The Democrats’ strategy on Obamacare is cynical, and kind of embarrassing: “Meet Jimmy, who will get something from the health-care bill. How dare you take it away?” But there is the seen and there is the unseen. The beneficiaries of Obamacare are easy to find. They are what is seen. What is unseen?
Obamacare achieves some purported deficit reduction (in a perfect world, in which CBO rules operate like the laws of physics), but imposes many billions of dollars in new taxes to do so. If we are willing to pay higher taxes to reduce the deficit, and if this is good, then the Democrats should have passed a straight-up tax increase. Obamacare is not a deficit-reduction plan; it is a giant tax-and-spend plan in which the taxes theoretically outweigh the spending. Obamacare’s deficit-reduction qualities, such as they are, are camouflage, a talking point built into the legislation. Even the CBO expresses serious doubts about the assumptions that were used to generate that talking point.
Obamacare will enable some people to get insurance coverage who did not have it before. That is what is seen. What is unseen is that many people will lose their insurance coverage, or have it degraded, because of the law.
But it goes deeper than that. Yes, some people will have better access to insurance coverage. But there is very little correlation between access to insurance coverage and access to health care; there is still less correlation between access to insurance coverage and health outcomes. Good insurance does not equate to good health or to good medical care. Likewise, spending lots of money on health care, even other people’s money, does not correlate very strongly with health outcomes. Why might that be? We are an aging and overfed society in conditions of great material abundance, and you cannot bribe cancer, Alzheimer’s, or diabetes, even with all the money in the Treasury at your disposal.
Here is what is unseen: There is an important relationship between medical innovation and health outcomes. Innovation costs money. Real money. Innovation requires investment, which requires capital. As Obamacare shunts great streams of capital out of the productive health-care economy into the growing health-care bureaucracies, for instance by taxing medical devices, that money will not be available to fund research, development, or innovation. Yes, little Jimmy, the 26-year-old “child” still clinging to his mommy’s insurance coverage, may lose out if Obamacare is repealed. But how many thousands, or more than thousands, will lose out because of the diverted investment and lost innovation? There is no way to know, of course, and no way to quantify that.
Trade-offs are a reality, in health care as in all endeavors. Obamacare does not make wise trade-offs, and it does not restructure our health-care system in such a way that it will empower consumers, encourage the emergence of a more functional market for health-care services, align economic incentives, or encourage innovation and organic cost controls. It is, simply put, a very badly designed piece of legislation, one rushed through Congress in order to give President Obama the opportunity to affix his signature to something titled “health-care reform.” It is an act of Congress, not an act of God, and it should be repealed and replaced with a more intelligently designed alternative. All of the political considerations are secondary: Obamacare is a bad law, like Prohibition was a bad law, like Smoot-Hawley was a bad law, and we need not live with it.
— Kevin D. Williamson is a deputy managing editor of National Review and author of The Politically Incorrect Guide to Socialism, just published by Regnery. You can buy an autographed copy through National Review Online here.
This is one of the finest posts to The Corner - ever. Thank you, Kevin.
Reply to this commentLinkReport AbuseSo Kevin's basic argument is: wealthy people who can pay for whatever they need may lose out if there is less innovation, because more energy is being poured into making sure that poverty isn't a death sentence. I can see why the more well-off might not like that.
But the majority of this is just rubbish. Saying that insurance coverage doesn't equate to better access to care is objectively false (if that were not true, why is anyone buying it at all?)
It is true that a more expensive health care system doesn't equate to better health care outcomes--on average. But that obscures that point that if you have a child with leukemia, springing for that $250,000 blood marrow transplant is quite definitely going to improve your chance at life. Or for my friend with Lou Gehrig's disease, that $25,000 a month that goes to pay for his nursing care, feeding tube, ventilator, and myriad medications quite definitely make a difference--without them, he would be dead in a matter of hours.
Kevin tries to talk is broad generalities as a way to avoid the realities of care. Yes, you can be denied care if you can't pay for it. Yes, many people are unable to get coverage through no fault of there own.
And then there are the even scarier problems; in our current system, being sick or having a child that is sick can lose you your job, if your presence on a small business' plan drives up every else's rates too much.
NR is a pretty small business. Kevin: do you know what would happen to you if you had a child diagnosed with leukemia? Are you even aware that you might be unable to find work simply because you have a wretchedly sick child?
Republicans occasionally hint that they want to solve these problems, but considering how much time they spend denying their existence, I have little faith in them.
Reply to this commentLinkReport AbuseMaybe it is time to make the loss of the unseen seen. There are people out there waiting for experimental and new treatments. Mona Charen's son has diabetes and wrote about how he may lose very important medical care because of this loss of innovation. Surgeons are now replacing nerves from one body part to another to bring movement back to limbs. They are even beginning to regrow tendon attachments. Bring these people out and explain how this will be gone!
Pull forward all those people whose companies will drop them completely because it is so much cheaper to pay the penalty. That is what will happen to me, without a doubt. How many thousands will this affect?
Is Jimmy even sick? Does he have a family to support? Does he have some medical condition that is on the verge of a breakthrough? You can kiss any medical advances and technologies goodbye.
The republicans need to start making this seen. People also do not understand the tax increases, even that there are any. Want to sell your house - got a new tax for that as well. It's obscene and needs to be made to be seen by all.
Reply to this commentLinkReport AbuseKevin Williamson brings to these important issues a viewpoint and a theoretical foundation that are both principled and persuasive.
These are the grounds upon which health care and all other issues should be debated, and I applaud Mr. Williamson for doing so.
Mr. Williamson is wrong, but it would take too many words to even begin to explain how. Suffice it to say that I give his arguments serious consideration.
Reply to this commentLinkReport AbuseThe problem of preexisting conditions has to be placed into its proper context.
When insurance is supplied by the employer it is not portable. As numerous commentators have noted, this is a surviving remnant of WW2 wage and price controls. If the policy is purchased directly by the insured, the issue can be made to disappear by prohibiting the cancellation of a policy due to covered conditions which developed during the policy term.
Pooling of purchasers and cross border purchasing might have to be adopted to make this more cost effective, but to justify $1.4 trillion fiasco like Obamacare because it purportedly addresses this problem is absurd.
Reply to this commentLinkReport AbuseRiot, KW's argument is not what you wrote but one that has been tested for generations: the state cannot come close to what private businesses do.
Seriously, God bless your friend with ALS, but there are ways Congress could actually help people like him/her without screwing the entire nation. And if you think there is a greater chance for that or any other disease to be conquered by bureaucrats, you are nuts. The #1 place for ALS research in the world is right here in the U.S. The #1 place for medical research period is right here in the U.S. If you think the U.S. will remain at that level if Obamacare kicks in full gear, you are again nuts.
Socialized medicine doesn't do anything but screw the citizenry. Why you cannot grasp this, when there is example after example after example all over the planet is beyond me.
Reply to this commentLinkReport Abuse"So Kevin's basic argument is: wealthy people who can pay for whatever they need may lose out if there is less innovation, because more energy is being poured into making sure that poverty isn't a death sentence. I can see why the more well-off might not like that."
So...one must explain how it is Steve Jobs is taking another medical leave of absence after having pancreatic cancer and liver a transplant.
Wealthy does not equal better healthcare. But to Lefties that doesn't seem matter.
"And then there are the even scarier problems; in our current system, being sick or having a child that is sick can lose you your job, if your presence on a small business' plan drives up every else's rates too much."
That's funny because I was in this situation and...nothing happened! Life is rough - deal with it. Government can't fix life, but it can sure mess it up. Ask anyone who is paying taxes right about now.
Reply to this commentLinkReport Abuse@Colonel Travis--really? The government cannot come close to what private industry can do?
Is that how private industry put a man on the moon, split the atom, electrified the South, and built the Internet?
Hmmmm, maybe we should go back and reconsider that proposition...
Reply to this commentLinkReport Abuse@CTFederalist, that does not make the problem disappear, because some people are born with medical conditions. republicans have howled about letting people stay on their policies until they are 26--then I can't believe you would be ok with letting that person keep that policy for life.
And then what of children whose parents don't have insurance when they are conceived (which is a good number, since young people are the most likely to be uninsured). Are they just screwed forever?
Also, it means that once you do become sick, you are at the utter mercy of your insurance. They can quintuple your rates, and there is little you can do, as you become prisoner of your policy once something happens to you.
Reply to this commentLinkReport Abuse@Chrisbolt -
Do you work for the government? I know what happens to small businesses when an employee gets a disease like leukemia. If nothing to happened to you, you either work for the government or a big business, and are apparently completely ignorant of what the rest of us have to deal with.
"Life is tough - deal with it." Sorry, but I don't think anyone who has had a child with cancer would talk about that experience in those words. So I call bs on you, sir.
Reply to this commentLinkReport AbuseHealth insurance coverage does not equate to better health care unless a doctor accepts that coverge as payment. As Obamacare lowers the amount to be paid, doctors will start not accepting the insurance. We have clinics wit signs posted that Medicaid people will be expected to pay cash for treatment. If the government then forces doctors to accept the insurance, there is no legal way to make the doctor stay in business and if he cannot make an adequate profit, he would be prudent to change careers, even declare bankruptcy to get out from under medical school loans. Then there are even fewer doctors to treat the sick. Doctors are not stupid nor limited to practicing medicine as a sole career choice. I don't expect that doctors can be treated as a public utility and forced to practice, but even utilities (e.g. electricity and water) can be denied to people who cannot pay for them. People buy insurance because their employers pay for it and because it improves their chances of getting medical care. The worse the care gets, including longer waits, the less likely people will be to buy the insurance because there will be insufficient advantage. This is not an overnight process, but what would stop it? And if it progresses at all, overall medical care in the USA will deteriorate for most people. Sure, the rich will be fine. Obamacare has only covered an additional 10 million of the 30 million uninsured, at a cost of a trillion or so over the first 10 years, lots of new taxes, and incentives for businesses to throw up their hands and not arrange group insurance plans. What will it take to get the other 20 million? Like other supply/demand situations, adding to the demand dilutes the supply and invites production of knock-offs, in this case, marginal doctors. I'd be okay with no medical insurance whatsoever in the entire country, to level the playing field. But Obamacare is only pretending to help everyone while making things much worse.
Reply to this commentLinkReport Abuse"Is that how private industry put a man on the moon, split the atom, electrified the South, and built the Internet?"
And what do we have to show for putting a man on the moon other than Tang and satellites?
Wasn't there electricity in this country before Tennessee Valley Authority?
What good was splitting the atom other dropping bombs on people and creating a hugely expensive energy supply?
If the government created the internet, then why are other countries using it? Indeed, how could government create the internet without the computer and the telecommunication lines? I thought there were several people who invented the internet?
In fact, isn't it PEOPLE who invent things, not governments?
Reply to this commentLinkReport AbuseSuggesting that the addressing of the problems mentioned by RiotLibrarian by implementing a massive, brand-new, Federally-managed beaurocracy - now that's rubbish. How anyone can think that getting the Federal government more involved in health care when it has failed (and failed miserably) to even attempt to manage Medicare (and to an extent Medicaid) is truly preposterous. The Federal government (and even worse, the marriage of the Feds and private insurance companies) is not the answer to the problems of health care access & costs. Didn't the "problems" start around the time that health care became a third-party payor system? Separate the man from the impact of his financial decisions and bad things happen.
Reply to this commentLinkReport Abuse@CT Federalist:
I agree with you on this: "When insurance is supplied by the employer it is not portable. As numerous commentators have noted, this is a surviving remnant of WW2 wage and price controls. If the policy is purchased directly by the insured, the issue can be made to disappear by prohibiting the cancellation of a policy due to covered conditions which developed during the policy term."
But you are considering only the do-not-kick-them part of the equation. The other part is the do-not-let-them-in part. Suppose you were covered by your company, then you were layed off. Should the insurance companies be forced to take you in? And if there is not individual mandate, how are you going to force insurance companies to take you in? Say you are 25 and you do exercise your right not to buy insurance. Then you develop a condition. OK, you are on your own. How long will you go without insurance because your 'youthful indiscretion' and what if you need care to survive and you don't have enough money, should hospitals deny care? Who should pay that bill?
The current system where the employer provides insurance is not efficient, limits the choices of the individual, distorts salaries and affects the competitiveness of companies. But for many millions it fixes the pre and post conditions problem. This system is also slowly unraveling –has been for a while way before Obamacare-- so what is going to be its replacement? What will happen to those many millions for which the employer mediated system fixed the pre and post conditions issue? “Pooling of purchasers and cross border purchasing” seems to me clearly insufficient. And I hear nothing else from the Republican side. Is it because the exchange and the individual mandate were supported by the Heritage Foundation? External Link
part of the equation.
Reply to this commentLinkReport Abuse"Do you work for the government? I know what happens to small businesses when an employee gets a disease like leukemia. If nothing to happened to you, you either work for the government or a big business, and are apparently completely ignorant of what the rest of us have to deal with."
Isn't it funny how Lefties always assume people who have conservative views are well off? So you know, I was unemployed from September to December, but was uninsured from February to the beginning of this year. This not only included myself, but my wife and two kids. During that time I incurred a hand injury and had to deal with migraines and my family and I was getting sick constantly. Not once did we use healthcare. Sure, my wife wanted to go every time something happened, but I wouldn't let her because I believe healthcare is to be used only for EMERGENCIES. My hand was cut pretty badly, about a quarter inch gash, but even that was not enough to make me go. I have nice scar on my hand after it healed properly.
"Life is tough - deal with it. Sorry, but I don't think anyone who has had a child with cancer would talk about that experience in those words. So I call bs on you, sir."
You're talking to a guy who got appendicitis, had his head bashed in, had a severe asthma attack and almost died in a car accident. LIFE. IS. TOUGH. Some people get cancer, others don't. Having the government give 300+ million people coverage is not going to make LIFE any easier and will make everyone's lives miserable. You want politicians using people as pawns to get elected? How do you call that compassion?
I can tell that you're another unreasonable Leftie so I'll just admit you've won and walk away.
Reply to this commentLinkReport AbuseChris, you're missing the point.
If everyone can't drive a Mercedes, then nobody will drive a Mercedes.
If everyone can't live in a mansion, then nobody will live in a mansion.
The likely decline of medical innovation as a result of Obamacare's implementation is not, repeat NOT, a bug -- it's a feature.
Reply to this commentLinkReport Abuse@Riotlibrarian
My dad ran a small business, got leukemia and died. The business collapsed as a result, and all family financial investment in the company evaporated. So yeah, I know what happens when an employee of a small business gets leukemia.
No amount of governmental intervention can ever eliminate this sort of risk. To pretend that the government can ever provide adequate insurance to satisfactorily protect the population is a delusion. Just as with private insurance, there are always going to be "bad cases" where things seem horribly unfair. Yet there has to be a line where society says "it is only economically worthwhile for the government to address a set level of risk, and this means some people at the margins are invariably going to get screwed."
Reply to this commentLinkReport AbuseNow wait a minute, folks. Let's think of a parallel situation and see what its outcome would be, to give us some perspective.
Let's consider ... mail delivery! The post office does such a great job with its monopoly position that it loses millions and millions of dollars every year and does a so-so job. FedEx and UPS charge significantly higher rates, but show no signs of going out of business.
So let's shut down FedEx and UPS, redirect everything through the post office, and by raising taxes high enough, the post office will maybe, someday, at some point, be as efficient and effective as UPS and FedEx. Someday. Maybe. But the important thing is that it will be more fair to those who can't afford or don't want to pay for UPS or FedEx. Speed? Accuracy? Who cares!
It is frightening that we are about to be forced to put our health at risk in a systemic model that no one is willing to trust our correspondence to.
Reply to this commentLinkReport AbuseTo Riot Librarian
"Saying that insurance coverage doesn't equate to better access to care is objectively false (if that were not true, why is anyone buying it at all?)"
People buy health care to protect themselves from the cost of catastrophic illnesses. That's what it's for. That's why you buy it. It's not there to fix every hang nail. It ought not be there to cover Nancy Pelosi's botox treatment.
The "pre existing condition" argument is a red herring thrown in by the Dems to muddle the discussion. The number one problem with health insurance is that the unions abuse their Cadillac coverage and drive up the prices for everyone else. The number two problem is that there are too many people who prefer Direct TV to a far less sexy health insurance policy. Speaking as someone who at one time had to eat mac and cheese every day to afford health insurance, I would suggest that there are too many people who fail to make the right choices with their money. Their failure to prioritize properly is simply not my problem.
Reply to this commentLinkReport AbuseRiot:
1.) Who came up with the guidance systems, the rockets, the rocket fuel, the computers, the food, etc. for not just the moon mission, but every space mission in history? Who invented the freaking telescope, for that matter?
2.) Your ignorance about nuclear fission is profound.
3.) Is "electrified the South" what happens at a Lynyrd Skynyrd concert? I have no clue what you're talking about.
4.) Internet - Besides ARPANET and Al Gore there's a little more to the story than those two. It goes beyond Samuel Morse, it goes beyond Jean Antoine Freaking Nollet.
There are tons of books on these subjects, I'd suggest reading some.
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