Authoritarianism

It's a Paternalistic World as Obamacare Advocates Admit Their Love for Bossing Us Around

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Lego hospital
Stefan-Xp

President Obama's famous promise that Americans would be able to keep health plans they like, even after the passage of Obamacare, has proven to be so much bullshit. Caught between immovable quotes and irresistable reality, Barry and friends now double down, explaining to us that, yes it was a lie, but the deception was for the greater good, whether or not we individually have been shafted. Welcome to a world of bare-faced paternalism, in which pundits and presidents sigh in relief at finally treating us all as so many little pieces in the snap-together Lego world they're cobbling together to replace whatever it was that we inhabited before.

President Obama himself dismissed complaints from people losing their health coverage because of the Affordable Care Act with an updated version of "gotta break a few eggs." In Boston, he shrugged and said, "a lot of people thought they were buying coverage, and it turned out not to be so good." Since Americans were too stupid to recognize that their health plans were "substandard," it's no great loss that they were swept away. People should shut up and shop for a new plan that complies with the law, he suggested, whatever the price or access to care.

Ezra Klein of the Washington Post took a similar for-your-own-good view of the Affordable Care Act's deceptions.

Health-care consultant Bob Laszewski buys insurance on the individual market in Maryland. His plan's benefits are excellent. "I can access every provider in the national Blue Cross network––about every doc and hospital in America––without a referral and without higher deductibles and co-pays," he writes…

But his plan is ending. The replacements all have tighter networks, higher deductibles, and higher premiums. And Laszewski isn't alone. Many Americans who currently buy insurance on the individual markets are seeing their plans canceled and finding the replacement plans have higher premiums or stingier benefits. For them, President Obama's promise that "if you like your plan, you can keep it," is proving a cruel hoax.

But that's OK, you see, Klein says, because Laszewski's attractive insurance policy existed under the old rules, and had to make way for the more inclusive, and expensive, new medical order.

But all the possible solutions have tradeoffs. Laszewski's preference, he said in a recent interview, would've been for the administration to grandfather in more existing insurance plans. That would've meant higher insurance premiums in the exchanges, as healthier people who're able to buy into the individual market now would've just stayed there. High-risk pools or any other kind of direct, government-provided insurance or subsidy for the sick needs to be paid for by someone.

There are no easy solutions to the health-care trilemma. Someone always loses.

And it's apparently the administration's job to pick the losers according to its policy preferences. Laszewski is too healthy and successful to benefit from subsidies or mandates that he be sold insurance. That makes him a loser. So screw you, Bob!

Father knows best
Father knows best

Matt Welch pointed, last week to David Firestone similarly rolling his eyes in the pages of the New York Times at people upset over the federal government's increasingly intrusive health policies. "Republicans were apparently furious that government would dare intrude on an insurance company's freedom to offer a terrible product to desperate people," Firestone wrote.

Yeah, such a "terrible product" that people are pissed that the new law makes those products go away. But they don't know better, so the decision has to be made for them.

But perhaps the most open and honest endorsement of paternalism you'll see that doesn't actually use the words, "all within the state, nothing outside the state, nothing against the state" is in a column by Timothy Noah at MSNBC in which he takes Charles Krauthammer to task for daring to use the "p" word as a criticism:

What's most striking here is Krauthammer's overconfidence that the word "paternalism" will be received as a crushing blow. In truth it is neither exceptional nor disturbing for government to place certain limits on individual choice, even when those choices affect nobody else.

It is illegal to kill yourself, or to sell yourself into slavery, or to sell your organs, or to practice prostitution. It is illegal to take certain drugs, either recreationally (because they're addictive and/or potentially harmful) or as treatment for disease (because their efficacy is not yet proven and/or the side effects are unknown).  State laws place maximum limits on how much interest to charge for a private loan. Polygamy is illegal in all 50 states.  And if a state trooper catches you driving 90 m.p.h., you will be fined, even if yours was the only vehicle on the highway.

There's certainly room for argument about whether particular paternalistic laws are just and humane. But any notion that government paternalism in general is inherently illegitimate stands well outside the mainstream of practical governance.

You'll notice that almost all of the restrictions and bans that Noah cites as examples of beneficial paternalism have been specifically criticized by libertarians and other advocates of personal freedom as government overreach—especially pernicious and dangerous overreach in the case of drug prohibition. The one exception would be selling yourself into slavery, which many libertarians consider a logical impossibility, since you can't alienate your free will. Maybe that ability will be available as a rider on the new exchange plans.

Noah dispenses with that inconvenient philosophical hurdle to his "we all dig paternalism" argument by simply dismissing consistent objections to exactly that as "outside the mainstream of practical governance." Paternalism is nothing for which to apologize, he tells us, loud and proud. It isn't a matter of whether we should all be pushed around by the state, but only the specifics of the pushing. Nothing else rates discussion.

So welcome to world of paternalism as explicit policy, in which substituting the preferences of politicians for our own choices is a moral good, and lying to us about the outcome of rules and laws is just fine in the pursuit of a worthy goal.

And if you object? Well, "someone always loses" in the pursuit of the greater good.