EspañolAs of this month, Obamacare has undergone not fewer than 50 substantial changes since its enactment in March 2010. One wonders what is worse: the law and its economically destructive mandates or that US President Barack Obama initiated 31 of these changes without legislative approval.
Such wholesale changes on the fly, by the law’s own architects, demonstrate the Affordable Care Act’s resounding failure better than any critic ever could. Many of those responsible have now admitted the error of their ways, resigned, or inadvertently revealed the dishonest manner of its passage. Political proponents such as former Senator Mary Landrieu of Louisiana have also suffered swift dismissals from their constituents.
US Americans have tasted the proof in the pudding and strongly oppose enforcement, as Obamacare enrollments slow to a trickle. They see that the complicated mix of mandates, subsidies, taxes, and “exchanges” have already reduced choice, raised costs, violated privacy, undermined constitutional government, and harmed employment prospects for the most vulnerable.
Far from serving constituent needs and promoting competition, “large health insurance plans … effectively are collaborating with government officials in carrying out federal health policy,” as explained in a Mercatus Center working paper (PDF).
However, diehard legislators and special interests still stand in the way of Obamacare’s repeal and parrot deceptive signup numbers, failing to discount those who either do not pay premiums or drop out. Ad hoc changes and delay tactics have mitigated some of the political fallout, and the medical reform has now achieved a considerable degree of inertia.
If advocates for deregulation are to achieve a meaningful reversal of this train wreck, they must (1) stand vigilantly against any progressive claim to the moral high ground and (2) zero in on and unravel the last stand of Obamacare adherents: the utopian march to socialized medicine.
Richard Epstein addresses the first point in a penetrating essay, “Obamacare’s Slow Death?” There was, as he notes, a problem: “inferior health care at premium prices for large portions of the population.” Unfortunately, the progressives in control of the reform chose to double down with more subsidies and tighter regulations.
If the reformers cared for the needs of constituents, rather than those of well-connected lobbies, they could have chosen an alternative path. In fact, there are many reforms that would cost less than nothing to enact and would immediately achieve better access to medical treatment. Consider, for example, that certificate-of-need laws, bans on imported drugs, onerous FDA approvals, and licensing requirements all block the underlying supply side of the equation.
Even if willing to acknowledge the failures of Obamacare in its present form, many proponents may respond by wanting to double down again on the interventionist route. They remain enamored by the myth of universal coverage under “single-payer” socialized medicine.
Apparently socialized coverage is not enough to keep Cubans from fleeing on makeshift boats for the Florida coast, but one can also look to Canada for wisdom on this matter. Although this development has flown under the radar in US discourse, medical tourism for Canadians is booming, with more than 52,000 traveling abroad in 2014, up 26 percent from 2013.
Canadians, supposedly with universal coverage, have thrown up their hands at rationing, unwilling to take the risk of waiting lists. Consider that “in 2014, the average patient in Canada could expect to wait almost 10 weeks for medically necessary treatment after seeing a specialist,” as reported by Bacchus Barua of the Fraser Institute in British Columbia.
There may be less fire in the belly now among establishment politicos to repeal Obamacare, but for those willing to take up the challenge and embrace deregulation, evidence continues to pile up in your favor. Further, you have a constituency that supports you, so it is a winning platform.