An Access Advertising EconBrief:
ObamaCare and the Point of No Return
The rollout of ObamaCare – long-awaited by its friends, long-dreaded by its foes – took place last week. In this case, the term “rollout” is apropos, since the program is not exactly up on its feet. Tuesday, Oct. 22, 2013 marked the debut of HealthCare.gov, the ObamaCare website, where prospective customers of the program’s health-insurance exchanges go to apply for coverage. By comparison, Facebook’s IPO was a rip-roaring success.
A diary of highlights seems like the best way to do justice to this fiasco. We are indebted to the Heritage Foundation for the chronology and many of the specific details that follow.
Tuesday, Oct. 22, 2013: This is ribbon-cutting day for the website, through which ObamaCare’s state health-insurance exchangesexpect to do most of their business. One of the most fundamental reforms sought by free-market economists is the geographic market integration of health care in the U.S. Historically, each state has its own state laws and regulatory apparatus governing insurance. This hamstrings competition. It requires companies to deal with 50 different bureaucracies in order to compete nationally and limits consumers solely to companies offering policies in their state. But ObamaCare is dedicated to the proposition that health care of, by and for government shall not perish from the earth, so it not only perpetuates but complicates this setup by interposing the artificial creation of a health-care exchange for each state, operating under a federal aegis.
Only 36 of those state exchanges open for business on time today, however. Last-minute rehearsals have warned of impending chaos, and frantic responses have produced lateness. Sure enough, as the day wears on 47 states eventually report applicant complaints of “frequent error messages.” Despite massive volume on the ObamaCare site, there is almost no evidence of actual completed applications.
Wednesday, Oct. 23, 2013: The Los Angeles Times revises yesterday’s report of 5 million “hits” on HealthCare.gov from applicants in California downward just a wee bit, to 645,000. But there is still no definitive word on actual completed applications, leading some observers to wonder whether there are any.
Thursday, Oct. 24, 2013: The scarcity of actual purchasers of health insurance on the ObamaCare exchanges leads a Washington Post reporter to compare them in print to unicorns. More serious, though, are the growing reports of thousands of policy cancellations suffered by Americans across the nation. The culprit is ObamaCare itself; victims’ current coverage doesn’t meet new ObamaCare guidelines on matters such as openness to pre-existing conditions. Ordinarily, a significant pre-existing health condition would preclude coverage or rate a high premium. In other words, writing policies that ignore pre-existing conditions is not insurance in the true, classical sense; insurance substitutes cost for risk and the former must be an increasing function of the latter in order for the process to make any sense. ObamaCare is not really about insurance, despite its protestations to the contrary.
Friday, Oct. 25, 2013: CNBC estimates that only 1% of website applicants can proceed fully to completion and obtain a policy online because the system cannot generate sufficient valid information to process the others. A few states – notably Kentucky – have reported thousands of successful policies issued, but the vast bulk of these now appear to be Medicaid enrollees rather than health-insurance policyholders. Meanwhile, the Department of Health and Human Services (HHS) announces that its website will be offline for repairs and upgrading.
Saturday, Oct. 26, 2013: In an interview with Fox News, Treasury Secretary Jack Lew refuses to cite a figure for completed applications on the HealthCare.gov website. Among those few that have successfully braved the process, premiums seem dramatically higher than those previously paid. One example was a current policyholder whose monthly premium of $228 ballooned to $1,208 on the new ObamaCare health-care exchange policy.
Monday, Oct.28, 2013: Dissatisfaction with the process of website enrollment is now so general that application via filling out paper forms has become the method of choice. It is highly ironic that well into the 21st century, a political administration touting its technological progressivity has fallen back on the tools of the 19th century to advance its signature legislative achievement.
This diary of the reception to ObamaCare conveys the impression of a public that is more than sullen in its initial reaction to the program – it is downright mutinous. It was hardly surprising, then, that President Obama chose to respond to public complaints by holding a press conference in the White House Rose Garden a few days after rollout.
Mr. Obama’s attitude can best be described as “What’s the problem?” His tone combined the unique Obama blend of hauteur and familiarity. The Affordable Care Act, he insisted, was “not just a website.” If people were having trouble accessing the website or completing the application process or making contact with an insurance company to discuss an actual plan – why, then, they could just call the government on the phone and “talk to somebody directly and they can walk you through the application process.” (How many of the President’s listeners hearkened back at this point to their previous soul-satisfying experiences on the phone with, let’s say, the IRS?) This would take about 25 minutes for an individual, Mr. Obama assured his viewers, and about 45 minutes for a family. He gave out a 1-800 number for his viewers to call. Reviews of the President’s performance noted his striking resemblance to infomercial pitchmen.
Sean Hannity was so inspired by the President’s call to action that he resolved to heed it. He called the toll-free number on-air during his AM-radio show. He spoke with a call-center employee who admitted that “we’re having a lot of glitches in the system.” She read the script that she had been given to use in dealing with disgruntled callers. Hannity thanked her and complimented her on her courtesy and honesty. She was fired the next day. Hannity declared he would compensate her for one year’s lost salary and vowed to set up a fund for callers who wanted to contribute in her behalf.
Health and Human Services Secretary Kathleen Sebelius was next up on the firing line. Cabinet officials were touring eight cities and selected regional sites to promote the program and at Sebelius’s first stop at a community center in Austin, TX, she held a press conference to respond to public outrage with the glitches in the program.
On October 26, 2013, the Fox News website sported the headline: “Sebelius Suggests Republicans to Blame for ObamaCare Website Woes.” Had the Republican Party chosen the IT contractor responsible for setting up HealthCare.gov‘s website?
No. “Sebelius suggest[ed] that Republican efforts to delay and defund the law contributed to HealthCare.gov‘s glitch-ridden debut.” Really. How? Sebelius “conceded that there wasn’t enough testing done on the website, but added that her department had little flexibility to postpone the launch against the backdrop of Washington’s unforgiving politics. ‘In an ideal world, there would have been a lot more testing, but we did not have the luxury of that. And the law said the go-time was Oct. 1. And frankly, a political atmosphere where the majority party, at least in the House, was determined to stop this any way they possibly could…was not an ideal atmosphere.”
It takes the listener a minute or so to catch breath in the face of such effrontery. The Obama Administration had three years in which to prepare for launch of the program. True, there were numerous changes to the law and to administrative procedures, but these were all made by the administration itself for policy reasons. The Democrat Party, not the Republican Party, is the majority party. The Republican Party – no, make that the Tea Party wing of the Republican Party – proposed a debt-limit settlement in which the individual mandate for insurance-policy ownership would be delayed. It was rejected by the Obama Administration. Ms. Sebelius is blaming the Republican Party for the fact that Democrats were rushed when the Republicans in fact offered the Democrats a delay that the Democrats refused.
Were Ms. Sebelius a high-level executive in charge of rolling out a new product, her performance to date would result in her dismissal. But when queried about the possibility of stepping down, she responded “The majority of people calling for me to resign, I would say, are people I don’t work for and who did not want this program to work in the first place.” Parsing this statement yields some very uncomfortable conclusions. Ms. Sebelius’s employer is not President Obama or his administration; it is the American people. Anybody calling for her resignation is also an American. But clearly she does not see it that way. Obviously, the people calling for her resignation are Republicans. And she does not see herself as working for Republicans. The question is: Who is she working for?
Two possibilities stand out. Possibility number one is that she is working for the Democrat Party. In other words, she sees the executive branch as a spoils system belonging to the political party in power. Her allegiance is owed to the source of her employment; namely, her party. Possibility number two is that she sees her allegiance as owed to President Obama, her nominal boss. This might be referred to as the corporatist (as opposed to corporate) view of government, in which government plays the role of corporation and there are no shareholders.
Neither one of these possible conceptions is compatible with republican democracy, in which ultimate authority resides with the voters. In this case, the voters are expressing vocal dissatisfaction and Ms. Sebelius is telling them to take a hike. In a free-market corporation, Ms. Sebelius would be the one unfolding her walking papers and map.
Whose Back is Against the Wall?
It is tempting to conclude that ObamaCare is the Waterloo that the right wing has been predicting and planning for President Obama ever since Election Day, 2008. And this does have a certain superficial plausibility. ObamaCare is this Administration’s signature policy achievement – indeed, practically its only one. There is no doubt that the Administration looks bad, even by the relaxed standards of performance it set during the last five years.
Unfortunately, this view of President Obama with his back against the wall, despairing and fearful, contemplating resignation or impeachment, simply won’t survive close scrutiny. It is shattered by a sober review of Barack Obama’s past utterances on the subject of health care.
As a dedicated man of the Left, Barack Obama’s progressive vision of health care in America follows one guiding star: the single-payer system. That single payer is the federal government. Barack Obama and the progressive Left are irrevocably wedded to the concept of government ownership and control of health care, a la Great Britain’s National Health Care system. In speeches and interviews going back to the beginning of his career, Obama has pledged allegiance to this flag and to the collective for which it stands, one organic unity under government, indivisible, with totalitarianism and social justice for all.
The fact that ObamaCare is now collapsing around our ears may be temporarily uncomfortable for the Obama Administration, but it is in no way incompatible with this overarching goal. Just the opposite, in fact. In order to get from where we are now to a health-care system completely owned and operated by the federal government, our private system of doctors, hospitals and insurance companies must be either subjugated, occupied or destroyed, respectively. That process has now started in earnest.
Oh, the Administration would rather that private medicine went gentle into that good night. It would have preferred killing private health insurance via euthanasia rather than brutal murder, for example. But the end is what matters, not the means.
Certainly the Administration would have preferred to maintain its hypnotic grip on the loyalty of the mainstream news media. Instead, the members of the broadcast corps are reacting to ObamaCare’s meltdown as they did upon first learning that they were not the product of immaculate conception. But this is merely a temporary dislocation, not a permanent loss. What will the news media do when the uproar dies down – change party affiliation?
For anybody still unconvinced about the long-run direction events will take, the Wednesday, October 30, 2013 lead editorial in The Wall Street Journal is the clincher.
“Americans are Losing Their Coverage by Political Design”
“For all of the Affordable Care Act’s technical problems,” the editors observe, “at least one part is working on schedule. The law is systematically dismantling the private insurance market, as its architects intended from the start.”
It took a little foresight to see this back when the law was up for passage. The original legislation included a passage insisting that it should not “be construed to require than an individual terminate coverage that existed as of March 23, 2010.” This “Preservation of Right to Maintain Existing Coverage” was the fig leaf shielding President Obama’s now-infamous declaration that “if you like your existing policy, you can keep it.” Yeah, right.
Beginning in June, 2010, HHS started generating new regulations that chipped away at this “promise.” Every change in policy, no matter how minor, became an excuse for terminating existing coverage at renewal time. This explains the fact that some 2 million Americans have received cancellation notices from their current insurers. Of course, the Obama Administration has adopted the unified stance that these cancellations are the “fault” of the insurance companies – which is a little like blaming your broken back on your neighbor because he jumped out of the way when you fell off your roof instead of standing under you to cushion your fall. Stray callers to AM radio can be heard maintaining that at least half of these cancellations will be reinstated with new policies at lower cost in the ObamaCare exchanges. If only those hot-headed Tea Partiers would stop dumping boxes of tea and behaving like pirates! Alas, a Rube Goldberg imitation of a market cannot replace the genuine article – with apologies to Mr. Goldberg, whose roundabout contraptions actually worked.
ObamaCare creates 10 types of legally defined medical benefits. They include general categories like hospitalization and prescription drugs. No policy that fails to meet the exact standards defined within the law can survive the ObamaCare review. It is widely estimated that about 80% of all individual plans, which cover 7% of the U.S. population under age 65, will fall victim to the ObamaCare scythe.
The law is replete with Orwellian rhetoric of progressive liberalism. HHS defines its purpose as the “offer [of] a small number of meaningful choices.” Uh…what about allowing individuals to gauge the tradeoff between price and quality of care that best suits their own preferences, incomes and particular medical circumstances? No, that would have “allowed extremely wide variation across plans in the benefits offered “and thus “would not have assured consumers that they would have coverage for basic benefits.” This is doublespeak for “we are restricting your range of choice for your own good, dummy.”
Liberals typically respond with a mixture of outrage and indignation when exposed as totalitarians. It is certainly true that they are not eradicating freedom of choice merely for the pure fun of it. They must create a fictitious product called “insurance” to serve a comparatively small population of people who cannot be served by true insurance – people with pre-existing conditions that make them uninsurable or ratable at very high premiums or coverage exclusions. The exorbitant costs of serving this market through government require that the tail wag the dog – that the large number of young, healthy people pay ridiculously high premiums for a product they don’t want or need in order to balance the books on this absurd enterprise. (Formerly, governments simply borrowed the money to pay for such pay-as-you-go boondoggles, but the financial price tag on this modus operandi is now threatening to bring down European welfare states around the ears of their citizens – so this expedient is no longer viable.) In order to justify enrolling everybody and his brother-in-law in coverage, government has to standardize coverage by including just about every conceivable benefit and excluding practically nothing. After all, we’re forcing people to sign up so we can’t very well turn around and deny them coverage for something the way a real, live insurance company would, can we?
It is well known that the bulk of all medical costs arise from treating the elderly. In a rational system, this would be no problem because people would save for their own old age and generate the real resources necessary to fund it. But the wrong turn in our system began in World War II, when the tax-free status of employer-provided health benefits encouraged the substitution of job-related health insurance for the wage increases that were proscribed by wartime government wage and price controls. The gradual dominance of third-party payment for health care meant that demand went through the roof, dragging health-care prices upward with it.
Now Generation X finds itself stuck with the mother of all tabs by the President whom it elected. The Gen X’ers are paying Social Security taxes to support their feckless parents and grandparents, who sat still for a Ponzi scheme and now want their children to make good. To add injury to injury, the kids are also stuck with gigantic prices for involuntary “insurance” they don’t want and can’t afford to support their elders, the uninsurables – and the incredibly costly government machinery to administer it all.
It’s just as the old-time leftist revolutionaries used to say: you can’t make an omelette without breaking eggs. Across the nation, we have heard the sound of eggs cracking for the last week.
The Point of No Return
The “point of no return” is a familiar principle in international aviation. It is the point beyond which is it closer to the final destination than to the point of origination, or the point beyond which it makes no sense to turn back. This is particularly applicable to trans-oceanic travel, where engine trouble or some other unexpected problem might make the fastest possible landing necessary.
In our case, the Obama Administration has kept this concept firmly in mind. By embroiling as many Americans as deeply as possible in the tentacles of government, President Obama intends to create a state of affairs in which – no matter how bad the current operation of ObamaCare may be – it will seem preferable to most Americans to go forward to a completely government-run system rather than “turn back the clock” to a free-market system.
A free-market system works because competition works. On the supply side of the market, eliminating state regulation of insurance would enable companies to expand across state borders and compete with each other. But this involves relying upon companies to serve consumers. And companies are the entities that just got through issuing all those cancellation notices. For millions of Americans today, the only disciplinary mechanism affecting companies is something called “government regulation” that forces them to do “the right thing” by bludgeoning them into submission. That is what regulatory agencies are doing right now – beating up on Wall Street firms and banks for causing the financial crisis of 2008 and ensuing Great Recession. The fact that this never seems to prevent the next crisis doesn’t seem to penetrate the public consciousness, for the only antidote for the failure of government regulation is more and stronger government regulation.
On the demand side of a free market, consumers scrutinize the products and services available at alternative prices and choose the ones they prefer the most. But consumers are not used to buying their own health care and vaguely feel that the idea is both dishonest and unfair. “Health care should be a right, not a privilege,” is the rallying cry of the left wing – as if proclaiming this state of affairs is tantamount to executing it. No such thing as a guaranteed right to goods and services can exist, since giving one person a political right to goods is the same thing as denying the right to others. In the financial sense, somebody must pay for the goods provided. In the real sense, virtually all goods are produced using resources that have alternative uses, so producing more of some goods always means producing fewer other goods.
This is not what the “health-care-should-be-a-right-not-a-privilege” proclaimers are talking about. Their idea is that we will give everybody more of this one thing – health care – and have everything else remain the same as it is now. That is a fantasy. But this fantasy is the prevailing mental state throughout much of the nation. One widely quoted comment by a bitterly disappointed victim of policy cancellation is revealing: “I was all for ObamaCare until I found out I was going to have to pay for it.” On right-wing talk radio, this remark is considered proof of public disillusion with President Obama. But note: The victim did not say: “I was all for ObamaCare until I found out what I was going to have to pay for it.” The distinction is vital. Today, a free lunch is considered only fitting and proper in health care. And the only free lunch to be had is the pseudo-free lunch offered by a government-run, single-payer system.
As it stands now, few if any Americans can recall what it was like to pay for their own health care. Few have experienced a true free market in medicine and health care. Thus, they will be taking the word of economists on faith that it would be preferable to a government-run system like the one in Great Britain. It is a tribute to the power of ideas that a commentator like Rush Limbaugh can make repeated references to individuals paying for their own care without generating a commercially fatal outpouring of outrage from his audience.
Grim as this depiction may seem, it accurately describes the dilemma we face.