Beyond the Mandate: The Mess That’s Obamacare

There are many practical problems with President Barack Obama’s health reform law.

Building of the Supreme Court of the United States in Washington DC, September 2009
Building of the Supreme Court of the United States in Washington DC, September 2009 (Ken McCown)

The Supreme Court of the United States later this week will hear the first arguments in the case against President Barack Obama’s signature health-care reform law. The individual mandate, which compels citizens buy insurance at the risk of a financial penalty, is at the core of the constitutional argument against “Obamacare,” as the law has been dubbed by opponents. But there are more, practical problems as well that will not be solved with repeal of the mandate alone.

Because government is inherently incapable of effectively regulating, let alone controlling, any sector of the economy, it should come as no surprise that in many instances, the health-care law only made a bad situation worse by trying to solve problems that were created by government intervention with more government intervention.

Health care comprises nearly a fifth of the American economy. The notion that central planners in Washington can somehow better manage it than the millions of health-care consumers and providers who constitute the market every day is so delusion that the collapse of the Soviet Union should have put it to rest entirely.

Yet America attempted programs premised on the same notion if executed on a smaller scale before. Medicaid, Medicare and an array of smaller health-care entitlements combined accounted for half of all medical spending in the United States before the Democrats enacted their reform measure which will all but destroy the limited free market that still existed in health care and insurance.

That is not to say that American health care was fine before March 2010 but many of the problems associated with it were the government’s own doing.

After creating two health-care entitlements, one for seniors and one for the poor, in the mid 1960s, public health-care spending soared to such an extent that Congresses repeatedly intervened with price controls and regulations to try to control costs. Meanwhile, the more fundamental impediments to competition and efficiency were ignored.

Americans can buy health insurance policies only from companies that are licensed by the states in which they live. There is no nationwide insurance market, let alone foreign competition.

State governments, moreover, mandate that insurers cover all sorts of treatments that the consumer may not require nor wish to buy, including prenatal and psychiatric care. In most states, it is impossible for a person to insure himself again medical catastrophe alone.

With Obamacare, it will be impossible across the country because it, too, forces insurers to offer a basic plan that covers ambulatory services, hospitalization, maternity and mental health care as well as rehabilitative services.

Health insurance costs can only rise as a consequence. The administration and others proponents of the health reform measure have pointed out that millions of Americans were uninsured and people with preexisting conditions denied coverage before the law came into effect.

As recent as 2001, just 1 percent of Americans reported to have ever been denied health insurance. If they had preexisting conditions, they were probably charged higher premiums but this isn’t unfair. Premiums that are based on risk incentivize people to buy insurance while they are healthy and encourage insurance companies to develop innovative products that protect against the risk of rising premiums. The real problem, again, was created by government when it tried to provide people insurance through their employer. This denied consumers choice and further undermined competition.

It’s not just the health insurance market that’s limited by mandates and perverse tax incentives. Providers of health care, too, can only operate with a state license and states typically require a licensed physician to carry out procedures that an experienced nurse can otherwise perform without supervision. Because a doctor is more expensive than a nurse, the costs of treatment are far higher than they would be if care were unregulated.

In both health care and health insurance, the laws of supply and demand do not apply because government rations the supply on many levels. With Obamacare, it will even ration specific procedures if they are deemed too costly. At the same time, demand is rising. No wonder costs skyrocket!

Democrats insisted that Obamacare would somehow reduce the federal deficit by $1 trillion but it bankrupts the states.

Half of all the net gain in insurance coverage will be due to higher enrollment in Medicaid, including its Children’s Health Insurance Program. Medicaid is administered by the states but federally funded. Obamacare forces the states to cover all persons with incomes up to 138 percent of the poverty level and prohibits them from setting their own eligibility criteria at the risk of losing their entire Medicaid funding.

The federal government will pay the increased costs until 2016 after which date the burden is gradually put on the states. Already, Medicaid costs, which are rising at more than 7 percent per year, are crowding out state investment in education and infrastructure. The additional costs will devastate state budgets unless they raise taxes substantially or chose to leave their poor without care entirely.

There is no way of salvaging whatever “good parts” may be in the reform bill while repealing the rest. The law should be overturned in its entirely once the Supreme Court rules the individual mandate unconstitutional. That should only be the start of a comprehensive deregulation of American health care and health insurance. Doing away with Obamacare will only bring back a system that was in need of repair. What’s needed is not more entitlements and “rights” but fair and free competition.