Today, the Supreme Court will begin oral arguments over the Patient Protection and Affordable Care Act, colloquially known as “Obamacare”. The act was signed into law in 2010; shortly thereafter its constitutionality was challenged by 26 state attorneys general as well as a number of independent organizations. My colleague Ryan will shortly provide Yi! News readers with a summary of the act’s legal issues. I will focus on the legislation’s likely policy and political effects. In short, I believe it will be an unmitigated disaster in both realms.
First, the policy. The Affordable Care Act was Washington’s answer to two very real but misrepresented problems: lack of access to health insurance and rising medical costs. Democrats claimed that over 46 million Americans didn’t have health insurance, but this was misleading. When adjusting for non-citizens and people who could afford to buy insurance but choose not to, the number is closer to 8 million. The act also seeks to curtail ever-rising health care costs, which have increased from $256 million in 1980 to $2.6 trillion in 2010. This, of course, overlooks that much of rising health care costs have been the result of longer lifespans and improved life-saving medicines and technologies. It also ignores the fact that, according to the Congressional Budget Office, even optimistic scenarios show negligible savings in long term health care costs.
To combat these problems, the Act creates a wildly complicated scheme that took over 2,500 pages to write. (The Cato Institute’s Michael Tanner “summarizes” it here in a 70 page whitepaper.) The key provisions are as follows. First, it creates a series of state-run but federally subsidized insurance exchanges. These exchanges technically are the responsibility of the states, but talk about faux federalism: if the states do not live up to the federal government’s rigorous requirements, they lose funding for Medicare. (Much of this funding, of course, is made necessary because of the Affordable Care Act.) Many also believe these exchanges are a precursor to a single-payer, or 100 percent government run system.
Second, it requires all citizens to either purchase insurance through their employer or through an exchange. Citizens not complying are subject to fines. Companies with 50 or more employees will be fined for not providing insurance deemed “adequate” by the Department of Health and Human Services (HHS). These provisions will, respectively, put every citizen at the mercy of the federal government and discourage small businesses from hiring more employees. Finally, the act requires all hospitals to participate in an on going cost benefit analysis by the Independent Payment Advisory Board (IPAB). IPAB then instructs doctors which procedures and medications they can and can’t use. Such rationing is very real: similar programs in Britain and Canada led to increased wait times and lower cancer survival rates.
Politically, the Affordable Care Act is a step in the absolute wrong direction. America has thrived as a constitutional republic with a government that largely respected concrete limits on its power. The idea wasn’t to come up with a system that would always come up with the best outcome…that would be impossible. Rather, the Founders hoped to create a government that could not trample the liberty of its citizens. Government for the citizens, not the other way around.
The Affordable Care Act stands in stark contrast to this sentiment. Congressional Democrats and President Obama believe that it is within their authority to, among other things, compel individuals to purchase a product that they will have themselves largely designed. They also find it appropriate to regulate the relationship between doctor and patient, something which has hitherto been private.
Setting and respecting areas of life in which the government cannot interfere is vital. It prevents unsavory politicians, or those who we seriously disagree with, from making laws that adversely affect our fundamental rights. This Act, if it and its major provisions are upheld by the Supreme Court, will be a major step in doing away with limited government as we know it.