There’s a reason why Marxism in practice is often called creeping socialism. It’s built one entitlement—or entitlement enhancement—at a time. Once in place, entitlements are difficult to undo because reformers must survive a siege of charges that they are taking something away from someone. The “something” can be food on the table, unemployment benefits, social security, or just about anything the left has decided should be provided by government. In this instance, it’s healthcare.
The left’s narrative on repealing Obamacare is that Republicans must figure out how to improve the system while not affecting those who are currently covered, including millions who received heavily subsidized plans through the so-called Affordable Care Act. The average monthly subsidy for new enrollees was almost $300 for a plan with an average premium of less than $400. In effect, this means that newly covered Americans are paying about $100 per month for a $400 plan. The upper limit for subsidy eligibility is 4 times the poverty level, or about $100,000 a year for a family of 4. Obamacare proponents consider existing subsidies to be cemented, so any rollback would just be heartless.
The Republicans I’ve heard are playing along. Nobody will lose their plan because of reform, they say. To be frank, real reform isn’t possible if healthcare—including routine trips to the doctor—is considered an entitlement. Quality care costs money, and it’s time that Americans who can afford iPhones, Netflix, Body art, and lottery tickets accept responsibility for paying the piper.
I don’t want to be an early Grinch, but we must face facts. When government pays for something, we all pay for it indirectly. It’s direct payments that give us control over the grocery stores, gas stations, auto repair facilities, and restaurants we deal with every day. If they don’t meet our needs, we find another provider who can. But with healthcare, government and insurance companies pay most of the bills, so they call most of the shots. It’s no surprise that doctors and hospitals don’t post prices for their services and most people involved in their delivery have no clue what they actually cost. The only way to regain control is to limit subsidies to catastrophic care for the truly poor, while unleashing the market and demanding control of our own healthcare expenses.
A predominantly market-based healthcare system would be a paradigm shift for most. If you get the flu, you should decide if a trip to the doctor is worth $100. Instead, if you have coverage with a modest copay, you are more likely to go and pass the additional cost along to others in the pool, who are, of course, doing the same. Economists refer to this as perverse incentives and it drives up costs for everyone.
I’m saying what Trump, Ryan, and other Republicans are hesitant to say. Yes, some Americans should lose their subsidies. Some assistance for those in poverty makes sense, but the rest of use need to regain control of our choices. That means no mandated plans, the ability to purchase coverage across state lines, and no expectation that insurance companies will accept us as new customers after we get sick.
Here’s to a complete overhaul of the system. Unfortunately, I doubt the Republicans have the fortitude to go as far as we need to go.