If It’s Broke, Don’t Break It

Republicans have been promising to repeal Obamacare for seven years, as well they should—it is a terrible law, it makes the American health insurance industry more dysfunctional and less stable, it has jacked up the price of health insurance for countless people, it is obviously unconstitutional regardless of the twisted pretzel logic of the Supreme Court, and it is fairly obvious at this point that it was always intended to be a stopgap measure, nothing more. Democrats are terminally incapable of telling the truth when it comes to policy, and what they didn’t tell you is this: the entire point of the law was simply to move us a little closer to single-payer healthcare, i.e. total government control of the health care industry and thus an enormous part of the economy and society.

So,  now that they’re in control of the House, the Senate and the White House, how do Republicans plan to scrap this awful legislation and put America on the path to a healthy and functional health insurance market? How?

House Republicans on Monday released long-anticipated legislation to supplant the Affordable Care Act with a more conservative vision for the nation’s health-care system, replacing federal insurance subsidies with a new form of individual tax credits and grants to help states shape their own policies.

Under two bills drafted by separate House committees, the government would no longer penalize Americans for failing to have health insurance but would try to encourage people to maintain coverage by allowing insurers to impose a surcharge of 30 percent for those who have a gap between health plans.

Do tell. Here is an honest question: why do we treat health insurance this way? Put another way: how come even the nominally small government conservatives in Washington feel compelled to “encourage people to maintain [health insurance] coverage” by way of “surcharges” and “individual tax credits and grants?” Why, after all, don’t we treat car insurance the same way? For that matter, how come we don’t treat every industry the same way? Why don’t we have tax credits that apply toward insurance covering the purchase of food, and computers, and barbells, and nylon pantyhose, and—well, everything? Why is it that, in contrast to most other areas of the economy, we feel the need to make the health insurance industry so stupidly complicated and so aggressively policed by government policy?

There is a common response to this question, mostly from people who want to control your medical choices to some degree: “Health care is different! It’s not like other products! It has to be regulated!” Always implicit in this response is the assumption that the health care market is an insanely volatile industry, that people by-and-large have no control over their own health, that the primary mode of health care consumption is one of emergency and exigency and desperation. “You can’t shop for health care when you’re having a  heart attack in the back of an ambulance,” people insist.  So it is assumed that (a) people must be compelled to buy health insurance, because otherwise they’ll have no way to pay for health care, and (b) people must be given financial help to purchase health insurance, as it is so expensive.

Both of these assumptions are deeply flawed. The first is wrong on the merits: genuine emergency spending accounts for a vanishing fraction of total health care expenditures in this country. There is, of course, the unstated presumption that we should use our insurance all the time, to pay for routine doctor’s visits, checkups, scheduled prescriptions and the like—but this is a profoundly stupid model of healthcare, one we should be moving away from as fast as possible. Anybody who believes that we should (or must) be using a third-party payer system to finance yearly physicals and oxybutynin scrips is not a serious thinker and should be ignored as a matter of policy: they are arguing from a position of static paralysis, insisting that the way things are is the way they will ever thus be. We should be encouraging and developing systems of direct billing and direct primary care in this country, and returning health insurance to its rightful place in the health care economy as a payment method for catastrophic events, nothing more.

As for the second notion—that we must construct an idiotically byzantine system of tax credits and tax breaks and subsidies and block grants and bursaries to help people pay for health insurance—we must ask ourselves: “Why is health insurance unaffordable in the first place?” The unserious thinkers, the ones you really need not be paying attention to, insist that this has always been the case and always will be the case. But this isn’t true. Our own radically unaffordable system of health insurance (and health care more generally) is the result of (a) a series of stupid government and progressive policies that have driven up the cost of health insurance, and (b) a health care industry that has come to rely almost entirely on health insurance to pay for at least part of just about every single medical procedure or undertaking, be it a major operation or a butt wipe in the Patient First bathroom. Bad government policy and systemic overuse: two factors guaranteed to drive up the price of anything. We treat no other industry even remotely like this: there are no co-payments at the grocery store, no insurance cards for buying televisions, no UCR charge for buying an ice cream cone. Have you ever wondered why it’s just assumed that you’ll have someone else pick up at least part of the tab when you go in to see your doctor about a nonemergency concern? Have you ever wondered if there might be a better, less foolish and more efficient way to manage your health?

Well, there is. And yet it is a testament to the entrenched thinking of modern health care policy that the Republican Party—a political machine in power largely because it promised to fix our miserable health care system—is refusing to consider anything more radical than tweaking the tax code and signing off on a surcharge or two. To really fix health care in this country—to make health insurance and health care more affordable and accessible—we’re going to need a lot more than that. The odds that we will get it anytime over the next four years, if ever, seems very low.


  1. j n

    Exactly, the government needs to rewrite what a minimum policy covers. I had a BCBS policy that did not cover office visit, unless I needed something out of the ordinary. No scrip coverage, $1500 deductible,$220 per month when ACA started. Way better than whats available now.

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