Obamacare

Big-Government Ratchet Turns Another Click

Soon, Obamacare II could limit how much you spend on health care.

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The government takeover of health care continues apace. Starting in 2014, the Affordable Care Act—i.e., Obamacare—will make you buy health insurance. Soon, Obamacare II could limit how much you spend on health care, too.

As critics warned, the Affordable Care Act will not "bend the cost curve downward" as promised. To the contrary, a June report by the Centers for Medicare and Medicaid predicts that national health spending through 2021 will continue to grow at a considerably faster clip than Gross Domestic Product.

That growth will not be even. Private health insurance spending will rise about 8 percent. Medicaid spending will grow about 20 percent. In a few years, government will account for 50 cents of every health care dollar spent in America. What's more, federal health care costs will consume a larger and larger share of the federal budget—and crowd out all other government functions in the process. If current trends continue, then by 2025 just four budget categories—Medicare, Medicaid, Social Security, and interest on the debt—will gobble up every last federal dollar.

This, naturally, has alarmed many progressives. But don't worry—as always, they have a plan.

According to The Washington Post's Ruth Marcus, "23 responsible Democrats—some of the left's leading thinkers in the health-care field—have just come up with a set of answers." And like a boozer who tries to drink himself sober, their answer is…wait for it…more government.

The group, Marcus writes, believes that "no matter how hard federal officials work to slow the rising trajectory of federal spending, their efforts will fail if overall health-care costs continue to rise. 'Health costs throughout the system drive federal health spending,' they write…'The only sustainable solution is to control overall growth in health costs.'"

Translation: Set a nationwide cap on all health spending, including private spending. This is the brilliant fix being offered by "responsible…leading thinkers" such as the Center for American Progress' John Podesta and former Obama health-care adviser Ezekiel Emanuel. (Just imagine what the irresponsible, second-rate thinkers would come up with.)

Pause for a second to review how we got here. Although numerous factors have contributed to the explosion of health-care costs—an aging population and expensive technology, for example—a chief driver is government itself. WWII-era wage controls, followed by the tax preference for employer-provided health insurance, combined to create the third-party-payer conundrum vexing us today. Medicare and Medicaid made the cost problem worse. It's the same dynamic driving up college tuitions: Massive government subsidies encourage massive price hikes, which then ostensibly justify yet more government intervention to bring prices down.

If you're wondering whether anyone could have seen this coming, the answer is: yes. Precisely the same story has played out in Massachusetts, thanks to Mitt Romney and Romneycare. According to The Wall Street Journal: "Health costs…will consume some 54 percent of the [Massachusetts] state budget in 2012, up from about 24 percent in 2001. Over the same period state health spending in real terms has jumped by 59 percent, while education has fallen 15 percent, police and firemen by 11 percent and roads and bridges by 23 percent."

So Massachusetts is imposing a cap on health spending, public and private. Here's the Journal again: "All Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure…They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics….An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017."

"Sweeping" is a woefully inadequate word to describe such policies, whose terminus is all too clear: If health-care spending hits the government-dictated ceiling, then even if you're willing to pay a doctor out of pocket for a consultation, the government won't let you.

The essence of Obamacare was the individual mandate—the decree that everyone must buy health insurance, whether they want it or not. Now, many of the same liberals who wanted government to make people spend money on health care also want to dictate the point at which they should stop. (And when that doesn't work, what then?)

Without knowing it, progressives are proving William Voegeli correct. "Liberals," he writes in Never Enough, "don't want the government to grow indefinitely. They just want it to be bigger than it is right now."

This column originally appeared in the Richmond Times-Dispatch. 

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    1. Unforgiven was terrific, but I don’t think it was so sacrosanct as to not get a ‘re-make’. Also, I strongly think that any ‘re-make’ featuring Ken Watanabe (especially presumably as Munny) would be VERY different than the original.

      As long as English Bob gets a bigger role, I’m happy.

      1. Yeah, at first I thought ‘Sacrilege!’ but then I thought that re-interpreting it as a samurai flick might be pretty interesting.

        1. It’s a reverse The Wild Bunch. Or a re-Ran (if you ignore Kurasawa’s denial).

    2. Isn’t Fistful of Dollars a remake of a Japanese film?

      1. Yah, ‘Yojimbo’. Which is awesome. Also remade as ‘Last Man Standing’

        1. FoD is not just a remake of Yojimbo it is almost a scene by scene copy with many of the same camera angles.

          I had never seen FoD till many years after seeing Yojimbo, and kept thinking I had seen the movie before, but I knew I hadn’t. It didn’t click till he was being carried past the fire in the coffin.

          The only thing added to FoD that is worthwhile makes the whole movie for me: the sensitive mule.

    1. It is as cunning as a fox what used to be Professor of Cunning at Oxford University but has moved on and is now working for the U.N. at the High Commission of International Cunning Planning.

  1. 2021? We’re not going to make it that long. There’s no realistic prospect of the economy (or the tax take) growing faster than government spending, so we’re stuck with trillion dollar deficits until the bond markets lock up. When that happens, we’re off the map, and whatever we wind up with next, won’t look much like what we have now.

    1. Look, all of these incomes are based on concrete predictions. I know it seems counter-intuitive that income (and hence tax revenues) will increase by an average of 1400% in the next three years, but Obama’s finest have assured us that they will.

      It’s fucking science, dudebro.

    2. Look, all of these incomes are based on concrete predictions. I know it seems counter-intuitive that income (and hence tax revenues) will increase by an average of 1400% in the next three years, but Obama’s finest have assured us that they will.

      It’s fucking science, dudebro.

    3. Look, all of these incomes are based on concrete predictions. I know it seems counter-intuitive that income (and hence tax revenues) will increase by an average of 1400% in the next three years, but Obama’s finest have assured us that they will.

      It’s fucking science, mang!

    4. Look, all of these incomes are based on concrete predictions. I know it seems counter-intuitive that income (and hence tax revenues) will increase by an average of 1400 percent in the next three years, but Obama’s finest have assured us that they will.

      It’s fucking science, mang!

    5. Your post (#3213719) has been marked as spam by a third-party spam filter. If this is a mistake, please email webmaster@reason.com.

      Le sigh.

    6. All we need is for the average American income to increase by 3400% over the next 3 years and it will be fine. Stop worrying and learn to love the handouts.

      1. Or raise taxes back to the Magic Rate of Thirty-Four-Point-Nine-Percent, Amen.

        Just ask Tony, or any other leftist. It’s the Rosetta Stone of tax law.

        1. Argh. Thirty-NINE-Point-Six.

          Ruined a perfectly average punchline.

          1. I thought the magic numbers were Nineteen-Point-Eighty-Four and Four-Point-Fifty-One.

            1. Good calls, darius. Though it would take a crafty, clever bugger to find the true meanings therein.

      2. Oh, the Fed is working on it.
        Tragically, everything else will go up by more (much more) than 4000%.
        sigh.

        1. Oh, the Fed is working on it.

          I doubt even Helicopter Ben believes that the Fed stepping in to monetize debt after a bond market lockup is any kind of solution. I don’t think he wants to go down in history as “Weimar” Bernanke.

          The kind of hyperinflation that would be set off after a bond lockup/overt debt monetization is just the sort of thing that will set off massive societal destabilization and set the stage for the Second American Republic. Because the First one will be done.

          1. Not when “top men” do it.
            Don’t you know anything about anything, the reason it didn’t work for the Prussians was because of G.W.Bush!

    7. Well, I suppose a few things could intervene. We could crack the fusion nut and begin an economic revolution based on cheap energy. Or benevolent superaliens could bail us out. Or we could go imperial, live on our pillage for a few decades, then blow to pieces.

      1. We aren’t already imperial? If only the superaliens can exchange our green pieces of paper for purple pieces of paper.

  2. “23 responsible Democrats?some of the left’s leading thinkers in the health-care field?have just come up with a set of answers.”

    TOP MEN

    1. “responsible”

      In what sense of the word?

      1. In what sense of the word?

        They’re very good at making sure that other people pay their taxes.

    2. sorry but I couldn’t reconcile the concept of responsible Dems, regardless of the number. Pray tell, what experience in health care do these “leading thinkers in the field” have beyond conjuring ways of controlling it?

  3. The stupid, it burns.

    1. Like watching Hannity or Lawrence O’Donnell… the stupid, it burns both ways.

  4. A black market in health services will rise. So, the left is leading us to… (wait for it)… back-alley abortions!!

  5. A black market in health services will arise, leading to … back-alley abortions.

  6. Libertarians face a conundrum in resisting growth of arbitrary government, ie, tyranny.

    1. By the non-aggression principle, violent resistance against a “soft coercive” government is not an option…ie, taxation is coercion, but the actual extorters are not the same people as the police who would come to your house if you don’t pay your taxes or comply with regulations.
    2. However, the extorters are, like the mob boss, culpable in violence by ordering a coercion that is backed by violence.

    So when is a libertarian justified in aggressive response?
    1. If the original aggressor is proven to be significantly complicit.
    2. If the response is proportional.

    But how do we respond to a documentary coercion, ie a nanny law (a sour tit), which becomes a regulation (rapulation)?

    With a proportional documentary coercion:
    1. A lawsuit
    2. Blackmail
    3. Slander
    4. Libel
    5. A proportional threat of detention if the aggressor does not comply with moratorium or repeal or nullification. Notice it’s a THREAT of detention, as is the sour tit or the rapulation.

    Proportionality is critical. Resistance to tyranny is a matter of survival.

  7. Outright price controls will, of course, come as a result of the ACA, but not before forcing doctors to accept the throngs of new Medicaid patients has been employed first. The order of operations in authoritarian coercion is important.

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  9. “Sweeping” is a woefully inadequate word to describe such policies, whose terminus is all too clear: If health-care spending hits the government-dictated ceiling, then even if you’re willing to pay a doctor out of pocket for a consultation, the government won’t let you.

    1. Yeah… if you don’t have a legitimate objection, making one up will do.

      Idiots.

  10. This bill bringing so much tensions and debates to the final election programs, Obama government will be under the scam.

  11. To me, government involvement in health care is immoral. Government forcibly takes from some, and gives to others. Taking money from people via force is considered theft, and government doing it doesn’t make it moral. While I agree we need government to protect us from those who’d harm us or our property, when it starts taking from us to give to others, it’s no better than the criminals.

    I wish our Constitution prohibited government interference in capitalist acts among consenting adults. Actually I think it does, by limiting the federal government to the list of activities in Article I Section 8. But the political hacks appointed by presidents to the SCOTUS have eliminated that freedom (a freedom from government interference and involvement in our transactions with others).

    While I’m on my soapbox, I’ll point out the other boxes protecting our freedom: the ballot box, the jury box, and the cartridge box. Hopefully we’ll get our freedoms back via the ballot box.

  12. There is a huge investment opportunity in coming years for offshore medical services. If any significant medical thing can be seen planned (non-emergency), it will go offshore for people who can pay.

    The cost inflation of US medical services with ClownCare makes a $10,000 addition for airfare and resort-style getaway a pittance compared to the $50,000 of paperwork and malpractice insurance and bureau-fodder stateside for the same procedure (say, a valve replacement). Plus, not having to play Progressive Paperwork and Trial Lawyer lets the doc/establishment concentrate on what they actually are supposed to do (medical stuff), leading to a better, more desirable experience to boot.

    Insurance companies will be all for it, until the gov makes it illegal. Then they’ll have to ban individuals from just paying out of pocket, then start building some walls…

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