The ObamaCare Fraud

The law will penalize doctors to pay patients and penalize patients to pay doctors.

There are a great many things wrong with Obamacare, but the biggest is perhaps one that neither party is paying any attention to: It is one huge entrapment scheme that will turn patients and providers into criminals.

The most blatant example of this is in the “doc fix” that Congress passed with major bipartisan support earlier this month, saving doctors from a nearly 23 percent cut in Medicare reimbursement that they would have otherwise faced this year. Congress has been passing this fix every year since 1997, but this time, in an effort to offset its $20 billion price tag, it has included a little twist to squeeze working families called “exchange recapture subsidy.” Under this provision, the government will go after low-wage families to return any excess subsidies they get under the Patient Protection and Affordable Care Act.

When the government hands out subsidies, it will use a household’s income in the previous year as the basis for guessing what the household is qualified to get in the current year. But if the household’s income grows midyear, the subsidy recapture provision will require it to repay anywhere from $600 to $3,500, compared to the $450 that the law originally called for.

This will make it very hazardous for poor working families to get ahead. In the original law, the loss of subsidy with rising income already meant absurdly high effective marginal tax rates—the implicit tax on every additional dollar of income earned. How high? The Cato Institute’s Michael Cannon puts them at 229 percent for families of four who increase their earnings by an amount equal to 5 percent of the federal poverty level or $1,100. In other words, a family that added this amount to an income of $44,700 would actually see its total income fall by $1,419 due to the loss of subsidies.

The subsidy recapture provision—essentially a tax collection scheme—means that low-wage, cash-strapped families will have no escape from these perverse tax rates. Many of them will find themselves owing the government thousands of dollars in back taxes. Since it is unlikely that they will have this kind of money sitting around, they will face a massive incentive to either fudge their returns or work for cash to avoid reporting additional income. Either way, Uncle Sam will come after them, just as it does with recipients of the Earned Income Tax Credit, the negative income tax scheme that is the inspiration behind Obamacare’s subsidies. In 2004, EITC recipients were 1.76 times more likely to be audited than others, no doubt because it is easier for the government to recover unpaid taxes from poor people than “lawyered up” rich people. In other words, Obamacare will first create the temptation for low-income families to commit fraud, and then penalize them when they do.

But just because Obamacare sticks it to families doesn’t mean that physicians will have it good. They’ll face their own—even more draconian—crackdown. Indeed, just as Obamacare goes after working-class families to pay doctors, it goes after doctors to pay working-class families, putting everyone at war with everyone else.

The government loses about 10 percent of its total health-care spending—or about $60 billion—to “fraud” annually. Some of this is genuine fraud involving physicians—or people posing as physicians—submitting claims for services or equipment never delivered and indefensible therapies that have nothing to do with patient care. But the most common fraud allegedly involves “overbilling” by providers. Medicare’s billing codes are a complicated, convoluted mess and deciphering them can sometimes be more art than science. Naturally, doctors try and interpret them to extract the best possible payment from Uncle Sam. Both Republicans and Democrats huff and puff against “waste, fraud and abuse” in Medicare. And they have already enacted Stasi-style laws such as the False Claims Act offering nurses, patients and other whistleblowers 15 percent to 30 percent of any money recovered if they report improper billing practices by providers. But the Obama administration has attacked the matter with renewed zeal because it is a key element in funding Obamacare’s generous new entitlements.

It has created a new interagency task force called HEAT (Health Care Fraud Prevention and Enforcement Action Team) under which health-care officials will collaborate with the FBI to go after Medicare fraud. In addition, it has expanded to several cities the Medicaid Fraud Strike Force that authorizes FBI and Drug Enforcement Agency agents to jointly analyze Medicare claims data in real time to detect and investigate irregularities by area doctors.

More chillingly, however, the administration is defining Medicare fraud down to include “unnecessary” and “ineffective” care. And to root this out, it plans to make expanded use of private mercenaries—officially called Recovery Audit Contracts—who will be authorized to go to doctors’ offices and rummage through patients’ records, matching them with billing claims to uncover illicit charges. What’s more, Obamacare increases the fine for billing errors from $11,000 per item to $50,000 without the government even having to prove intent to defraud.

This is utter insanity. And it has been caused by the transformation of health care into a government-controlled industry where the natural, self-regulating forces of the market have been badly subverted. There is nothing left but the coercive apparatus of the state to keep patients and doctors in line. This would be unimaginable where the customers receiving or contracting for services are actually the ones paying for it. If Whole Foods “overbilled” its shoppers, they would just go to Trader Joe’s. No one would think of summoning the police. If a mechanic submitted unjustified bills to All State Insurance for car repairs, All State would contract with someone else. There would be no need for an FBI stakeout.

ObamaCare is pushing America down the road to serfdom, but neither its opponents nor advocates seem to have noticed. It is time for civil libertarians in both parties to wake up and strangle it before it strangles what’s left of American freedoms.

Shikha Dalmia is a senior analyst at Reason Foundation and a columnist at The Daily. This column originally appeared in The Daily Beast.

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  • ||

    I think the serfdom part is a feature, not a bug, in their eyes.

  • Bucky||

    i think tarring and feathering will making a comeback.

  • DLM||

    i think tarring and feathering will making a comeback.

    Super glue and styrofoam. Get with the times.

  • West Texas||

    This is true.

    Since some people are poor and forced to have subpar health care arrangements - and therefore be serfs of the government or of healthcare companies - our Democrat overlords think it only fair that everyone else be forced into similar serfdom arrangements in the interest of "equality".

    It's a lot easier to achieve "equality" by tearing down the people at the top than it is to bring the people at the bottom up. In fact, it's damn near impossible to do the latter.

  • ||

    But they're not aiming to help the poor on this one--that's the farce.

    They say they want to help the uninsured--but their solution is to sic the IRS on the uninsured?

    They're not even trying to help the uninsured--they're treating the uninsured like the solution! Not the problem.

    All their rhetoric is about helping the uninsured--but what they're doing is declaring war on the uninsured. They're scapegoating the uninsured.

    People have lost their jobs and they're trying to stay in their homes, and here comes the government bringing the full coercive force of the IRS to bear on them--to force them to choose to make the choice the government wants? ...and not make tough choices the government doesn't like...

    How does that help the uninsured?!

    They aren't even pretending anymore!

  • ||

    "There is nothing left but the coercive apparatus of the state to keep patients and doctors in line." Didn't you realize that was the whole point of the exercise? Eventually, everyone is going to be a patient, and with the threat of criminal prosecution hanging over your head, I am in full control. All of those old white folks at the tea party rallies--they are soon going to be getting visits from the medicare examiners, and I won't need to worry about them in 2012!!!

  • Mike Laursen||

    I know we libertarians like to ascribe such motivations, but the progressives do have the good intention of providing more people with health care.

    Yes, they are reckless and incompetent in their methods. And see the expansion of their power over people as a benign side effect, to be generous, or a feature, to be not so generous.

    Politicians, and people on general, act out of such mixed honorable/ dishonorable intentions all the time.

  • Mr. FIFY||

    IMO, the expansion of power is the primary impetus, not the provision of health care itself.

  • Mike Laursen||

    On what are you basing that opinion?

  • Bucky||

    on their actions. watch what they do, not what they say.

  • Mike Laursen||

    But part of what they are doing is providing supplemented health care/insurance to more people. By your own standard, that means at least part of their motivation is to enact this expansion of entitlements.

  • Jeffersonian||

    Entitlement expansion is the means, not the motivation.

  • Mr. FIFY||

    Mike, I am an amateur skeptic (if I were a pro, I'd be getting paid for it). Therefore, I can only surmise that any action engaged in by a politician is to either attain or gain power.

  • DLM||

    IMO, the expansion of power is the primary impetus, not the provision of health care itself.

    You don't understand. The expansion of power is necessary to be able implement to comprehensive policies to 'help' the people, and people always need more help; hence more power is always needed.

  • Bucky||

    no, you don't understand inalienable.

  • JoshINHB||

    I know we libertarians like to ascribe such motivations, but the progressives do have the good intention of providing more people with health care because progressives only care about having power over others.

    FIFY

  • Mr. FIFY||

    Same can and must be said about social conservatives, Josh, but otherwise spot-on.

  • JoshINHB||

    This meme is way overblown.

    There are a few SoCons that want a government enforced Christian nation, but they are a very small minority. In 08 Huckabee directly appealed to these people in the Rep primary campaign and was a distant third or fourth. Even in the South Carolina primary, the so con part of the heart of the bible belt, Huck only got 30%.

    Most social conservatives just want to be left alone and not have a secular agenda imposed on them by the government.

    Contrast that with progressives which are all about government mandating how everyone should live their life, whether it's salt intake, seat belts, helmets, etc. etc. etc.

    SoCons wanting a christmas display at city hall is not equivalent to progressive totallitarianism.

  • Mr. FIFY||

    Joah, I don't mean to imply that every single so/con wants to run the lives of others, but IMO they are only slightly better at *not* wanting that than liberals. OTOH, not every so/con uses Christianity as a basis for wanting to run our lives - they just use what They see as The One True Path. Just like social liberals.

    IOW, trust neither side.

  • Mr. FIFY||

    Ugh! Who put A and S keys so close together? Me not happy!

  • Joah||

    IOW, trust neither side.

    Agreed.

  • Jeffersonian||

    I'd agree, too, but you have to calibrate your mistrust with the liklihood of each side's agenda actually getting enacted. I don't see much of the SoCons' agenda being very popular, and what is popular doesn't have much scope to it.

    Contrast that with the wrenching, idiotic shit the Democrats have just enacted.

  • Mr. FIFY||

    True, but also consider that even in the case of failure to pass legislation, it's the thought that counts. *Attempting* to fuck us in the collective ass is, IMO, almost as bad as completing the act.

  • ||

    Given the choice, I'd rather be attacked by a rapist I can overpower than one that I can't.

  • DLM||

    I'd agree, too, but you have to calibrate your mistrust with the liklihood of each side's agenda actually getting enacted.

    Exactly. There's no point pissing your pants over something that's very unlikely to come about. Save it for those things that are truly a threat. You'll notice pretty much nothing considered "so/con" was enacted during the 6-year reign of terror in which Republicans (*gasp*) had majorities during the Bush years.

  • Bucky||

    can you say rino?

  • ||

    We all know where the road paved with good intentions leads.

  • Almanian ||

    Somalia?

    Wait - their Libertopia, so there are no roads, right?

    Ummmm.....Greece? Portugal? Ireland?

  • Almanian ||

    Doh! their = they're, just for today

    If only there were some feature where we could look at our grammar and spelling before posting...a "preview" or some such thing...

  • Mike Laursen||

    Don't disagree. It would be easier to buy them off and get their incompetent fingers out of running our lives if they were purely driven by selfish motivation.

  • CJ||

    the progressives do have the good intention of providing more people with health care insurance.

    Punishing people for not buying a service isn't the same as providing that service. If it was the same, we could say that laws against driving without a license are providing people with driver's licenses.

  • Mike Laursen||

    No, I said it right. Their intention is to provide health care. But they're confused about the difference between health care and health insurance. I'm not.

  • Wind Rider||

    It's almost like the entire scheme was intended to fuck things up so completely, that an argument could be made that the only available solution was to completely nationalize the entire health care 'industry'. Nahhhh. Saying that was the ultimate liberal/progressive/socialistic intent is just crazy talk!

    Well, yeah. Cause those fuckers are some of the craziest motherfuckers running around wasting everybody else's oxygen.

  • ||

    I dont think they are that smart. Most people are economically illiterate, esp. socialists/utopianists.

  • Ron||

    you mean like when Barny Frank forced fanny may and freddi mac and other banks to accept bad loans hence destroying the banks so the government then gets a foothold on them all?

  • Johnny Longtorso||

    "Did you really think that we want those laws to be observed?" said Dr. Ferris. "We want them broken. You'd better get it straight that it's not a bunch of boy scouts you're up against - then you'll know that this is not the age for beautiful gestures. We're after power and we mean it. You fellows were pikers, but we know the real trick, and you'd better get wise to it. There's no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren't enough criminals, one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws. Who wants a nation of law-abiding citizens? What's there in that for anyone? But just pass the kind of laws that can neither be observed nor enforced nor objectively interpreted - and you create a nation of law-breakers - and then you cash in on guilt. Now, that's the system, Mr. Rearden, that's the game and once you understand it, you'll be much easier to deal with."
    --Ayn Rand, Atlas Shrugged

  • wheelock||

    Ayn Rand at her best. Summarizes so much in so few lines it makes one wonder what possessed her to make that book soooo damn long. Thanks for posting. Happy new year.

  • ||

    Ayn Rand quote. The true mark of a moron.

  • wheelock||

    Who would you quote? Or are you talented enough to treat us with an explanation of your convictions yourself?

  • Mr. FIFY||

    Didn't even bother to read the quote, did you, Ray...

  • Ray, you must be... ||

    one of Ayn's cardboard cutout background characters echoing the leadership's nonsense.

  • ||

    Don't feed the trolls!

  • Mr. FIFY||

    True. From now on, I should phrase that sort of thing as "apparently, Ray didn't read the quote".

  • Ray Butlers||

    The bureaucracy is a circle from which no one can escape. Its hierarchy is a hierarchy of knowledge.-K Marx

  • Mr. FIFY||

    Apparently, Ray admires the work of Karl Marx.

  • Ponce||

    Good contrast. Rand says stuff she means in simple language, Marx says a bunch of impenetrable bullshit. Any middle schooler can understand Rand. It takes a master's degree to "figure out" Marx, and even then it's only pretend. Thus, Marx's appeal to people who want to look real good'n'smart without actually being. Unfortunately there's nothing else there.

  • DLM||

    It doesn't help that Marx disagrees with himself.

  • wheelock||

    This obviously wasn't the same guy. He wouldn't have bothered to read Marx either...

  • Joah||

    I confess,

    It was me,

    But I expressed the essence of Ray Butlers better than he did himself

  • Mr. FIFY||

    I couldn't tell the difference! Well-played.

  • ||

    That'll get you arrested in New York, as of today.

  • ||

    Ad hominem. Debate the merits.

  • DLM||

    Ayn Rand quote. The true mark of a moron.

    Whereas you don't need one. Any writer who becomes popular will have good quotes, else they would not have become popular. You may not agree with the totality of Ayn Rand's work (I've never read any of what she wrote myself), but only a moron would disagree with every specific item merely because he did not agree with the sum.

  • P B||

    It just keeps getting better. Let's not forget Pelosi "we have to pass to see what's in it". Time to fine tune the escape plan.

  • ||

    excellent work, Ms. Dalmia

  • Mike Laursen||

    If Whole Foods “overbilled” its shoppers, they would just go to Trader Joe’s.

    Yeah, if.

  • Destrudo||

    Awwww looks like it's going to be a quiet day with no updates.

  • Mike M.||

    The cosmos have started drinking early.

    Auld Lang Syne, and good riddance to an absolutely horrendous year and a worse Congress.

  • Mr Thompson||

    Happy New Year from my balmy Hawaiian retreat. I'll probably extend my vacation for a while. Hope you make it through the winter ok.

  • Wind Rider||

    Uhm, hey, for all you folks that sometimes wonder if the witty banter and speculation of certain individual's proclivities for barnyard animal satisfaction aren't just a big freaking waste of time. . .

    Behold - results that translate to the real world!

  • ||

    the administration is defining Medicare fraud down to include “unnecessary” and “ineffective” care.

    In principle (famous last words...) I have no particular objection to this.

    If doctors were held more strictly accountable for results, that would be good. Of course, agents of the government are unlikely to be the best judges.

    I have this little fantasy scenario which plays in my head:

    Doctor (swooping imperiously into operating room): Let's get this show on the road! I've got three more of these hips to do, and a reservation at the Club for dinner.

    *peers irritably at patient*

    What the fuck? Why hasn't this patient been knocked out yet?

    Nurse: Doctor, he says he has something to tell you...

    Doctor: Jesus.. What now?

    Patient: I still have some concerns about this whole thing...

    Doctor: Don't be such a fraidy cat; I've done this hundreds of times!

    Patient: I just think it's only fair to tell you this: I have taken out an insurance policy... just in case, well, you know... If something goes wrong. If the policy should pay out, the beneficiary is a guy who is going to come to your house and cut your hands of with a meat axe.

    Ready? Let's get this show on the road!

  • LarryA||

    More realistic conversation:

    HEAT SWAT: “You tested this patient for Lumpkin Disease. He didn’t have it! Therefore the test was unnecessary. Put your hands behind your back!”

    Physician: “But last week you arrested me for not testing a patient with the same symptoms who did have Lumpkin Disease.”

    HEAT SWAT: “Last week’s arrest was for malpractice, not Medicare fraud. That time the procedure was necessary, and we would have reimbursed for it.”

    Physician: “But if you keep arresting me, how can I practice medicine?”

    HEAT SWAT: “In between arraignments, like every other doctor in the U.S.”

  • jacob||

    +100

  • Mike Laursen||

    More realistic conversation...

    Patient: I think I should have a lymphoma test.
    Doctor: Sure. Just as soon as it is approved by three levels of ass-covering bureaucracy. Should only take about six months or so.

  • Death Panelist||

    No procedure is really all that necessary.

  • Mike Laursen||

    Depends on how much stock the death panelist owns in the company providing the procedure/medical equipment/medicine.

  • Contrarian P||

    the administration is defining Medicare fraud down to include “unnecessary” and “ineffective” care.

    "In principle (famous last words...) I have no particular objection to this."

    I sure as hell do. I already spend a bunch of my time jumping through the ropes of insurance and Medicare paperwork having to "justify" to some cubicle-bound gnome who knows nothing at all about medicine that my patient actually does need the things that I'm prescribing. I'd much rather deal with "waste, fraud, and abuse" (much of which is engendered by the desire to overtreat and overtest to avoid the perceived threat of lawsuits) than guys with MBAs who tell me that my patient doesn't get treatment because they've decided it doesn't work.

    The government is incredibly bad at deciding what is effective anyway, leading to all sorts of unintended consequences. One of the "quality measures" currently being used to evaluate hospitals is that all patients who come in with a pneumonia should receive antibiotics within four hours of arrival. The idea is that is supposed to hasten the recovery from the pneumonia and shorten hospital stays. Unfortunately, it has been pretty conclusively demonstrated that getting antibiotics within four hours as opposed to eight hours or whatever else doesn't make any difference as to the length of hospital stay. In fact, it has led to overtreatment as the temptation is to treat anyone with a cough and fever with antibiotics as in a really busy emergency department it may take a long while before a doctor can see the patient and get an x-ray. The hospital does this just to make its numbers look good, never mind that antibiotics have their own potential risks. In other words, the government created its own waste. It's been several years since the four hours hypothesis was discredited, but still the requirement is there.

    I agree that the idea of cutting down on unnecessary and ineffective care sounds great. Unfortunately, the government just isn't good at identifying what those things are and even worse when coming up with ways to crack down. I'd submit that we'd have way less waste, fraud, and abuse with an HSA based system, but now we're doing away with those. As a physician I find myself doing more and more that has less and less to do with taking care of my patients. It's incredibly frustrating.

  • Bucky||

    Avastin

  • Jeffersonian||

    Get used to it, Doc, the worst is yet to come.

  • ||

    You people are a bunch of idiots.

  • wheelock||

    As opposed to who?

  • Oh Ray....||

    you are such a flirt!

  • wtf dude?||

    Wow, great insults!! You are an intellectual giant.

  • Mr. FIFY||

    Ray Butlers = Edwin minus the filth.

  • Bucky||

    ...sigh... brought back memories of my long dead father who was in the Navy in WWII.
    his favorite: JESUS H. KEEEYRIIIST!

  • Rich||

    Racist *and* offensive to the developmentally challenged.

  • Almanian ||

    The developmentally challenged - like Ray.

    What a great addition to Paul and Edwin. We're so blessed!

  • ||

    I simply can't stand people like Ray. Instead of going ad hominen add to the discussion on the topic.

    Until then, you're the real idiot - regardless of you ideology.

  • .||

    You're wasting your time, Butlers. Fuck off.

  • ||

    You people are a bunch of idiots.

    I know you are, but what am I?

    *flicks dust from framed "Pee Wee Herman Institute of Advanced Interlocution" diploma*

  • Almanian ||

    My bike!!!! Somebody stole my bike!!!!!

  • tarran||

    The comments on the Daily Beast site are comedy gold.

    Lots of rage against Goldstein, capitalist roaders and other wreckers. The arguments consist mainly of ad-hominems and of appeals to authority.

    Apparently top men have reviewed the bill and concluded that these negative incentives are not a problem. Because we all know that a huge complex bill hammered out in a frantic rush of politicking and backroom deals can't possibly have defects in it. And if there were defects, it would be 'reputable' journalists that would identify them. A disreputable journalist, presumably defined as anyone who works for Reason can only bring up invalid points.

    Applying this way of thinking, I conclude that many of the readers of the Daily Beast think that the Mississippi criminal justice system is not railroading poor people into jail for crimes they did not commit based on fraudulent forensic evidence, since Radley Balko, who broke the story, is not 'reputable' and must therefore be wrong.

  • Mr. FIFY||

    I just burned ten minutes of my life reading Daily Beast bullshit. Now I know what *not* to do when surfing the internets.

  • Jeffersonian||

    If it's not Tunku Varadarajan, you can safely skip reading TDB.

  • Bucky||

    ...the comments by "don'tmakemelaugh"
    ...there is no reason to spend vast sums of money on medical heroics that just continue pain and suffering...
    whaaaaaat?

  • Jeffersonian||

    Precisely the central theme of the Aktien T4 program in 1930s Germany.

  • Jeffersonian||

    Precisely the central theme of the Aktien T4 program in 1930s Germany.

  • Dan Lavatan||

    There seems to be a simple solution to the marginal tax problem - people shouldn't use the subsidy. Granted if PPACA were constitutional they might have to pay a fine if uninsured, but I believe this can be avoided by creating an ERISA summary plan description indicating they will pay their medical costs out of the self-employment income described in the article.

    Providers should probably stop taking medicare. In addition to not having to worry about fraud allegations, if everyone did this it would solve a lot of our budget problems as well.

  • DesigNate||

    That would be awesome, except the second that a large chunk of doctor's threw their hands in the air and said "Fuck Medicare" the government would turn around and force them to take those patients.

  • ||

    How did you know we were planning this?

  • Jeffersonian||

    We've observed the progression of those who say "A," Governor. They always then say "B."

  • ||

    Generally, I define "ineffective" as "didn't improve the patient's condition".

    If Medicare fraud includes "ineffective" care, does that mean that Medicare will fine doctors whose patients get worse or die despite their treatment?

  • Bucky||

    if it moves tax it
    if it keeps moving regulate it
    if it stops moving subsidize it
    if it becomes ineffective...

  • ||

    Nationalize it?

  • ||

    Granted that government often over does its policing and that civil libertarians should counter this behavior. But it is quite a jump to conclude that Obamacare puts us on "the road to serfdom". Instead try reading Hayek's The Constitution of Liberty. Shikha will find that Hayek considered a program compelling everyone to have health insurance to be a plausible social policy choice.

  • tarran||

    Actually, it does put us 'on the road to serfdom' in that every failed intervention leads to further interventions.

    Incidentally, Hayek is no god. Like any human being he could have really dumb ideas, such as supporting state-controlled charities.

  • Numeromancer||

    Every machine has its friction...but when friction comes to have its own machine, I say, let us not have such a machine any longer.


    H.D. Thoreau.

    The most eternally apropos quote, ever.

  • ||

    This article is so strange. The author is trying to turn correcting an over-paid health care benefit--without which the recipient wouldn't have any health care--into an injustice.

    Our past system is so incredibly unjust that it was the leading cause of bankruptcies. Almost anything else would be an improvement.

    The goal of health care reform is to provide health care for all (as opposed to our previous "only for those who can afford it"). To provide that service while spending a minimum of taxpayer money, you have to try to get taxpayer money back when you've over-subsidized someone, right?

  • sevo||

    "Our past system is so incredibly unjust that it was the leading cause of bankruptcies."
    What should the leading cause of bankruptcies be?

    "The goal of health care reform is to provide health care for all..."
    And having a stated goal is sufficient to excuse any perverse result?

    "To provide that service while spending a minimum of taxpayer money, you have to try to get taxpayer money back when you've over-subsidized someone, right?"
    Don't bother answering the earlier questions:
    You could also over-subsidize those you've under-subsidized and then under-subsidize the ones that were earlier over-subsidized.
    Or you could admit that the attempt at 'right-subsidizing' anyone is a failure from the beginning and let people pay for what they want.
    Put it this way, Moniker, you don't have enough bandaids to fix this or any other socialized mess.

  • Liberal||

    Haven't you caught on? We're pro-choice on only one issue! Of course, we're wrong on that one, but what the hell, we go to bed each day with more power that we had when we awoke.

  • ||

    @sevo: I'm more sympathetic than you think. I would love to have a pure free market lead to great results. It's elegant, beautiful. The problem is that it doesn't work.

    We tried it in the Gilded age. The problem is that you have starving people, so you feed some of them. You have starving elderly, so you create Social Security. You have people who die early because they don't have access to medical care, so you make it a rule that they can use emergency rooms, to prevent them from simply dying in the streets like the lepers in India. But you still have people dying early from lack of preventative care. Plus, the care they do get costs a fortune, so it's just a dumb system. So then you create a subsidy, e.g. Medicare and Medicaid.

    Sooner or later, you can either address social inequalities by callously letting lots of people suffer and die, e.g. Social Darwinism, or you end up subsidizing some members of society.

    After that choice is made, the question is "what's the most efficient way to manage the subsidies?"

    The author is attacking one of those solutions. I agree, we could absolutely have a more efficient health care system than ObamaCare. We could all have reasonably good care at much lower cost than Americans currently pay. But this system is the one that could pass our benighted congress.

    The choice unfortunately isn't between an old system that worked well and ObamaCare. For decades we've suffered through recissions (basically, fraud), tens of millions of people uninsured and clogging emergency rooms, and overall we were paying ~30% more than Europeans for similar care.

    We were getting a raw deal. The new deal is somewhat less raw for the average American. It's lame but it's progress.

    So I'd say that ObamaCare is a mess, and not nearly as cost-effective as systems like Germany's, but it's less of a mess than what we've had.

  • Contrarian P||

    Really? Would you care to furnish evidence to substantiate your assertions that without these programs people were dying in the streets prior to EMTALA or that elderly were starving en masse without Social Security?

    Keep in mind that much of our present system, which you call a mess, is directly attributable to government intervention in health care and the unintended consequences of that intervention. Our health insurance system? A direct creation of government through wage controls and subsequent regulation of what insurance could and must cover. Crowded emergency rooms? They get more crowded with "universal coverage", not less (shown quite clearly in Massachusetts). I could go on and on. Your argument that further government intervention will fix the problems created by government intervention has never been shown to actually work.

  • sevo||

    "For decades we've suffered through recissions (basically, fraud),"
    Cite, please. And please make sure the cited recissions are *not* the result of a government mandate.

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    And there is no evidence that Obamacare will improve any of this.

    "and overall we were paying ~30% more than Europeans for similar care."
    Your presumption of 'similar care' is questionable, as is your presumption that Obamacare will have any effect.

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