Since Obamacare moved unsteadily over the first finishing line, liberals have been jubilant and conservatives wracked by variations on depression, including existential despair. This is a rare emotion on the right, and even when experienced, it tends to be expressed inappropriately. John Derbyshire’s hilarious We Are Doomed is the nearest thing to a conservative suicide note. Its exuberance undermines its professions of despair.
But the argument that socialized health care, once firmly established, will both ensure liberal majorities into the foreseeable future and starve the defense budget is a realistic prediction of a serious threat. In such circumstances, as Mark Steyn points out in his distinctive blend of hilarity and doomsaying, conservative parties in order to be elected would gradually cease to offer conservative policies. A generation or two later, conservatives themselves would die out or — let us look on the bright side — “evolve” into the sober half of a fully social-democratic political spectrum. And all this time, U.S. power in the world would be shrinking.
Hence an unusually passionate internal Republican debate over repeal. If Obamacare covers the euthanasia of conservatives, then it must surely be the aim of the GOP to repeal it. Replacing or reforming it would be fine, too, provided that what emerges is something very different from a state-financed and state-run health-care system. But here Republican despair springs its final trap: It is alleged to be impossible to repeal Obamacare (or any other government entitlement program) since the voters will never give up a “free” benefit, however costly it proves in taxes, freedom, or health.
Summary: Repeal is impossible. We are doomed.
The principal evidence for these assertions is the British National Health Service. Introduced in 1948 by a Labour government, the NHS was an instant success and within a short time it had become the nearest thing to a religion in post-Christian Britain. Its basic principle — that medical treatment should be free at the point of consumption — is sacrosanct. Its undeniable failings — e.g., long waiting times for elective surgeries for painful conditions — are blamed on the government of the day, never on the NHS itself. It is financially untouchable. All political parties now pledge either to increase or (in times of financial crisis and spending cuts) to “ring-fence” expenditures on the NHS.
This history seems to mount an irrefutable case for the inevitability of Obamacare. A former British minister of health, Enoch Powell (himself a strong devotee of free markets), seemed to concede the point when he said: “In the welfare state not to take away is more blessed than to give.” That concession, however, points to the first vital difference between the NHS in Britain in 1948 and Obamacare in the U.S. today: In 1948, nothing was taken away.
Almost everyone gained when the NHS came in. Working people and the poor had previously obtained decent health care from a patchwork quilt of public and private institutions: charity hospitals, government poor relief, and so on. The middle class paid for health care of a similar quality. Both now received such care “free at the point of consumption” (i.e., paid for out of taxation) and naturally felt like gainers. Only the very rich had previously enjoyed health care with frills. Most of them were rich enough to pay both higher taxes and their insurance premiums. And as F. Scott Fitzgerald never said: “The rich are different from you and me. They have accountants. And tax havens.”
By contrast, most Americans in jobs today (and their families) have good health-insurance policies. At best, they gain nothing under Obamacare; at worst — for instance, if they lose employer-provided insurance — they may feel like losers. Some of those now counted as winners — i.e., the wealthy or young non-insured — will also feel like losers if they are forced to buy insurance but remain inconveniently healthy. Above all, not even manifest beneficiaries of Obamacare get something “free.” They will still have to pay insurance premiums. So because Obamacare both “takes away” and does not “give,” it fails Powell’s test of inevitability.