Are We Stuck with ObamaCare?

ObamaCareby Jon N. Hall    10/26/15
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 health care 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 the worst feature of 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 be 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. • (736 views)

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7 Responses to Are We Stuck with ObamaCare?

  1. Kung Fu Zu Kung Fu Zu says:

    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.

    Hopefully we will go forward. Compared with most of the industrial world, the US medical system is highly wasteful. This is not because people are getting such superior medical attention, rather it is because medical costs here are extremely high.

    We have all heard of numerous reasons for this, but unless we come up with a smarter way of doing things, costs associated with medicine will go up even if they cancel Obamacare. For example, the consolidation of the medical insurance industry since the law was passed will insure higher costs.

    • NAHALKIDES NAHALKIDES says:

      That’s true, and what we Conservatives need to remember is that the problems we had before Obamacare, while nowhere near as bad as the problems we now have under Obamacare, needed to be addressed (they weren’t, because the GOP Establishment wants always to preserve the status quo rather than making things better while the Democrats, of course, want to make things worse). But the basic outlines of a solution is simple enough when we remember that all the problems we had were always caused by government intervention, and the solution is therefore to push toward a free market in health care and health insurance.

      Some examples:

      1. Costly mandates – mostly at the state level, these drove up the costs of health insurance and are the real reason for the number of “uninsured”.

      2. Medicare – drives up the cost of health care itself by artificially increasing demand while insulating consumers from costs. This is probably the hardest part to fix because of Democratic demagoguery. The way out is probably to transform Medicare into something like today’s Medicare Advantage without changing the name until years after we’ve gotten the government entirely out of the program.

      3. Tax code that favors employer-based health insurance, thus stopping portability – the easy fix here is to remove the favorable tax treatment (preferably along with abolishing the income tax).

      4. Medicaid – the biggest problem of all. I would suggest turning it over to the states, which will have to make politically-unpopular cuts. But the welfare state is unsustainable, and Medicaid is already busting state budgets. They will have to make cuts or go bankrupt. One important point: no block granting! We need to get “Federal” money out both to break Federal control and to force the states to make cuts to the program.

      • Timothy Lane says:

        One minor caveat: I doubt many Democrats actually wanted to make the system worse. But it’s true that their ideology of control is what matters, and the harmful effect it had was irrelevant to them (unless it led to a repeal of Obamacare).

        In addition to the suggestions you make, I would point out the need for transparency in billing. All too often, people have no idea what an operation will cost. Worse yet, there are multiple charges, and patients (i.e., victims) have no way of knowing if they’re legitimate.

        When I had an anal fistulectomy back in the 1980s, I was told it would be $850, but then it turned out to be $1410 — with another thousand or so in additional charges for other payees (most of which I never paid). Paul Ryan, discussing the subject at Hillsdale (which appeared in an Imprimis several years ago) noted that there are often huge price differences for the same operation from facility to facility.

  2. Timothy Lane says:

    The reason they didn’t bother to keep some sort of access to the old system in case the new one failed badly (as in fact it did, in many ways) is simple: The purpose all along was simply government control over as much of people’s lives as possible. Improved medical care was merely the excuse for the takeover. This is why no Democrat (not a single) cared when it turned out (in 2011) that “if you like your plan you can keep your plan” was totally false. This is why no Democrat cares as people are often forced to pay more for grossly inferior plans (quite possibly already killing some of their victims). And this danger is why Ted Cruz was so eager to stop Obamacare in its tracks in 2013. He knew it was probably the last decent opportunity.

    And all this helps explain why the Democrats are the Evil Party.

  3. Steve Lancaster says:

    The only thing Obamacare offers is access to stand in line for healthcare that is regimented, bureaucratic, and overblown with high paid “professionals” who administer the programs. It is fortunate that Friedrich Hayek is dead, as sure as the world Obama would have killed him.

  4. Brad Nelson Brad Nelson says:

    Yes, we are likely stuck with Obamacare if only because we lack an opposition party with the will to repeal it or do something better.

    The irony is, it took somewhat undemocratic processes for this latest ratchet of socialized medicine to be implemented and it will similarly take Napoleonic-type executive powers to eradicate it. And such powers would be contrary to our form of government. So to paraphrase George Bush!, “We have to kill democracy in order to save it.” And there would be some truth to that. And such precedents are bad, even in a good cause.

    We are at the point where the Progressive generations have made their bed and they’re going to have to lie in it. The people who love and trust Big Government and don’t think unicorn farts stink will have to deal with the reality of the beast they have created. The only question is, how long will they pretend to love it. And how deep will the Orwellian thought-crime paradigm ooze as seen in the chilling movie, Equilibrium?

    As much as a good citizen, patriot, and conservative ought to say “Never surrender,” we’re long past the tipping point regarding the lost mind of Americans. They have been seduced by the promises of politicians and bought into the utopian schemes. It is now only a matter of watching the inevitable crash and burn. And just hope that you are not “the New Jew” who is blamed for it, for when the dreams are dashed, someone will be made to pay. And it is unlikely by this time that the moral and intellectual capacity of your typical citizen will be able to see through the fog of blame-shifting as perpetrated by the ruling class.

    The idea that ideas and principles matter may occur to some, but far too late.

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