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Friday, June 29, 2012

TFD Opinions: Why Are Republicans So Angry About the Obamacare Ruling?

There are a lot of extremely divisive issues in partisan politics but one I will never understand is Obamacare. While I can totally understand that someone might legitimately oppose Obamacare and believe that a more conservative approach would be ideal, I will never understand the level of outrage and hatred that it receives. Sometimes I wonder if it's purely based on ignorance and misinformation. First of all, it's not that liberal. A liberal plan would obviously something that it is or approaches single payer healthcare that many other industrialized countries already have. The plan that actually passed was significantly watered down and preserves the private insurer system contrary to the false portrayal as a government takeover of healthcare.

Second, the mandate is not a mandate. There are no criminal penalties for not purchasing healthcare and the tax consequences are weakly enforced so the idea that the government is forcing you to buy healthcare is fairly silly. Even if you are forced to buy health insurance, is that so bad? If we just let people die on the streets, I might actually understand the opposition but we don't. Emergency rooms treat the uninsured and thus those who are allowed to skip out on buying health insurance and subsequently have to use emergency care are just freeloaders that aren't taking personal responsibility for their expenses. That's probably why Republicans were the ones that came up with the mandate in the first place. The lack of a mandate is essentially de facto welfare because people are given healthcare for free. In addition the lack of a mandate just encourages people to skip preventive care and roll the dice knowing that if they're unlucky, they'll just go to the emergency room. In addition, Republicans are hardly opposed to government mandates as long as they're for policies they like. Abortion restrictions have been increasing since the Republican wave election in 2010 and none of them seem to have a problem with that version of big government. So if they favor government forcing people to do or not do things, they should be prepared to defend the policy that everyone shouldn't need health insurance.

Third, what's so great about the private insurance system? A lot of people claim to be satisfied with their current insurance plans but that's probably because most of them have never had a real problem that requires jousting with the insurance companies. First, employer provided health insurance as opposed to government provided insurance is purely an accident of history. When wage controls were in place earlier in the 20th century, employers got around those controls by offering health insurance. There was no great policy debate about our healthcare system; it just worked out that way and now people act like it's in the Constitution. Employer provided insurance is a stupid system that doesn't reflect the reality of the fact that people constantly change jobs, are sometimes unemployed, and only work for a certain portion of their lives so other fixes like Medicare, Medicaid, and CHIP are necessary. Also, what exactly do private insurers provide? Competition in the private sector is supposed to be better than the public sector because it encourages efficiency and better quality. But an insurer is just a middleman. There's nothing of quality to provide because it's just a risk pool. The best way to minimize risk is to increase the size of the population so those who are lucky enough to avoid health costs can fund the unlucky ones. Essentially, the private insurance industry exists to skim off the top of payments that could otherwise be lower. As a for profit industry, their incentive is to keep as much money as possible and pay out as little as possible which creates a perverse incentive to deny coverage as much as possible. For all those who complain about the idea of a bureaucrat getting between them and their doctor, is it really much better now with decisions being interfered with a profit driven insurance company employee? At least the bureaucrat doesn't have a personal profit incentive to deny your coverage.

Beyond all that, the law was just approved by a solidly conservative Supreme Court justice who presumably recognized that the legal arguments were clearly not conclusive in favor of striking down the law as unconstitutional. Obviously these arguments have been hashed out before without much of a resolution but I just don't believe that any well-informed Republican can seriously believe that Obamacare is the end of freedom as we know it. It's one thing to have a policy disagreement but please at least save the nuclear meltdown for the day that single payer healthcare passes.

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