© 2022 St. Louis Public Radio
Play Live Radio
Next Up:
Available On Air Stations
Government, Politics & Issues

Commentary on Obamacare: Mulling the known unknowns

This article first appeared in the St. Louis Beacon, Oct. 3, 2013: The adage has it that a camel is a horse that was designed by a committee. Understood thusly, the Affordable Care Act — a.k.a. “Obamacare” — is a steed worthy of Lawrence of Arabia.

The eponymous proponent of the measure, Barack Obama, spent his pre-political career as a constitutional law professor/community organizer. The care bill he championed reflected the Janus-faced nature of the president’s civilian occupations as it sought to provide health insurance to the needy — thereby appealing to his inner social worker — while trying to convince members of Congress that doing so was their idea in the first place.

When Bill Clinton sought to reform health care, he appointed a blue-ribbon panel headed by his wife to explore options. To limit undue influence from vested interests, the group met in closed sessions while crafting an executive proposal to submit to the Congress.

Nothing fuels paranoia faster than secrecy. Taking full advantage of the dearth of information from the Clinton think-tank, opponents from the political right launched a deft propaganda campaign alerting the public to the hazards of health care. Needless to say, “Hillarycare” was pronounced DOA before reaching Capitol Hill.

Seeking to learn from his predecessor’s mistake, Mr. Obama decided to allow Congress to craft the legislation — the process the founders anticipated. He challenged his legislative allies to send him a bill that would maintain the profitability of private insurance without reducing benefits or increasing costs for the presently insured while expanding coverage for up to 48 million additional souls.

The mathematical impossibility of the task would be mitigated by eliminating three unknown — and largely unknowable — factors within the current health care delivery system: 1) inefficiency, 2) fraud and 3) unremunerated services provided to the currently uninsured. Unfortunately, none of these can be measured with anything close to accuracy.

Duplication of services could be theoretically reduced by centralizing operations but a key selling point of the program was the promise that people would retain the right to choose their own caregivers. One man’s inefficiency thus becomes another’s freedom of choice. It’s difficult to quantify a value judgment.

As for fraud, individuals engaged in illegal activity are notoriously reticent about telling others what they’re up to. We can reliably count only the crooks who’ve been caught, and they’re already out of the system. Measuring undiscovered fraud is guesswork at its finest.

One thing everybody can agree on, however, is the fact that under the present system, uninsured people regularly receive medical services they cannot afford and their unpaid bills drive up the cost of health care for all of us.

Unfortunately, your otherwise itemized hospital bill never offers a line item for “price inflation to offset the expense of treating the uninsured.” Rather, it will bury the obvious within the obscure and you’ll notice something like a $10 charge for a “non-steroidal, orally-induced analgesic” that, upon further review, turns out to be an aspirin.

Worse, inflated costs compound themselves if providers use them to calculate the value of their uncompensated services to the uninsured. In my admittedly hyperbolic example, once the baseline cost of an aspirin becomes established at $10 for insurance purposes, that’s the loss a hospital incurs every time it dispenses one for free. Small wonder we pay more for health care than any nation on Earth.

The status quo is dysfunctional but it’s still reasonable to make sure that the remedy doesn’t turn out to be worse than the disease. For civil libertarians like myself, the most troubling unknown is just how far the nanny state will be allowed to extend its reach while hiding behind the skirts of Florence Nightingale.

Private choices can have consequences to one’s health but if health care is a collective concern, at what point do we draw the line between personal prerogative and public responsibility? Can an adult voluntarily put himself at peril when his neighbors have to pick up the tab for his unwise choices?

We know from experience that dangerous instrumentalities supported by organized lobbies will be spared. So, guns and motorcycles will remain readily available. But what about smoking?

There are already private companies that refuse to hire smokers to keep health insurance costs down. Should the government follow suit and penalize adults who use tobacco — a perfectly legal substance — or will Obamacare deem nicotine addiction to be a pre-existing condition?

Obesity is a problem of epidemic proportions thought to be as hazardous to health as cigarettes. Perhaps the authorities should enforce healthy diets. Step away from the sundae, Tubby!  Maybe we could fashion a program modeled on the Hitler Youth whereby children can report parents who skip exercise in favor of a six pack and a bag of Fritos. 

Of course, all this healthy living figures to extend general life expectancy, which should bankrupt Social Security. If that happens, we’ll wind up with a burgeoning population of fit codgers crowding already overburdened homeless shelters.

The citizens of a republic would normally rely on their elected representatives to keep a well-intentioned program from devolving into a dystopian hell. They would be expected to fine-tune the legislation to ensure reasonable outcomes.

But as Congress has just shut down the government rather than deal with the practical difficulties of implementing health care reform, I wouldn’t hold my breath. Besides, interrupting your respiratory pattern might be bad for your health.

Send questions and comments about this story to feedback@stlpublicradio.org.