ObamaCare and My Cognitive Dissonance Moment

Liberals, rejoice; conservatives, despair: After what felt like an interminable, mind-numbing debate, Barack Obama's signature health reform bill is the law of the land. And sadly, we as a country are probably in for months and years of continuing debate, not to mention lawsuits challenging the law's constitutionality and entire political campaigns devoted to upholding or repealing the most significant piece of social engineering legislation of our time. What a dreary prospect.

It's been an exhausting national debate, not least because the various bills, the final law and the underlying issues are so complex and detailed. I've opposed the basic plan all along, on constitutional, philosophical and economic grounds. But now that it's passed, I'm not here to rehash those arguments yet again. Because, having followed the news coverage of congressional Democrats celebrating their legislative victory, I realized I have a much more basic problem with ObamaCare: It makes my head explode.

To elaborate on that a bit, I cannot reconcile the things I hear liberals say about this legislation with other things I hear liberals say about this legislation. For months now, I've been listening to Barack Obama, or Nancy Pelosi, or another Washington Democrat make certain claims about health care and health reform. I hear those claims, and I say "Uh huh...," and then Obama, or Pelosi, or Senator Whoever immediately goes on to conclude something that makes me go "Huh?" It's gotten to the point where no amount of aspirin can cure the headache this causes me.

And so, rather than delving into the minutia of the law, I humbly submit the following list of basic claims about health care reform that I, personally, cannot hold in my mind simultaneously without suffering severe cognitive dissonance. Or a massive stroke.

1) "The present health insurance system is dysfunctional (uh huh...). We need to make sure everyone in this country has health insurance! (huh?)

So health insurance is outrageously expensive, maddening to access and bad at actually doing the things it's supposed to do? And this is a reason to expand it to an additional 30 million people? This isn't evidence that it's a bad system that we should have gotten rid of years ago? This doesn't cause Democrats to pause and ask, "Hey, maybe the reasons the current system sucks for the people who have health insurance are related to the reasons other people don't have insurance at all"?

2) "Our country is facing a serious fiscal crisis due to the unfunded liabilities created by government entitlement programs. (uh huh...). So we need to create a new, bigger entitlement program! (huh?)

I know, it sounds crazy, but I didn't say it. Obama said it: "Make no mistake: health care reform is entitlement reform."

Previous entitlement programs, mostly Social Security and Medicare, are threatening to bankrupt our government, so we need to cut them and put the money into a new entitlement program that's available to more people? Once again, the first part of the statement sounds reasonable: the federal government's current unfunded liabilities (that is, the value of the future benefits it has promised to pay but won't have the funds to afford) is $43 trillion. Toss in the national debt of $12.5 trillion, projected future deficits and some other liabilities, and our country is in a $62.3 trillion hole.

Yet somehow, the solution to entitlement spending is ... entitlement spending? Despite a proven track record of previous entitlement programs growing far beyond our capacity to pay for them? I can just hear the earnest, liberal policy wonk going: "But this time it'll work...!"

(And in case you were wondering just how much money $62.3 trillion is, the total value of everything produced by our entire economy in 2009 was $14.2 trillion. In individualized terms, that would be equivalent to a worker earning $50,000 with debts of $219,366.)

3) This one might be my favorite: "We're going to force insurers to cover people with expensive health problems at the same cost as everyone else (uh huh...), and health insurance is going to become more affordable." (huh?!?)

This, in essence, is what Obama's plan boils down to: Somehow we're going to make sure that the people who need medical care the most are going to get it, while still making sure that insurers stop ripping off the rest of us by keeping costs under control. Both halves of that goal are perfectly noble in and of themselves, but they are what logicians call "mutually exclusive." You can have one, or the other, but not both together. Say, did somebody mention something about baking a cake, eating the cake, and then still having the cake?

I think there might be a 4) and a 5) somewhere on this list, but for the sake of my own (mental) health, I should probably stop there. Besides, I've got a cake to bake.

I Never Thought I'd Say This...

...but for once in my life, I agree with Joe Biden.

After giving a little speech today at the White House signing ceremony for the Patient Protection and Affordable Care Act, the vice president turned to his boss, and said, into a live microphone, "Mr. President, this is a big fucking deal."

Chalk it up as yet another of Joe Biden's seemingly endless string of public gaffes (though it still doesn't top my all-time favorite).

Still, this one is worth noting, because today the veep got it right. When you enact a law that dramatically restructures 16 percent of the American economy, on a strict partisan vote, over the objections of public opinion polls everywhere, under the veil of a massive accounting gimmick and completely unrealistic policy assumptions, relying on a series of special deals for individual lawmakers, and you cement in place the worst aspects of a seriously dysfunctional health care system, and create the legal precedent that health care is an entitlement regardless of your ability to pay for it, it's a really big fucking deal.

You hit the nail on the head, Joe.

Bam!

Just in case anyone was in need of a refresher on why Obamacare is a horrendous idea that will only exacerbate the problems with the American medical system rather than solving them, here it is.

Apparently it takes Democrats in Congress 2,000 pages to further undermine our health care system, but a columnist at humble little Reason Magazine can debunk their plan in about 600 words. I don't know whether that's comforting or terrifying.

Suggested Reading

Last week, in need of some reading material to pass the relative tedium of riding a stationary bike in my local gym, I spied a back issue of The Atlantic, a magazine I never read. Plastered across the cover was the headline, "What Washington Doesn't Get About Health Care," above a photo of a pensive (or even confused-looking) Barack Obama. On a whim, I picked it up.

And never has a chance encounter with a piece of nonfiction writing paid greater dividends than did columnist David Goldhill's comprehensive, illustrative discourse on everything that is fundamentally wrong with our country's health care system, and how the so-called "reforms" being pushed by Democrats in Washington would effectively double-down on a bad bet by expanding the current system.

Goldhill asks the basic questions that never got answered when Harry Reid, Nancy Pelosi and other liberals in Congress started writing their thousand-page bills to revamp health insurance. "How often have you heard a politician say that millions of Americans 'have no health care,' when he or she meant they have no health insurance?" Goldhill inquires.

From that simple observation, he proceeds to demonstrate why modern health insurance is the problem, not the solution, to the hyper-expensive, often shoddy treatment Americans pay for every day. Liberals harp endlessly on the 40-million Americans without health insurance, and they constantly blame "the insurance industry" for the high costs and poor service experienced by the hundreds of millions who do have insurance.

But they never bother asking why no one likes their insurance. Goldhill does, and more importantly, he provides answers that go beyond facile charges of corporate greed. That someone can so coherently apply some basic Economics 101 to the multi-trillion dollar boondoggle that is American medicine, and explain the problems in plain language, is incredibly encouraging to someone such as myself, who's been arguing all along that paying for health care with health insurance makes utterly no sense.

And in case you're wondering, David Goldhill isn't some weird, right-wing fringe anarchist who blames government for every social problem. In fact, he is a self-declared Democrat with an obvious concern for our country's poorest citizens. But unlike Democrats in Congress, he brings a businessman's eye for rational, conceptual analysis, backed up with the data to make his case.

So, if you have 45 minutes and want a real explanation of the single largest problem facing this country, I implore you to give him a try. You won't regret it.

ObamaCare: An Offer You Can't Refuse

I happened to catch the president today on CNN, telling a townhall meeting of New Hampshire voters that the health care plan everybody loves to hate really isn't that controversial. New "exchanges" will allow the uninsured to buy health insurance, and new rules will bar insurance companies from denying coverage to those new customers, even if they have preexisting medical problems.

Sounds reasonable enough. And in return, the president assures us the government is simply going to "ask that everybody get health insurance." What a nice guy! How could we angry voters say no to a deal like that?

Except apparently, Obama's definition of "asking" differs from mine, because both health reform bills currently stuck in Congress require virtually everyone to buy health insurance, or face steadily escalating fines in coming years.

If this little nugget of coercion sounds familiar, you might be remembering it from the 2008 presidential campaign, when a candidate named Barack Obama criticized his chief Democratic rivals for supporting an "individual mandate" that would force all Americans to buy health insurance. According to candidate Obama, "A mandate means that in some fashion, everybody will be forced to buy health insurance. ... But I believe the problem is not that folks are trying to avoid getting health care. The problem is they can't afford it. And that's why my plan emphasizes lowering costs."

Flash forward a year, and President Obama has apparently had a change of heart, telling CBS news that "during the campaign I was opposed to this idea ... [but] I am now in favor of some sort of individual mandate as long as there's a hardship exemption."

I think it's fair to say that the term "flip-flop" will die with John Kerry, but still, that's quite a turnaround on an important issue. But hardly a surprise, since anyone remotely acquainted with basic economics can tell you that "universal" health insurance breaks down if you don't force healthy people to buy it and pay the insurance premiums that underwrite the medical costs of insuring the sick. Nobody right, left or center argues that simple fact.

Of course, quite a few conservatives and libertarians on the right argue that government has no business, or constitutional authority, to tell citizens to buy a stick of gum, let alone health insurance. House Speaker Nancy Pelosi neatly summed up the left's response to this objection recently when a reporter asked her if she believed the Constitution gives Congress the power to mandate health insurance, responding: "Are you serious? Are you serious?" Good comeback, Nance.

Since I'm already on record as opposing the mandate to buy insurance on constitutional grounds, and since Nancy Pelosi doesn't care what I think, I won't belabor the point further. However, the Obama-Pelosi mandate does entail one rather bizarre consequence that gets too little attention.

Health care, the president and his backers declare, should be a right for every American, and universal health insurance is the mechanism for upholding that right. But universal health insurance doesn't work without a universal mandate, so our participation in this plan will not be optional.

Ponder that for a moment. Because the rights enumerated in the Constitution -- the right to speak and worship freely, assemble peacefully, vote, etc. -- share an important similarity: in each case, the Constitution protects these rights by prohibiting the government from interfering with them. The Constitution says you can speak as you please, own a gun, and go to whatever church you want; but it makes no provision forcing you to do any of those things.

The newfound right to health insurance, if enacted, would become a first in our history: a right that cannot be refused. What you choose to do with every human right enshrined in the Constitution is your business; when it comes to Democratic health reform, you have the right to do what you're told.

Quick Hits

I'm sure I'll have more to say about the recent upset election in Massachusetts, but for now, I offer you a quick rundown of my favorite left-wing reactions to - and explanations for - the sudden threat to their plan for "reforming" health care.

From The New York Times' editorial writers: "To our minds, it is not remotely a verdict on Mr. Obama’s presidency, nor does it amount to a national referendum on health care reform..."

No argument here. I fail to see how a Senate election in which 49 states' voters were ineligible to take part could possibly constitute a "national referendum." Note to Times editors: It doesn't count if you win an argument that nobody's having.

From Times op-ed writer Timothy Egan: "In famously well-educated Massachusetts, it cannot be said that the voters were stupid."

You know, as opposed to all those stupid states whose votes shouldn't count.

From University of Maryland Political Communications Professor Trevor Parry-Giles: "Other things intrude, like the Christmas Day terror attack, Haiti, anxieties about the economy."

Yeah, sometimes when a natural disaster strikes in some foreign country and inflicts terrible loss of life, I suddenly change party affiliations right before a crucial Senate election. It's the darnedest thing.

From Rep. Patrick J. Kennedy, D-R.I.: "The problem isn't our message. It's the messaging of the message that's the problem."

Translation: I don't want to be in Congress either!

Wrong on Rights

If, like me, you weren't quite able to drown your health care socialization sorrows in food and drink this holiday season, enjoy this small palate cleanser, courtesy of Reason.com's Jacob Sullum.

Amid the feckless rhetoric that has marked this fall's long, dispiriting slog toward some form of government health care "reform" ("Death panels!" "Evil insurance companies!"), it was rather refreshing to find a cogent, compact, philosophical challenge to the notion that health care is suddenly a "right" that "everyone" is entitled to. That assertion, as espoused by Barack Obama, Harry Reid, et al., represents the starting point for every left-wing argument in favor of government-run health insurance, and the key to understanding why mainstream liberals take genuine offense at the notion that the provision of medical care might have some connection with paying for said.

Without poaching on his argument too much, Sullum raises the basic objection that any opponent of government-provided health insurance ought to start with: That for much of human history, "health care" was non-existent. Only the technological advances and material prosperity achieved in the last few hundred years have made meaningful health care a possibility for some, let alone for all, of humanity. "Health care" would have meant nothing to a Stone Age mammoth hunter or a 15th Century Russian serf, because they lived in worlds incapable of providing it, at any price.

So how exactly, Sullum asks, can we assert a right to something that until relatively recently, did not exist? And if we can do that, what does this imply about our right to future goods that do not exist yet? Do I have a right to eternal life if scientists ever discover a way to achieve it? If so, do I have the right to force you to pay for it? Did I have these rights all along, without knowing it?

Anyway, read for yourself. It's a wonderful, if concise, commentary on the nature of "rights," and what constitutes a right. Two thousand years ago, men like Aristotle took great pains to weigh these questions and define their terms. Sadly, the men who rule us today do not burden themselves with such circumspection.