So, I was wrong with my prediction on the ACA. I was correct that if the mandate went down, all of it would go. But Chief Justice Roberts agreed that the mandate acts as a tax. Okay.
There are still other problems. Eugene Robinson highlights them, although not intentionally.
The political impact of Thursday’s stunning Supreme Court decision on health-care reform is clear — good for President Obama and the Democrats, bad for Mitt Romney and the Republicans — but fleeting, and thus secondary. Much more important is what the ruling means in the long term for the physical and moral health of the nation.
I find the idea that this is an improvement to our nation’s “moral health” ridiculous and offensive. It’s the simplistic view that opposition to the ACA is opposition to the claimed goals. It’s the pretense that opposition is founded on an “I got mine, so screw you” idea. It’s hackish. Opposition guarantees no such intention, and maybe I’m foolish, but granting the government more power to use force against individuals is hardly an improvement in our moral health.
All but lost in the commentary about the court’s 5 to 4 ruling, with Chief Justice John G. Roberts Jr. unexpectedly joining the majority, is that the Affordable Care Act was intended as just a beginning. We have far to go, but at least we’re on our way.
Obama’s great achievement is not any one element of the health-care reform law — not even the now-upheld “individual mandate,” which compels individuals to have health insurance or pay a fine. The important thing is the law’s underlying assumption that every American, rich or poor, should have access to adequate health care.
But that’s not the issue. The important thing is how well the law will achieve its aims. Will it? Which unintended consequences will result? What will it cost in trade-offs? Early evidence suggests a strong “no” for the first question, which should raise further concerns about questions two and three.
Here, we don’t even get to the first question. Mr. Robinson is endorsing the Do Something theory of government. This is Something, so it must be good. It’s untethered from outcome. We’ve merely expressed the right feelings that every American should have access to adequate health care. That isn’t a solution to a problem that exists in large part because of previous feelings-premised public policy solutions. The ACA is not the only way to try to achieve the real goal of reform and improving health care access and outcomes. The ACA merely doubles down on the existing structural problems. When government is failing, ordering more government is hardly a credible solution.
As I wrote in my prediction, tying insurance to employment is inefficient and stupid. Our current unemployment rate is an excellent indicator of a flaw in the policy. Mr. Robinson gets at this:
Most working-age Americans who have health insurance obtained it through their employers. But this is a haphazard and inefficient delivery route that puts U.S. businesses at a disadvantage against foreign competitors, most of which shoulder no such burden. Tying health insurance to the workplace also distorts the labor market and discourages entrepreneurship by forcing some employees to stay where they are — even in dead-end jobs — rather than give up health insurance.
With this acknowledged, it appears the only way to endorse the ACA is to focus on the important thing, the good feelings. The ACA will work to untie insurance from employment, but only because it makes the burden of employer-provided insurance so onerous. It pushes people into public options. That’s aiming for single-payer without having the political courage to admit the aim. Such lack of courage does not suggest good outcomes when the inevitable financial crisis from the ACA results. And now, because this reform was so ham-fisted and clueless, no one will have the political capital necessary to reform the reform.
Rather than seek a radical reshaping of the health-care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured — about 30 million — but still not all. He also tried to use free-market forces to “bend the curve” of rising costs, slowing but not halting their rise.
The ACA doesn’t try to use free-market forces. It attempts to manipulate them, at best, and pretend they don’t exist, at worst. It’s the idea that prices can be mandated, that supply and demand are fully malleable with political will. It’s neither an honest nor an intelligent attempt by the Congress and President Obama. It will fail. The only questions are how soon, who will be harmed, and what will we do in response.