Of Obamacare, Kevin D. Williamson writes, “It doesn’t work because it couldn’t work.” Yes, *we* all knew that was coming…
Many of Obamacare’s failures came fast and early. Strike one: “If you like your doctor, you can keep your doctor.” Strike two: Obamacare will save “the average family $2,500 a year on their premiums.” Strike three: Obamacare will add “not one dime” to the deficit. We all knew that was coming, just as we knew that people would respond to the very strong incentives not to buy insurance by not buying insurance.
Other failures took longer to become manifest. The architects of Obamacare are deeply distrustful of the role of for-profit companies in the health-care business because, in their nearly pristine ignorance, they falsely believe profits to be net deductions from the sum of the public good rather than measures of the creation of real social value. So they created incentives to set up co-ops, nonprofit enterprises that would administer Obamacare plans in particular states and jurisdictions. It was obvious from the beginning that if Obamacare’s perverse incentives created insurance pools that were older and sicker rather than younger and healthier, these co-ops wouldn’t be economically viable: You need lots of young, healthy insurance subscribers to offset the costs associated with your older, sicker subscribers. Many of us — myself included — assumed that the federal government under President Obama would simply write these co-ops huge checks to keep them afloat. We were half right: The government is writing them huge checks, but they are failing anyway, so fundamental is their economic unsustainability.
Obamacare’s partisans were confronted with the economic facts long before the law was even passed, and their answer was: “Never mind the economics, we’re the good guys, and you want poor people to die.” Democrats argued that Republicans literally wanted to kill poor people, that their plan was for the poor to “die quickly.” This is a habitual mode of discourse among progressives: Reality doesn’t matter; only the purity of Democrats’ motives matters. Obamacare is what it is: Another damned five-year plan based on wishful thinking and very little else.
The author later outlines “the basic principles of meaningful health-care reform.”
Let insurance be insurance; understand that ordinary, regular medical procedures, such as physicals and prostate exams, are not insurable events, and account for that in your calculations; the only way to mitigate the effects of scarcity on health care is to make it less scarce by expanding the supply of medical practitioners and facilities; the only way to make insurance more competitive, and therefore more affordable and more responsive to consumers, is to increase the number of players in the markets; the best way to deal with people who are, for example, profoundly disabled, children, or otherwise unable to provide for their own care, is direct, clear-eyed subsidy of their medical expenses, rather than laundering those payments through the insurance market; so long as practicing medicine pays less than filing frivolous lawsuits against doctors, there’s going to be a lot of politically induced inefficiency in the system.
Of course markets work for most people, and of course there are exceptions to that. For 93 percent of the population, the solution to health-care reform is: Let markets do their thing. The only real argument is how big a check to write to those looking after the other 7 percent, and how to structure the payments. That’s a real fight, too, but it isn’t the one we’re having. Right now, the Republicans and the Democrats are two political coroners arguing over what time and cause of death to put on the paperwork; rigor mortis set in long ago.