LETTERS TO THE EDITOR
Saludos from San Antonio,
Nanette & Antonio Enciso
In the discussion about Obamacare started by Ken Crosby’s December article in El Ojo “Obamacare Is A Bad Law”, I came across this passage from Trevor Burrus’ introduction to a newly published book titled “A Conspiracy Against Obamacare: The Volokh Conspiracy and the Health Care Case” I thought relevant to the discussion.
Burris writes “Some argue that the inefficiencies of America’s pre-ACA [Affordable Care Act] system demonstrated that free-market mechanisms do not work for health care. This is an odd thing to say about a system that essentially lacked two of the most important qualities of a market: meaningful prices and fluid consumer choice. ... The predominance of the insurance model of health care, as well as the growth of Medicare and Medicaid, helped create a literally ‘priceless’ system.”
“The ACA took the dysfunctional parts of our former system-particularly the persistent, incorrect, and damaging belief that health insurance is the same as health care-and made them worse. The act tries to create the functional equivalent of a single-payer system-mandatory coverage for the sick at no cost to them with the extra funding coming from healthier citizens-and wrap it in the patina of a market. By using the trappings of a market, lawmakers got many bonuses. Not only were they able to sidestep the criticism of a ‘government takeover of health care,’ but they were able to hide the true cost of the ACA, an enormous political win.”
To Burris’ analysis I would add that the obscuring and obfuscation of the various costs paid by consumers will increase resistance to any future reforms, and benefit lawmakers and politicians who champion the status quo.
The resistance to Social Security reform is due to similar hidden costs: mixing actuary based pension costs and benefits with government mandated increases in benefits and beneficiaries, that make Social Security unsustainable in the long term.
Mandating healthy insureds to share the higher costs of sick insureds is the equivalent to a hidden tax. Only because insureds are able to compare pre-ACA with ACA premiums, is this hidden tax revealed and obvious. This hidden tax artificially inflates the number of insureds eligible for a government subsidy, and if the hidden tax were not included in premiums, many of the 26 million in households earning up to $94,200/year who are eligible, would no longer be eligible. For many of those still eligible, the subsidy would be substantially less. Neither group would actually pay more, but for insureds who would become ineligible, or choose to not accept a subsidy, they would avoid any stigma they may feel about receiving government assistance, and they would not feel beholden to lawmakers and politicians who promise to maintain the status quo.
Rational reform would empower health care consumers, increase consumer choice, eliminate mandates, revert insurance to actuary based insurance, revert pensions to actuary based pensions, and any government subsidies should be decoupled and separated out to reveal their true costs and number of beneficiaries.