Obamacare's Gruesome Fiscal Logic
According to President Obama, "health care is the single most important thing we can do for America's long-term fiscal health." In a gruesome way, he is right. The explosion in entitlement caused debt is the greatest challenge facing the United States, and its origins lie in the retirement of "baby boomers" and a shrinking tax base due to expanding unemployment, which is itself due in part to the excessive debt monetization and taxation required to pay for the current retirees. Assuming President Obama is correct, how does (un)affordable healthcare solve the problem?
The ACA is a hideously complicated circus of statutory and regulatory rules. The ACA was itself 2409 pages long (granted, double spaced with 1.5 inch margins), and the associated regulatory documents tally somewhere between 5,000 and 40,000 pages, depending on how you count them up. Many tens, perhaps hundreds of millions of people will lose their health insurance due to rules and regulations enforced under the ACA, rather than any overt clause within the ACA itself. The cost of insurance is also skyrocketing, again due to rules. Keep this in mind: if President Obama wanted, he could order the Secretary of Health and Human Services to change those rules, and people could obtain almost any type of insurance plan they wanted, paying an appropriate price for their coverage.
Apart from dictating insurance, the ACA also forms multiple boards that control treatment options. The United States Preventative Services Task Force (USPSTF) issues decisions on what preventative services will and will not be covered, and for whom they are or are not indicated. The Independent Payment Advisory Board (IPAB) is tasked with cutting Medicare costs, primarily through reduction of services, or reduction of payment for services rendered (presumably causing services not to be rendered). What services these panels allow or not will depend entirely on the President who appoints them. The ACA cuts Medicare spending and promotes (or rejects) preventative services, so it should reduce Medicare costs, but what does this have to do with Social Security?
The ACA leaves so much up to the bureaucracy that it could do anything. For example, FactCheck.org analyzed the claims found in a chain E-mail and determined that 26 of the 48 claims were outright false, with only 4 being perfectly valid, but if one carefully considers the reasoning provided for scoring some of those claims "false," it comes down to how benevolent or tyrannical you think the administration will be. Under a saint, the ACA explodes into a massive entitlement. Under a socialist, the non-productive retirees die off and the ACA saves the fiscal health of the country. Lost? You did read the previous paragraph, right?
For example, the IPAB could decide that persons over 67 with low bone density (what defines low?) are ineligible for joint replacement surgery. Living with the quasi-immobility of joint pain rapidly degrades the quality of life and worsens health; in fact, the difference in the 7-year mortality between replacing an arthritic joint and not is 50%. If 1 in 1,000 people on Medicare are denied a joint replacement (about 30% of those who currently receive one), and they live only 11 more years instead of 18, then that reduces all retirement benefit payments by about 0.04%. This seems like a paltry amount, but throw in minor restrictions on other life-saving procedures, such as treatments for cataracts, incontinence, macular degeneration, immobility, retinal detachment, or hearing loss, and the reduction quickly adds up to significant entitlement savings.
A much less hypothetical example was when the USPSTF recommended that routine breast cancer screenings were unnecessary for women under 50. At the time, it did not have the force of law, but under the ACA, no insurance can cover more than 1 mammogram every 2 years for women under 50. What happens when the USPSTF decides that colonoscopies should be performed no sooner than once every 5 years for people over 65?
This is only about what government will pay for, right? It would be a poor method to exterminate the elderly, because they can still pay for a mammogram or colonoscopy or joint replacement out of their own pockets. So then why does the ACA allow the IPAB to create rules to reduce Medicare reimbursements to providers who perform too many "unnecessary" procedures, regardless of who paid for them. Would a hospital be willing to take a cash payment from a rejected Medicare patient if the IPAB might reduce its reimbursement rate to that hospital for approved procedures by 10%?
The ACA does not require the elderly to get sick and die quickly, just as it does not force the President to appoint boards that will decide to ration care; however, it allows the President to do so, should he choose, but it is not as if Barack Obama ever said that people might be better off taking a pain pill than getting surgery; oh wait, he did.
Obama seems an ardent supporter of pain pills over treatment. To further quote President Obama, "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here." When asked how we deal with it, "It is very difficult to imagine the country making those decisions just through the normal political channels, and that's part of why you have to have some independent group [e.g. IPAB, USPSTF] that can give you guidance." President Obama clearly understands that the American People will never tolerate legislators who pass laws to withhold healthcare, and so care must be withheld through regulations crafted by boards. Obama has said that he will not ration care, but he has said many things, mostly landing somewhere between inaccurate and outright lie.
At this point, it is impossible to say if care will be rationed. It is the one TEA Party prediction about ObamaCare yet to come true, but if Obama did not want to ration care, then why did he demand a law that allows him to do it? If Obama wanted you to be able to keep your insurance, then why did he construct rules that prevented you? If Obama wanted you to have cheaper insurance with better benefits, then why did he create rules that make it expensive with fewer benefits? If Obama wanted an honest debate about health reform, then why did he lie? When an ogre asks, "Please hand me my club; I promise not to club you with it," grab the club, and run away. Waiting for a better President is like waiting for a better ogre. ObamaCare has one and only one fix: complete repeal.