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August 14, 2014

The “Opportunity” To “Co-Opt ObamaCare” And The Lies We Tell Ourselves

When last we met former Romney advisor and conservative health policy expert Avik Roy he presented the broad outline of a “conservative” alternative to ObamaCare (first problem with it…conservatives needed to embrace the progressive dream of universal coverage).

Now he’s back with the full plan and it’s…we’ll here’s Philip Klein’s summation.

And on Wednesday, Roy unveiled a detailed reform proposal he estimates will insure 12 million more Americans than Obamacare by 2025 while bringing down premiums, reducing deficits by $8 trillion over 30 years, and making the pre-existing entitlements of Medicare and Medicaid fiscally sustainable.

Quick side note…I’ve invented a perpetual motion machine that will provide all the world’s power needs for free. So that’s nice.

And what do we have to do to realize this utopia we are being granted? Not much.

The Plan would repeal many of the ACA’s cost-increasing insurance mandates, including the individual mandate. But it would preserve the ACA’s guarantee that every American can purchase coverage regardless of preexisting conditions. And it would utilize the concept of using federal premium support subsidies, on a means-tested basis, to defray the cost of private health coverage.

Hmm, that seems like a problem since you know, those are the things driving the costs of ObamaCare and all.

This is how liberals win. They spend decades trying to get something and conservatives stop fighting against it and start trying to “make it work” six months later. There’s no longer any argument about whether or not we should be doing what liberals want, just how we should be doing it.

Oh sure there are really smart ways all of this will be off-set and we’ll make it up in volume or whatever (most of them, like the Medicaid and Medicare reforms are political non-starters with Democrats who will pocket the coverage expansion and never pony up the reforms). Look, I’m not going to pretend that I’m competent to get in the weeds on this. What I and anyone who has been paying attention to American in the last 80-100 years is competent to tell you is any big government plan to fundamentally run large and important parts of the economy and people’s lives is doomed to fail.

Conservative experts are no smarter than liberal ones when it comes using public resources to rearrange society to their liking. They simply cannot account for all the variables that comes from a large and complex system like a nation of 300 million plus people. And as unexpected situations and reactions arise they will simply insist the solution is just another government tweak here and a little more power there. Rinse, lather and repeat until you have a huge, expensive and ineffective government program that consumes massive amounts of resources while providing at best a mediocre product.

Hey, it’s not that technocratic solutions won’t work, it’s just that they haven’t been tried by the right technocrats!

I’m sure policy wonks will sneer at this attitude and say it’s anti-intellectual. That’s fine. I sneer at their arrogance in thinking they will succeed in harnessing society to their will where others have failed and that the laws of nature don’t apply to them.

Here’s the dirty little secret politicians and health care wonks either won’t admit or only acknowledge silently to themselves in the dark of night…you can’t provide health insurance and health care services to people who can’t afford it without bankrupting the country and/or redistributing money and access from those who would be able to afford it under normal circumstances. And once you start providing “insurance” to people who have conditions that will lead to claims before they pay any premiums and those premiums are unrelated to the health care they will consume, you have created something that isn’t actually “insurance”.

If as a society we want to provide these products and services to people who cannot afford them, let us be honest about what we are doing here….enforced charity. Let’s just call it that and get on with the business of redistributing money and resources from those who have it to those who don’t in the most direct way possible.

That’s the essential truth of ObamaCare. We are rearranging the health insurance and care system for the vast majority of Americans in order to deliver Medicaid to another 7 million or so people. A naked expansion of Medicaid was an impossible political sell so we got all sorts of fairy tales about families saving “up to $2,5000 per year” that never materialized but it was the lie that helped sell the real goal…move people onto government insurance.

Roy’s plan (see it here) is more market oriented than ObamaCare but that’s not exactly a high bar to clear. Eventually though it will collapse under its own weight and lead to greater government cost and interference because it’s promising to do the impossible…provide a free lunch.

This is the same philosophical problem I have with Paul Ryan’s welfare reform ideas. They both presume a level of government competency, agility and responsiveness that has never been displayed in all of history. Just because they are smart guys who say they want to do conservative things doesn’t mean they will have any more success in getting government to function like a private enterprise. It’s simply the nature of government to be inefficient, unresponsive and inadequate to the task of improving people’s lives. Like trying to use a saw to tighten a screw, it’s simply the wrong tool for the job. Until we can admit this, we're running down the wrong road.

But politicians and experts who want to use government to test out their pet theories will simply not admit this fact. It makes them less important or even irrelevant.

So what should we do? Ideally we’d repeal ObamaCare and simply let an insurance market develop without government input or interference. Short of that, I’m starting to come around to the idea of some sort of "guaranteed income". I don't think it will be any more effective in changing people's lives but it'll be cheaper and cleaner. If we’re going to spend all this money on welfare for people, let’s stop pretending the government can spend it well. Some people will use their money on crack and hookers, others will invest in the tools that will lead to a better life. Either way, we shrink the government and make people live with the consequences of their decisions.

In the last few years I’ve gone from a conservative who identified as a Republican to a conservative but am rapidly moving to libertarian. Sure the libertarians are crazy about a lot of things but at least they don’t pretend to have all the answers in the face of decades of evidence to the contrary.

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posted by DrewM. at 09:34 AM

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