Thursday, March 29, 2012

Some Random Thoughts On Obamacare

E. J. Dionne has piece out today in the Washington Post attacking the "conservative activists" in the Supreme Court. If you read his article, you will notice that Dionne fails to provide one shred of evidence to back up his claim. He rightly points out some of the benefits of the Affordable Care Act. And while I agree with some of his assertions, I think they are beside the point. The Supreme Court does not judge the effectiveness of policy, it judges the constitutionality of those policies. It is very possible to agree with the concept of the individual mandate while at the same time understanding that it is not constitutional. I know, because that is how I think. So for Dionne, any Justice that rules against Obamacare, does so because he or she is an "activist." It is really revealing of the knee-jerk journalism that you see of some in the press.

If Obamacare is ruled unconstitutional, it will not be a straight victory for conservatives, though. Unfortunately, for Republicans, the repeal of the Affordable Care Act will come with a heavy price. It paves the way towards a single-payer system. We all know that the government can control an industry (Medicare, anyone?). We just don't think that the government can force people to buy a product from a private company. This scares me a great deal as I am against a single-payer system. That is why I (and the pre-2009 Republicans) liked parts of the Affordable Care Act. It provided a free-market mechanism that would accomplish the same goals of a single-payer system but without the government monopoly.

But as much as I agree with the individual mandate, I also recognize that it is not constitutional. And our Constitution matters! Even when the policy seems right, the Constitution serves as a check to prevent the government from needlessly expanding its powers. Conservatives should stand up for those checks and balances.

Policy also matters and the hard work of Republicans now is to figure out how to replace Obamacare with something that would actually solve the severe problems of rising health care costs and the denial of coverage to those with preexisting conditions. Outside of a system with an individual mandate or a single-payer system (of which I oppose), I am not aware of a big enough solution to solve those problems. Nevertheless, the Republicans will be sending the right guy to take on that issue.

Here is to hoping that Republicans will get serious about governing. Our nation needs it. 

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Massachusetts Conservative said...

Look at Mitt's health care plan. It's on his website.

It doesn't guarantee everyone gets insured, but it solves the real problem - that costs are so high, people cannot buy insurance on their own, and thus are slaves to their job for fear of losing their insurance. And others who are not offered insurance at their job may be able to afford insurance after Mitt's market reforms take hold. Go look at it.

Anonymous said...

As a lawyer who's worked in the health insurance business for years, I can tell you that the problems of how to pay for the medical care that Americans want and need are huge and complex.

A one-size-fits-all solution at the federal level will never work. It's centralized planning at its worst. Last week I downloaded the final HHS regs that implement only one portion of the federal PPACA/Obamacare: "Accountable Care Organizations" (integrated medical provider partnerships). The regs are 800 pages long! I almost fell off my chair. Virtually all the other HHS regs that have been issued to date, implementing other parts of Obamacare (HHS is still on a roll), weigh in at many hundreds of pages each. Lawyers and consultants are making out like bandits, frantically trying to interpret this stuff for their clients.

A national single-payer system is a cherished illusion of the Left. Sounds great, except when voters find out how much it will cost them in taxes, and how it will inevitably limit their options for care. No doubt, E. J. Dionne, like President Obama, believes in his heart that "single payer" is the right way to go. That’s where Obamacare will take us anyway, if it is allowed to stand. Its regulatory comprehensiveness and its centralization of decision-making at the federal level are truly breathtaking.

Single-payer legislation has been proposed at the state level for 25 years or more, and has always failed—mainly because of its enormous tax burden and the adverse selection it would cause in that state by creating a magnet for the very sick. To the best of my knowledge, Vermont is the only state that has enacted, and is currently trying to construct, a single-payer system for its own population. Let's see how that works out for them. However, I think we can all agree that small, largely-rural Vermont is about as far as you can get from a microcosm of the entire U.S.

Correct me if I'm wrong, but I don't believe a single-payer health care system has ever been attempted in a nation as large and diverse as the U.S. (except giant communist powers). Obviously, Canada is very large geographically, but it lacks our population density. For a variety of reasons (taxes, access to care), the flawed Canadian system has been repeatedly rejected by legislatures at the state level. My hunch is that it would also be rejected by Congress for the foreseeable future, except by the most liberal representatives of the most liberal states. If Obamacare will add trillions to the national debt, how much more would a single-payer system add? And at what cost to the quality and availability of care?

Pablo, you are right that Republicans have to do more than just say No to Obamacare. I personally think Romney is right. The most practical solutions will be developed at the state level, where they can be tailored and revised and junked (if necessary) to meet the needs of the people of that state. That is not the final word, of course. We’ve still got the federal Medicare program, EMTALA (emergency treatment), ERISA (self-insured benefit plans), etc. There is much, much more to be said on these subjects, and much more will be said by Left and Right, regardless of how the Supreme Court decides on Obamacare. All I know is that centralized federal planning, where the IRS is the collector of my health care payments and thus the ultimate gatekeeper of my access to care, is very bad medicine.

Anonymous said...

Listening to the arguments made before the Supreme Court the past few days has been an amazing experience. The brilliance of our Constitution continues to amaze me. The mandate is unconstitutional under Federal law. The States have different constitutional powers.

If we can get out from under the heavy load of Obamacare, the States will NEED to do something to work on health care, and I hope that the Federal gov't will do what they can, such as finding ways for more insurance portability and purchasing across state lines. Otherwise, the next time the Dems are in power, we will get something even more nasty than the 2700 pages that has come to be known as "Obamacare."

As Ann Coulter is fond of pointing out, if all governors had been as courageous as Mitt in tackling health care in their states, Obamacare would never have been enacted. The dems' hunger for power never ceases to amaze me; so maybe they would have tried for Obamacare, anyway.