Latest posts by Jane M. Orient, M.D. (see all)
- Does Your Medical Licensure Board Protect You? - May 8, 2018
- Mandates: the Other Side of the ‘Right to Healthcare’ - May 1, 2018
- Setting National Health Priorities: Trump and Climate Change - December 21, 2017
The Affordable Care Act (ACA), they point out, incorporates some ideas from a Heritage Foundation proposal and a law promoted by Mitt Romney. Those are not, however, conservative ideas, much less good ideas, and are not a “sound chassis” for anything.
There is nothing conservative about the forcible redistribution of wealth. And even Wall Street Occupiers should be against redistributing people’s earnings to Big Insurance, Big Pharma, Big Hospitals, Big Data Mining, and nameless unaccountable bureaucrats in the vast, ever-expanding realm of Kathleen Sebelius.
Redistributing wealth is a prescription for social unrest. There is nothing more divisive than dividing up loot. The “contributors” don’t like having their earnings taken, and the recipients are chronically unhappy too because their share is always too small. People resent having to pay for other people’s medical care—a resentment that was exploited in the disingenuous “free rider” argument for the law.
Young, healthy people don’t want to pay higher premiums so that older, sicker people can pay less than their actuarial costs. And without a mandate, they won’t.
ACA tries to conceal the fact that “insuring” everybody and everything means that everybody is always paying for everybody else’s medical care, with a big chunk siphoned off by managers and money shufflers.
Obama didn’t create the third-party payment system, which caused the spending crisis. But ACA expands it still more, rigidifies it, and attempts to crush true free-market competition.
Insurance is a voluntary risk-sharing contract. Real insurance companies are not third parties. They reimburse subscribers who suffer a loss. They do not provide or manage services or write checks to those who do. Nor do they tell subscribers how to spend their check. To the extent that some casualty insurers are beginning to imitate “health insurers,” they are damaging their industry and inviting a cost spiral, as well as corruption and deterioration of quality in the auto repair and other industries.
ObamaCare is compulsory. Most of the provisions of coverage are government-dictated, and pricing by risk is mostly forbidden. Hence, “health plans” are not insurance.
ACA is also the antithesis of affordability. Those who have a prepaid plan have every incentive to use it to the maximum. Plus there are enormous built-in transaction costs. These factors are reflected in the premiums—which HealthCare.gov attempted to conceal from people eligible for subsidies. Not that beneficiaries of taxpayer largesse necessarily care about how much invisible, presumably richer other people are having to pay on their behalf.
Those who seem to be getting something for nothing are still likely to be hurt. If the subsidy is miscalculated, they may have to “repay” that which they never received (it went to the insurer). Those who have coverage may still be unable to get care. They may be trading coverage for loss of a full-time paycheck. They may face a greater-than-100% marginal tax rate if they do earn more money, owing to the income thresholds.
In every case, forcible redistribution of wealth decreases the total amount of wealth. There is no prosperity without a reward for working.
ACA is not an opportunity for bipartisan coalition-building. There is no “tweak” that can help a rotted-out chassis, no advantage in trying to steer the vehicle built on it in a slightly different direction.
There is nothing conservative about theft, deceitfulness, forcing people to act contrary to interest or conscience, undermining the work ethic, or politicizing the practice of medicine.
There is also nothing compassionate, moral, ethical, or prudent about these things.
ObamaCare cannot be fixed. It must be repealed before it destroys the medical system, the economy, and the American system of constitutionally limited government.
We must learn from this debacle that compulsion is not the answer. Pasting a conservative, Republican, or bipartisan label on forcible redistribution of wealth, or hiding it behind a show of good intentions with well-chosen tragic stories, does not change its evil, destructive nature.