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little Jimmy, the 26-year-old “child” still clinging to his mommy’s insurance coverage, may lose out if Obamacare is repealed.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.