Are We Really Stuck with ObamaCare?
On September 15, former Health and Human Services Secretary Kathleen Sebelius spoke in Kansas City at the annual luncheon of the Health Care Foundation of Greater Kansas City (website). The speech didn’t seem to get much attention, so I called the CEO of the foundation for a transcript or video, but she said there aren’t any. However, Mike Sherry reported on the speech for the Kansas Health Institute with “Sebelius lays down health challenge to KC region.”
The thrust of her speech seems to have been about making “Kansas City the healthiest region in the country” or something. But at KMUW radio and at KPR, Jim McLean provides a very brief audio of Sebelius at the luncheon saying this: “Anybody who stands up and says we’re going to repeal this law is just not telling the truth, because frankly there isn’t anything to go back to.”
Conservatives might get riled by such a statement, so I Googled it in quotation marks and got exactly one hit, to the KMUW link above. On September 21, the Kansas City Star ran a print column about the speech by Alan Bavley headlined “Sebelius Says ACA Is Here to Stay.” It had been posted online the day before as “Kathleen Sebelius says Obamacare is here to stay”:
Sebelius was confident that the ACA was so “intimately entwined” into the fabric of the nation’s health care system that it would be impossible to dismantle it wholesale, as some Republicans presidential contenders vow.
Any politician promising to repeal the ACA “is just not telling the truth,” she said. “It really can’t happen.”
The ACA has changed the way doctors and hospitals are paid, how health insurance companies price their plans and how millions of people get health care coverage. If you took away the ACA, there would be nothing left to go back to, Sebelius said.
I’m reminded of the scene in David Lean’s Doctor Zhivago (1965) when Zhivago and his family learn of the execution of Tsar Nicholas. Ralph Richardson wails: “They’ve shot the tsar, and all his family. Oh, that’s a savage deed. What’s it for?” The good doctor answers: “It’s to show there’s no going back.”
As with the Russian Revolution, so, too, with ObamaCare -- you see, “there's no going back” because “there isn’t anything to go back to.”
Or so progressives would have us believe. But there’s no reason to think Mrs. Sebelius knows any more about this than she knew about Healthcare.gov during its disastrous rollout. As a programmer/analyst on old IBM mainframes, I have some experience with system conversions, and one thing you never do is assume that things will proceed without a hitch. Rather, you operate under Murphy’s Law, which holds that “Anything that can go wrong will go wrong.” And the thing is: no one knows what all can go wrong. So, what are ObamaCare’s O-rings?
Murphy’s Law (and plain old common sense) dictates that you always leave a path to go back to the old system that you’re migrating from. In some conversions, you may even, for a time, operate off the new system and the old one simultaneously. So if ObamaCare made it impossible to go back to the old system, I’d say that’s a major failing, especially since ObamaCare has been up and running for such a short time, not to mention its problem-plagued implementation.
If ObamaCare has in fact been “so ‘intimately entwined’ into the fabric of the nation’s healthcare system” that going back would be “impossible,” was that done deliberately? If so, that goes beyond failure and into malpractice. (Sebelius may have said more than she intended to.)
Just how has ObamaCare “entwined” itself so irreversibly into the nation’s healthcare system? ObamaCare is not so much a healthcare reform as a health insurance reform; it hasn’t “changed the way doctors and hospitals are paid” as much as how insurance companies are paid.
But ObamaCare did not require people to use health insurance; it did not abolish paying entirely out-of-pocket. Otherwise, ObamaCare would have destroyed concierge medicine, and medical tourism to the United States. Some doctors and hospitals simply don’t accept health insurance and Medicaid. So ObamaCare didn’t affect the cash-only sector of healthcare.
ObamaCare also didn’t entwine itself into Medicare; Medicare is a stand-alone system funded by its own dedicated tax. ObamaCare didn’t really entwine itself into Medicaid; it merely expanded the number of people on it. Where ObamaCare really did get “intimately entwined” is in its new tax credit subsidy system, which means that it got entwined into the IRS.
And the subsidy system may be worst feature of the ObamaCare. At least with Medicaid there aren’t government payouts unless people use healthcare. But with the subsidy system, payouts are made upfront, as premiums to private insurance companies, regardless of whether claims are made or not. Surely those upfront payments put an upward pressure on prices.
ObamaCare’s “individual mandate” is triggered not by an individual existing, but by an individual having an Individual Income Tax liability. If your income isn’t high enough to be taxed by the feds, the mandate doesn’t affect you. That’s one of the reasons millions are still uninsured in America -- they’re not taxpayers.
But some Americans who owe no income taxes nonetheless file returns. And when they look at the 1040 instruction booklet for 2014 they may be a bit flummoxed. For “Line 61, Health Care: Individual Responsibility” on page 50 doesn’t state that only those with a tax liability must have coverage. So a filer who owes no income tax for any part of the tax year and who is filing a return only to get his refund will think he needs to buy health insurance or pay the ObamaCare penalty/tax. Again, was that deliberate?
ObamaCare may be too “intimately entwined” for its own good, because it is quite vulnerable to tax reform. The FairTax, for instance, eliminates income taxes and our beloved IRS. Donald Trump’s tax reform exempts huge swathes of Americans from paying the income tax. Such changes would mean the undoing of the subsidy program precisely because it was so “entwined” into taxes and the IRS. (Perhaps ObamaCare was designed to be a roadblock to tax reform.)
One of the standard lines of the Left, whether Democrat or Bolshevik, is that their systems can’t be undone, they’re irreversible, here to stay, there’s no going back. So the Left’s systems must be “intimately entwined”; there can no choice. Where this is most insidious is in the ensnarling of the individual; individuals get hooked on “free stuff” -- free ObamaCare, free Obama phones, free “Obama money” from Obama’s stash (video). If we don’t free ourselves from government freebies, there may not be much hope for Freedom.
Do remember that America actually had a healthcare system before Obama came on the scene, and doctors were regularly performing medical miracles all around the country. Not only that, before the advent of the ObamaCare exchanges, which Obama’s apparatchiks are careful to always refer to as “the Marketplace,” we had a market for health insurance. Surely we can go back to that, or go forward to something even better. But first we must get un-entwined.
Jon N. Hall is a programmer/analyst from Kansas City.