to enforce the contracts.

It's very much a shame that the feds shut it down.

Charley Hooper writes:

Whatever the pre-ACA medical system's faults, and there were many, poor and uninsured people regularly got world-class medical care. I have a friend with kidney problems. She has had multiple procedures at Stanford University's Medical Center. She tells me that she owes something on the order of half a million dollars, which both she and they know she won't ever be able to repay. Each time she needs a new procedure, Stanford happily gives her more world-class care and adds to the total bill.

And because of a problem that didn't exist, we were forced into an even more government-run health care system? Now, with the IPAB and limited health plans, people like my friend will probably receive worse care than before.

Another example: A different friend and I had appendectomies around the same time. I have health insurance and he was uninsured. Was he left to die in the street? No. We both received the same care at the same hospital. We both ended up paying about the same amount. His total bill was roughly equal to my out-of-pocket costs with my high-deductible health plan (HSA).

Doctors and hospitals have been taking care of uninsured patients for decades.

Floccina writes:

Even this is not true:

cost nearly $200,000, an impossible sum for the vast majority of Americans, to say nothing of a public school teacher.

A school teacher could amortize such a bill if he wanted to. If you do not believe me look here.

Given that I retired without million/s of dollars sitting on my bank account, some have asked me why I didn’t continue working so I could earn enough money to become a millionaire? I have lived on $5-7,000/year for almostover a decade now. While I now have a higher income than what I need, I see no reason to increase my spending. I figured I had already proven that it was possible to become a millionaire if I wanted to do that—if I had continued working, I would have been a dollar millionaire at age 39 or so—and while seeing seven figures on my balance sheet net would be nice, it’s not worth 6 years of my life. Besides, thanks to having saved too much (woe is me), I’ll still hit the magic number, only a decade later.

School teachers amortize $200,000 home loans.

Kevin Smith writes:

White starts the show with metastatic lung cancer with a 5 year survival of...0%. So, the rest is details. Under future "death panels" or whatever we want to call them, Obama would have given him morphine and a wave goodbye. He is the absolute worst health investment from a "health system" point of view and would have chemotherapy and maybe radiation in the most generous situation. His life expectancy was on the order of 8-14 months.

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