Obamacare Dissected
Ten things that probably will be in the health-care bill (but shouldn't).


Stephen Spruiell

Rummaging through the stacks here at National Review world headquarters, I discovered in our Dec. 13, 1993, special supplement on Hillarycare a curious little ad that read “Just say NO to socialized health care.” The ad implored me to call 1-800-5RESIST, so just for fun, I dialed the number, hoping that maybe, just maybe, the brave soul who set up this hotline back in the ’90s was still manning the post, dispensing advice on the best way to oppose Obamacare.

Wrong. A male voice offered me an invitation to “talk to ladies all over the country,” and I don’t think he meant Blanche Lincoln and Olympia Snowe. I hung up and returned to the health-care debate, 2009. The Republicans are in disarray. The Democrats are cutting deals. The Congressional Budget Office is acting like Burger King, telling Max Baucus, “Have it your way.” Of course 1-800-5RESIST is now a phone-sex line: We’re screwed.

Or are we? After all, back in 1993, conservatives were able to stop a health-care-reform plan that looked just as ominous and unstoppable. The Democrats had the White House, 56 senators, and an 80-vote margin in the House. They had James Carville, Hillary Clinton, and a secretive task force (though these might have turned out to be liabilities). They faced a Republican party coming off a historic defeat. R. Emmett Tyrrell had just published The Conservative Crack-Up about infighting among conservatives following the end of the Cold War. Then as now, the Right lacked an identifiable leader, save for Rush Limbaugh.

But we did have one thing going for us: Hillarycare was awful. It was loaded with mandates, government control, empty promises, and taxes. Obamacare differs in the particulars, but it is built on the same rotten foundation: a belief that dumb consumers and greedy insurance companies are to blame for the health-care mess, and therefore bureaucrats need to step in and tell them what to do while the rich pay for it.

Has this diagnosis ever been right? Has this prescription ever cured a single patient? Of course not. In fact, government interference initially created and has since greatly exacerbated the third-party-payer problem that has saddled the system with runaway costs. Wage and price controls during World War II prompted companies to compete for workers by offering generous medical benefits, and changes in the tax code entrenched this practice to the point where we now use insurance to pay for routine health care. For the poor and the elderly, the government created a system of entitlements whose bad design led to cost-shifting in the private sector and looming budgetary shortfalls in the public sector that the political class has no idea how to finance.

Instead of reintroducing concepts like competition and personal responsibility as a way to bring down costs and make coverage more affordable, Obamacare relies on coercion and taxation to pursue these same goals less efficiently. Here are ten reasons why no proposal built on this foundation deserves to pass:

1) Removal of the Ability of Insurers to Deny Coverage. The first thing Obama and his backers want to do — the main thing they all agree on — is take away insurers’ ability to deny people coverage or charge them different rates based on pre-existing conditions. The question of what to do for people whose health status has rendered them uninsurable is a thorny one, but the heavy hand of regulation is not the answer. States have conducted successful experiments with “high-risk pools,” and “health-status insurance” offers another promising idea. The problem with what the Democrats want — mandatory coverage at low rates for sick people (also known as “guaranteed issue” and “community rating”) — is that it gives people an incentive to postpone buying insurance until they need expensive care. Theoretically, guaranteed issue and community rating work only if the government requires everyone to have insurance. The Democrats know this; insurance mandates are integral to Obamacare.

2) Coverage Mandates on Individuals and Employers. Once upon a time, Obama was against insurance mandates. In the run-up to the Iowa caucuses, his campaign ran an ad attacking Hillary Clinton on the grounds that the mandates in her plan “would force people to buy insurance even if they can’t afford it.” Realizing that his health-care plan would be unworkable without a mandate, Obama has flip-flopped and rebranded required coverage as “shared responsibility.” Clinton fired back at the time, and Obamacare supporters argue now, that the mandate would come with subsidies to help lower-income people afford the coverage they would be forced to buy. A look at the fine print on that offer reveals that many Americans would be forced to buy pricey policies without any help from the government. Workers offered coverage by their employers (who would be required to offer it) would not be eligible for subsidies and would have to take what they’re given — which, under Obamacare, would be some minimum package of benefits designed by bureaucrats in Washington. That sounds like something that could quickly exceed what a lot of people consider affordable.


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