by Barry A. Liebling
More than three years ago in 2010 the Patient Protection and Affordable Care Act (popularly referred to as “ObamaCare”) was signed into law. Contrary to the predictions of some of its most passionate supporters, the number of Americans who disapprove and are uncomfortable with the law has increased over time. ObamaCare is stupendously complex and is riddled with ambiguities – so much so that even seasoned health care experts are anticipating that as the law goes into effect there will be plenty of surprises – probably unpleasant. But the big picture is clear. The law will put a huge chunk of the economy under government control, regulation, and supervision. The sphere of autonomy enjoyed by private individuals and private institutions will shrink substantially.
Bear in mind that Americans are heterogenous in their reasons for either endorsing or condemning ObamaCare. Enthusiasts might believe that they will personally benefit, may be impressed that their peers or celebrities tout it, or could have an affectionate attachment to the Democratic party that has been its sponsor. Sophisticated enthusiasts understand that it represents a significant expansion of the welfare state which they regard as a “sacred moral imperative.” Detractors could recognize that ObamaCare will materially harm them, might be convinced by critics who have lambasted the new law, or may identify with the Republican party that has largely (but not consistently) taken positions in opposition to it. Discerning detractors recognize that it is a boost to the scope and size of the welfare state which is inimical to individual rights and personal freedom.
One of the key features of ObamaCare is that citizens who do not have health care coverage through their employer and also have modest incomes will be eligible for government money to defray the cost of health insurance. Recently, the Obama administration announced that when Americans apply for ObamaCare subsidies they will not have to prove what their income is or that they do not get insurance at their place of work. Instead, prizes will be administered on the honor system. Applicants who say they are qualified to receive subsidies will get them. http://www.washingtonpost.com/national/health-science/health-insurance-marketplaces-will-not-be-required-to-verify-consumer-claims/2013/07/05/d2a171f4-e5ab-11e2-aef3-339619eab080_story.html
Some critics reflexively jumped on this news and excoriated the administration for introducing a policy that seems to tolerate misconduct. They carped that distributing government loot without reliable verification procedures is an invitation to fraud. People who are not “legitimately entitled” may receive health insurance subsidies and not get caught.
Fraud and dishonesty is never acceptable, but the critics fell into a trap. Whether any particular person meets the standard to receive ObamaCare money is a minor, peripheral matter. The essential problem is that government will be dispensing ObamaCare funds to Americans in the first place. Pushing ObamaCare money on the citizenry is – by deliberate design – addictive. Once a person gets used to receiving bounty from the government for anything – think food stamps and student loans – he is loathe to give it up.
A cohort of Americans accustomed to ObamaCare subsidies will indignantly scream their heads off at the suggestion that their government benefits be eliminated – or even reduced. Notice that citizens hooked on funds coming from the federal government are a guaranteed voting bloc for Democrats.
The ObamaCare critics who focus on the issue of fraud are presenting their opponents with a gift. Boosters of the new law can reply, “You are right. We ought to create controls that assure only the truly deserving receive subsidies. And once the controls are in place you should be satisfied, and stop complaining.”
It is noteworthy that the ObamaCare subsidies employ a technique that statists routinely use to create entitlement addicts. Step one is to craft government policies to make a product or service more expensive than it otherwise would be. Food stamps driving up the price of food and student loans encouraging colleges to raise tuition have preceded ObamaCare as case studies. ObamaCare with its guaranteed issue (for example, citizens with pre-existing conditions may not be charged more than anyone else) and mandates (insurance coverage must provide a host of benefits that many people would not voluntarily choose to buy) necessarily pushes up the cost of insurance.
Step two is to come to the rescue with government assistance. Statists attempt to soothe their victims by promising to provide “free benefits” – benefits that the recipients will hate to lose. The architects of ObamaCare knew from the beginning that the durability of the program hinges on inducing people to accept goodies.
Step three completes the vicious circle by making the product or service even more expensive – pushing the addict into deeper dependence. Since ObamaCare does not cover every possible health issue, it can be “improved” with additional mandates. “We have to add to the list of ObamaCare benefits,” the pushers will say, “and it is only fair to compensate health care providers (who are our political allies) even more for their service to society.” This forces the cost of premiums upwards. And greater expenses can be addressed by offering “needy people” more generous subsidies to pay for the health care that they are “legally required” to purchase.
The solution to the problem of ObamaCare addiction is parallel to how any government dependency should be broken – get the state out of the health care business. If you really want to help people with modest incomes, create a free market. As a start allow individuals to buy health insurance across state lines – from any provider that offers them a policy that meets their needs. Insurance carriers would compete on a nationwide basis for their business. Get rid of all government mandates. Let private citizens and health care providers decide without government intervention what each policy will cover. People who do not want fancy – all-encompassing – packages should not be forced to buy them.
Of course, a free market in health care is odious to statists – who have a passionate desire to have everyone’s life planned and controlled by a “wise and benevolent” government. The political obstacles that must be overcome to regain individual autonomy are substantial. But the prize of eliminating a noxious government addiction is worth the effort.
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