obamacare healthcareSome of us remember Democrats’ claim during the Obamacare debate that “if you like your health insurance plan, you can keep it.”  The claim was made as part of a “compromise” position in which the Democrats gave up on a “single payer system.”  That is, in order to get enough votes to pass their program, the Obama Administration and its supporters agreed to not insist on an actual government run healthcare system—right away.  Americans have always been shy of terms like “socialized medicine” and “social democracy” because such terms make clear that we are giving up our liberties in exchange for a nanny state that promises to take care of all our needs.  Unlike our more “progressive” cousins on the other side of the Atlantic, we still take pride in the idea (if not the reality) of taking care of ourselves, and so fear the appearance of owing our well being to the government.

American independence has been increasingly illusory for decades.  And Obamacare is in the process of putting the illusion to rest once and for all.  I’m not saying, here, that Obamacare is a piece of “stealth socialism.”  There is little stealth to it, and, sadly, Americans may well continue denying the truth that we are living in a social democracy long after Obamacare and its consequences (some intended, some less intended than inevitable) have made the difference between a social democracy and a cradle-to-grave welfare and administrative state merely rhetorical.

In another sense, the claim that we may “keep” our own health insurance will always be true.  One thing we know about socialized medicine in Europe, like government run programs everywhere, is that they don’t apply to the rich.  So, if you have enough money, you will be able to buy your way out of the system.  As for the rest of us, things are moving a bit faster than even the Obama Administration had intended.  A little-noticed but quite important observation was posted awhile back over at instapundit.  In it, blogmaster Glenn Reynolds relates the observations of a former colleague, Colleen Medill, who is a lawyer working in the area of ERISA or employee benefits.  Ms. Medill has been communicating with lawyers advising firms of all sizes and wealth on what to do with employee health benefits in the face of Obamacare regulations.  Her conclusion?

“It has become very clear to everyone involved who is analytical and not ideological that the rational strategy, for both large and small firms, is to cease providing health care insurance to employees.”  No company wants to admit that they are considering eliminating employee health insurance from their benefit plan, “but once a competitor does so, the preference cascade will begin. The clear sentiment is ‘We will not be the first one to drop our health insurance plan, but we would be a close second.’”

Why hasn’t this coming revolution in our economic system been widely noted?  Because the Obamacare legislation is so insanely complicated that “only $800+ an hour ERISA attorneys and the most sophisticated HR people understand how Obamacare really works.”

People haven’t caught on to the coming demise of employer-provided health benefits for the same reason that this demise is inevitable:  because Obamacare is so impenetrably complex and onerous that it is all but impossible to understand or administer, and so clearly not worth the cost for employers to provide.  Medill’s conclusion, here, seems clearly true.  Less convincing is Ms. Medill’s take on the political implications of this situation.  She sees Democrats as being in terror of the oncoming cascade of medical benefit eliminations because it will show the lie to their claim that regular people would be able to keep their own health care plans.  Ms. Merrill’s view of Democrats’ fears fails to ring true for the simple reason that the consequences of Obamacare were rather obvious to most people from the start.  I’m not saying that every Democrat who voted for Obamacare saw it as a stalking horse for socialized medicine.  But we should keep some things in mind:  first, most liberal “policy experts” wanted a government (“single payer”) healthcare system and only settled for Obamacare’s hyper-regulated “markets” out of political necessity; second, at a certain point hyper-regulation makes socialization not only inevitable, but a necessary means of rationalization and simplification.

Some Democrats may be concerned that people will be angry with them for taking away their doctors and insurance plans, but that was a problem they sought to mitigate, not avoid, through hyper-regulation.  And when the end comes the Obama Administration will simply blame “greedy employers” and pledge to “fill the gap” with expanded government services.  Moreover, the logic of Obamacare, that somehow everyone can have affordable healthcare if only everyone is forced into the system, is the logic of univeralism, meaning nationalization, whether fulfilled in one step or many.

Nor is the push for nationalization a purely Democratic phenomenon.  Republican governors are doing their part to “universalize” (or at any rate nationalize) healthcare by falling for the Medicare bait like the dumbest fish in the pond.  Of course, New Jersey’s Chris Christie signed on to the Medicare expansion; but he proved his only concern is the popularity of Chris Christie when he sold out Mitt Romney for the mere appearance that he might get some extra federal assistance after Hurricane Sandy.  Other, supposedly more conservative governors (Kasich in Ohio, Scott in Florida, Snyder in Michigan, and at least two others) have followed suit, convinced that three years of federal funding for an expanded government healthcare program is “too good to pass up.”

This calculation assumes that the federal government will actually provide the funding for those three years.  But what do even these pillars of integrity believe will happen at the end of that time?  Will we all decide to go back to saner, more financially and socially responsible programs?  Of course not.  Everyone will expect that the system will continue and expand, and that the federal government will be in charge.

Florida’s Scott, in announcing his sell out, called it a “compassionate and common-sense step forward,” referencing the “poor and helpless” he says will benefit.  A step forward toward what?  Compassionate in what sense?  Of course, the “progressive” answers remain the same as always:  a step forward toward universal benefits, guaranteed by the government.  Compassionate in the sense of entrusting the government to take care of us all, and take from our shoulders the responsibility to care for the less fortunate among us.

The jump from recognition of human dignity to the demand for state-guaranteed healthcare is a long one.  And it leads over a cliff into a state run system that forces people to give up control over their lives, forces doctors to give up control over their vocation, and leaves millions of people with lousy medical care while costing billions in waste.  It dehumanizes everyone in the process, and undermines, yet further, the social institutions in which people can actually find human dignity.

The feckless dream of a system in which one’s ability to pay has nothing to do with the quality of one’s healthcare will simply result in a system in which all but the rich get lousy healthcare, and in which there is a certain equality in that incompetence and shortages will impact (non-rich) people in a more random fashion, hitting many more people, though not on the basis of income.  The sad thing is that many people really do believe that government guarantees of pro-forma care really do constitute a system that is fairer than one in which community and charity hospitals care for people who can’t pay for themselves.

Obamacare will result, sooner rather than later, in a two-tiered system, in which the rich can buy quality healthcare, and in which the rest of us will spend increasing amounts of time waiting in lines for care that we would today call substandard, but which the government will define as the new standard.  It rests on the increasingly prevalent fantasy that political structures can take the place of human virtue—that we can have a “program” that makes it unnecessary for us to take care of one another in the institutions of our local lives.  The transition to a socialist (“government run” if you prefer) system became inevitable when Americans decided that a nation, as a political system, has a right to decide that no one should be “left behind,” rather than it being our duty as people and communities to care for our neighbors.

The result is progress—in a direction we ought not to be going.

Books mentioned in this essay may be found in The Imaginative Conservative Bookstore

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8 replies to this post
  1. Mr. Frohnen:
    Assuming that you and Glenn Reynolds are correct, isn’t it a good thing for American businesses to be freed from providing ever more expensive healthcare benefits to their employees? Hasn’t this long been recognized as a major factor hampering our international competitiveness? As for some of your other gloomy predictions–a “two-tiered system in which the rich can buy quality healthcare” is what we have today, “waiting in lines” is what many of us today experience as “waiting in ER’s,” and “substandard care” is your unproven assumption. I guess we’ll find out. Obamacare might not work, but the system under which we’ve been working for decades hasn’t been working either.

    Finally, you write: “The jump from recognition of human dignity to the demand for state-guaranteed healthcare is a long one. And it leads over a cliff into a state run system that forces people to give up control over their lives, forces doctors to give up control over their vocation, and leaves millions of people with lousy medical care while costing billions in waste. It dehumanizes everyone in the process, and undermines, yet further, the social institutions in which people can actually find human dignity.” With all due respect, millions of Europeans would disagree with your claims.

    • Why are the only two options: employer provided or government provided health care? Let’s take the “European” system out of the equation and suppose that employers pay to their employees that which they currently pay to insurance companies, thus allowing employees to choose where to purchase their health care. I can only imagine what benefits would accrue to the “system” from individuals making choices on how to deploy their purchasing power?

      Let us throw off the egotistical view that our ability to make good choices is directly tied to our status or wealth. I know more “poor” wise folk than those who are “wealthy”.

      • Mr. Colburn: I didn’t mean to suggest that there were only two options, and in fact Obamacare is unwieldy precisely to the extent that it’s tried to cobble together all sorts of options–employers, individuals, government subsidies, regulated state insurance exchanges, etc. Your suggestion that employers take the money they pay in benefits and give it directly to employees as wages isn’t much different from what Obamacare does in that regard: employers who choose not to provide healthcare coverage pay into a pool which in turn provides subsidies to the individuals who have to seek insurance on their own. As for taking the “European” system (which is, as you know, actually a variety of systems) “out of the equation”–why? It works, it provides universal coverage and quality care, it’s more efficient and less wasteful than our system, and people in Europe overwhelmingly (not unanimously, of course) like it. We don’t have to copy “it”–again, there’s a variety of “its” to copy–but why should we ignore it? Whatever else “American Exceptionalism” might mean, it shouldn’t mean refusing to learn anything from anyone else in the world.

  2. Europe’s healthcare system is composed of 27 different healthcare systems, not counting the non-EU member states. Under Obama, 50 American states must adopt one system.

    Abstracting for a moment from my own views and experiences, which prefer a free market in healthcare, I think it’s worth pointing out how disingenious the President and his suppporters are being when they invoke the spectre of European social democracy as if it were a monolith, when in fact it is in many ways closer to the spirit of America’s tenth amendment. Critical as I am of the EU, it does not mandate means, only ends. Individual member states have their own systemic solutions.

    If you wish to make any real comparrisons, you must compare healthcare laws country by country.

    • Mr. Rieth: You’re correct, and I made the same point in my response (above) to Mr. Colburn. But you fail to acknowledge that Obamacare allows–in fact, encourages–states to set up their own insurance exchanges, mandating only certain ends (percentage of residents covered, basic coverage offered, etc.); the fact that some states, mostly governed by Republicans, are refusing to do so is what might force the federal government to create, for those states, a “one size fits all” exchange.

  3. If President Obama’s bill really allows and encourages states to create their own systems, why was it even necessary? The states had that power without Federal encouragement.

    The real problem with Obamacare, insofar as I can see, is that it creates extra costs for business where none existed, which ultimately hurts regular working Americans who will be forced out of the labor market or into lower paying temp jobs by companies trying to stay afloat. Let me repeat that: trying to stay afloat, not growing, not hiring, not expanding.

    You write that Europeans are generally happy with their healthcare systems, and statistically, you are right. But statistics are misleading without critical analysis. Ask Europeans if they are happy with chronic unemployment and they will overwhelmingly say “no.” Now what is the cause of this unemployment? Fundamentaly, it is the excessive relative cost of labor. What is the cause of the excessive relative cost of labor that itself is the cause of unemployment? It is the bloated cost of entitelments funded by runaway debt, inflation and high taxation.

    The end result is a dying economy, where it matters little that you are legally guaranteed free healthcare, since the relative quality of said healthcare deteriorates along with living standards in general. Americans will soon experience the same problems, and this is what makes the Obama administration such a failure. Rather than fix the economy, it has created yet another liability. I understand the issue is more complex, and I’m generalizing.

    If we are going to go fishing for a good healthcare system, I am personally interested in the Chinese model. The little I have read about it makes it sound like it is focused on not creating new costs for business, relying on technological advances like the newly developed IOT Health Pods for rural areas, and encouraging corporations to provide direct housing with healthcare for factory workers so long as they are on the job. Whatever it is they do, we should learn more about it. After all, who wouldn’t want a Chinese economic crisis of “only” 7, 3% growth?

  4. Mr. Rieth: If you’re still asking “why was it [Obamacare] even necessary,” then we’d need a much longer conversation than either of us wants to have. I’m not going to argue about Obamacare–it exists, and it’s being implemented. By all means send your suggestions for improving it to the appropriate agencies.

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