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On Doing No Harm



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In an interesting argument, Megan McArdle compares opposition to President Obama’s health-care law to opposition to the Iraq War:

The goal was a great one: Free Iraq from a dictator who was a destabilizing geopolitical force and help the Iraqi people to establish a prosperous and functional democracy. But the downside risk of embroiling the U.S. in an unwinnable war that would kill a lot of Iraqis and destabilize the region even further was horrifying, and all too likely. Looking at the aftermath, I sure wish I’d listened — and even more that our leaders had.

Which reminds me of something that I’ve been wanting to say. I admire the way that fearless liberals have come out to criticize the rollout of the exchanges — much more quickly and completely than supporters of the Iraq War managed, I’m afraid. (Though of course, in fairness, the malfunctioning exchanges are right here where everyone can see them, not thousands of miles away.) But as with Iraq, I fear that the bitterness of the debate in the run-up is making the administration and many of its supporters discount too deeply the valid criticism coming from the opposition. It is true that I, and many others who are talking about the problems with these exchanges, opposed the health-care law; my preference is not for a delay but for completely getting rid of this law, and starting over with something that works better. (More on that later.)

But I’m also an American who wants our insurance market to work. My first preference is for Obamacare to go away, making room for a more market-oriented solution. Failing that, of course I want Obamacare to work as its designers envisioned, rather than destroying the market for individual insurance and costing the federal government boatloads of money that it doesn’t have. It’s just that I don’t think this is the most likely outcome, and frankly, it’s looking less likely with every ham-fisted management decision that endangers the long-term health of the system and gains only some evanescent political advantage.

In this, I expect I feel much the same way as patriotic critics of the war who wanted the troops brought home ASAP because they thought that our efforts in Iraq were doomed — but, failing that, would rather have seen their opponents proven right, their country prevail, and peace and prosperity come to Iraq.

That’s why I want to either see the whole law delayed for a year or see the whole law go forward — even though I understand that, yes, the latter choice would mean hardship for uninsured folks who get hit with a fine. Not because it’s 100 percent certain that we’ll end up in a death spiral, but because a merely high risk of a death spiral is unacceptable to me, and I should hope to everyone else. Isn’t the foundational rule of health care to first do no harm?

 



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