Some of us remember the Democrats’ claim during the Obamacare debate that “if you like your health insurance plan, you can keep it.” The claim was made as part of a “compromise” position in which the Democrats gave up on a “single payer system.” That is, in order to get enough votes to pass their program, the Obama Administration and its supporters agreed to not insist on an actual government run healthcare system—right away. Americans have always been shy of terms like “socialized medicine” and “social democracy” because such terms make clear that we are giving up our liberties in exchange for a nanny state that promises to take care of all our needs. Unlike our more “progressive” cousins on the other side of the Atlantic, we still take pride in the idea (if not the reality) of taking care of ourselves, and so fear the appearance of owing our well being to the government.
American independence has been increasingly illusory for decades. And Obamacare is in the process of putting the illusion to rest once and for all. I’m not saying, here, that Obamacare is a piece of “stealth socialism.” There is little stealth to it, and, sadly, Americans may well continue denying the truth that we are living in a social democracy long after Obamacare and its consequences (some intended, some less intended than inevitable) have made the difference between a social democracy and a cradle-to-grave welfare and administrative state merely rhetorical.
In another sense, the claim that we may “keep” our own health insurance will always be true. One thing we know about socialized medicine in Europe, like government run programs everywhere, is that they don’t apply to the rich. So, if you have enough money, you will be able to buy your way out of the system. As for the rest of us, things are moving a bit faster than even the Obama Administration had intended. A little-noticed but quite important observation was posted awhile back over at instapundit. In it, blogmaster Glenn Reynolds relates the observations of a former colleague, Colleen Medill, who is a lawyer working in the area of ERISA or employee benefits. Ms. Medill has been communicating with lawyers advising firms of all sizes and wealth on what to do with employee health benefits in the face of Obamacare regulations. Her conclusion?
“It has become very clear to everyone involved who is analytical and not ideological that the rational strategy, for both large and small firms, is to cease providing health care insurance to employees.” No company wants to admit that they are considering eliminating employee health insurance from their benefit plan, “but once a competitor does so, the preference cascade will begin. The clear sentiment is ‘We will not be the first one to drop our health insurance plan, but we would be a close second.’”
Why hasn’t this coming revolution in our economic system been widely noted? Because the Obamacare legislation is so insanely complicated that “only $800+ an hour ERISA attorneys and the most sophisticated HR people understand how Obamacare really works.”
People haven’t caught on to the coming demise of employer-provided health benefits for the same reason that this demise is inevitable: because Obamacare is so impenetrably complex and onerous that it is all but impossible to understand or administer, and so clearly not worth the cost for employers to provide. Medill’s conclusion, here, seems clearly true. Less convincing is Ms. Medill’s take on the political implications of this situation. She sees Democrats as being in terror of the oncoming cascade of medical benefit eliminations because it will show the lie to their claim that regular people would be able to keep their own health care plans. Ms. Merrill’s view of Democrats’ fears fails to ring true for the simple reason that the consequences of Obamacare were rather obvious to most people from the start. I’m not saying that every Democrat who voted for Obamacare saw it as a stalking horse for socialized medicine. But we should keep some things in mind: first, most liberal “policy experts” wanted a government (“single payer”) healthcare system and only settled for Obamacare’s hyper-regulated “markets” out of political necessity; second, at a certain point hyper-regulation makes socialization not only inevitable, but a necessary means of rationalization and simplification.
Some Democrats may be concerned that people will be angry with them for taking away their doctors and insurance plans, but that was a problem they sought to mitigate, not avoid, through hyper-regulation. And when the end comes the Obama Administration will simply blame “greedy employers” and pledge to “fill the gap” with expanded government services. Moreover, the logic of Obamacare, that somehow everyone can have affordable healthcare if only everyone is forced into the system, is the logic of univeralism, meaning nationalization, whether fulfilled in one step or many.
Nor is the push for nationalization a purely Democratic phenomenon. Republican governors are doing their part to “universalize” (or at any rate nationalize) healthcare by falling for the Medicare bait like the dumbest fish in the pond. Of course, New Jersey’s Chris Christie signed on to the Medicare expansion; but he proved his only concern is the popularity of Chris Christie when he sold out Mitt Romney for the mere appearance that he might get some extra federal assistance after Hurricane Sandy. Other, supposedly more conservative governors (Kasich in Ohio, Scott in Florida, Snyder in Michigan, and at least two others) have followed suit, convinced that three years of federal funding for an expanded government healthcare program is “too good to pass up.”
This calculation assumes that the federal government will actually provide the funding for those three years. But what do even these pillars of integrity believe will happen at the end of that time? Will we all decide to go back to saner, more financially and socially responsible programs? Of course not. Everyone will expect that the system will continue and expand, and that the federal government will be in charge.
Florida’s Scott, in announcing his sell out, called it a “compassionate and common-sense step forward,” referencing the “poor and helpless” he says will benefit. A step forward toward what? Compassionate in what sense? Of course, the “progressive” answers remain the same as always: a step forward toward universal benefits, guaranteed by the government. Compassionate in the sense of entrusting the government to take care of us all, and take from our shoulders the responsibility to care for the less fortunate among us.
The jump from recognition of human dignity to the demand for state-guaranteed healthcare is a long one. And it leads over a cliff into a state run system that forces people to give up control over their lives, forces doctors to give up control over their vocation, and leaves millions of people with lousy medical care while costing billions in waste. It dehumanizes everyone in the process, and undermines, yet further, the social institutions in which people can actually find human dignity.
The feckless dream of a system in which one’s ability to pay has nothing to do with the quality of one’s healthcare will simply result in a system in which all but the rich get lousy healthcare, and in which there is a certain equality in that incompetence and shortages will impact (non-rich) people in a more random fashion, hitting many more people, though not on the basis of income. The sad thing is that many people really do believe that government guarantees of pro-forma care really do constitute a system that is fairer than one in which community and charity hospitals care for people who can’t pay for themselves.
Obamacare will result, sooner rather than later, in a two-tiered system, in which the rich can buy quality healthcare, and in which the rest of us will spend increasing amounts of time waiting in lines for care that we would today call substandard, but which the government will define as the new standard. It rests on the increasingly prevalent fantasy that political structures can take the place of human virtue—that we can have a “program” that makes it unnecessary for us to take care of one another in the institutions of our local lives. The transition to a socialist (“government run” if you prefer) system became inevitable when Americans decided that a nation, as a political system, has a right to decide that no one should be “left behind,” rather than it being our duty as people and communities to care for our neighbors.
The result is progress—in a direction we ought not to be going.
This column first appeared March 5, 2013 on The Imaginative Conservative website and is reprinted with permission.