Megan McArdle At Bloomberg: ‘A Few More Arguments Against Obamacare’

Full piece here.

A thoughtful piece:

‘This is not a tedious rehash of my reasons for opposing Obamacare, though two years in, perhaps such a rehash is due. If it is, I will provide it in a different post. This is just a post on why I don’t think that the argument for Obamacare can rest very securely on the argument that we are simply cleaning up some ugly negative externalities, in much the same way that we do with noise ordinance and anti-pollution laws. That is not what we are doing, and if it were, we wouldn’t be doing it’

You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:

As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Pascal Emmanuel Gobry At The American Interest: ‘What Americans Won’t Learn About Health Care’

Full piece here.

I tend to agree with the below, that the ACA will further remove health care decisions from many consumers.

‘One ray of sunshine might be an involuntary heightening of the contradictions: The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.’

Many people have been brought onto Medicaid rolls under the ACA, and some onto the exchanges, but many incentives are simply backwards, such as inducing young people in their prime to buy-in with carrots and sticks. Under this law, you, me and everyone (in theory) will eventually be forced to join the government-run exchanges.

I could easily see a massive, health-care bureaucratic complex on the time horizon of a few decades; sprawling, good for the politically and culturally well-connected along with a large swathe of people who have enough money and freedom to access it and who would often have other options available, if necessary.  They would be accessing near the top, too, where there would be higher-end facilities and better points of access, and this is also where the choice jobs and opportunities would be on the bureaucratic side, as I envision a generational conveyor belt moving through the suburbs, universities and on down to Washington (a permanent coalition of majority Democrats, if other bureaucracies offer any example).  People with enough money always tend to have other options, and there would be winners and losers in this set-up just like any other.

Clearly, many poor and working poor would get more care than they got before, early childhood vaccinations and urgent care, some basic access and routine checkups, but again, in a world of limited resources, they would get promises but not always delivery. There would definitely be more availability for some and lots of brochures and ‘nudges’ that usually don’t work as advertised.

Of course, paying for these folks would be many others who are working poor and non-poor who could very easily be getting the short-end of the stick: Paying for all of this and perhaps getting very little in return and having no other options and virtually no political recourse. Such people would be paying for an immovable bureaucracy and more politicians controlling more of the money supply. They would be paying for more union control through the activists who benefit from the law along with the standard corruption and inefficiencies inherent in such systems. Such folks would sometimes be working against their own interests, disincentivized and unfree.

Richard Epstein looks pretty prescient on what the law’s specific challenges are:

‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily’

Epstein on Obamacare’s Moral Blindness, the Obamacare Quagmire, and Watching Obamacare Unravel.

Still Looking For Alternatives-Charlie Martin At PJ Media: ‘Obamacare vs. Arithmetic’

Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Related On This Site:    From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Richard Epstein At The Hoover Institution: ‘Watching Obamacare Unravel’

Full piece here.

The exchanges are a bureaucratic mess, and will not likely be functioning soon:

‘At this point, the total administrative burden on the federal government has massively increased. Yet neither the federal government nor the states have the human or financial resources to discharge these tasks in a timely fashion, making it highly unlikely that these exchanges will be up and running by January 1, 2014. To achieve that goal, the various private participants on the exchanges must design and post their policies by October 1, 2013.’

He finishes with:

‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

We’ll see what happens.  I still visit Obamacarefacts.com to see what they’re telling me I should believe.  They’re getting desperate.

More broadly, If you haven’t noticed, many progressives have a problem with that ‘voluntary’ part. Individuals usually end up as pawns on a chessboard of ideals. I suspect many progressives are so caught up in the oppressor/victim mentality, are so busy responding to the endless injustices of life (someone else is always to blame), and are so concentrated on deriving rights from the top-down and from abstract principles, that they completely ignore human nature.  Solidarity!

Perhaps as with Obamacare’s exchanges, they haven’t thought that far ahead. The trick was to ram it through and worry about the details later. It’s now getting to be later.

In my experience, such idealism will always fail to recognize just how such regulations, taxes, and laws stagnate the economy and the reasons that people work and pursue their aims. The private sector will have the life sucked out of it, and everyday people will have to run through mazes of red tape. This twists the incentives beyond recognition. The earthly kingdom set-up on the road to such ideals consistently fails, calcifying either into an unresponsive, bureaucratic mess that can’t respond to new challenges, or worse, the same mess controlled by worse and worse people and desires, until it really starts getting nasty.

The ideals, of course, are just that, even if they’ve settled into mainstream thinking in the U.S. Political parties who work in the trenches to protect me from such idealism are welcome. What’s important usually happens far away from politics.

My two cents.

Related On This SiteFrom The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Covering the law and economics from a libertarian perspective: Richard Epstein At The Hoover Institution Journal: ‘Three Cheers for Income Inequality’Richard Epstein At The Hoover Institution: ‘Death By Wealth Tax’Richard Epstein At The Hoover Institution: ‘The Obamacare Quaqmire’

Link From A Reader: ‘Richard Epstein Introduces Chicago’s Best Ideas To Students’

Obamacare Checkup-Peter Suderman At Reason

Full piece here.

‘ObamaCare gives small employers with healthy workforces an incentive to jump ship and insure themselves.’

and:

‘The larger thread here, though, is that we’re once again seeing that ObamaCare’s design is pretty clunky, at best. From a purely practical perspective, the law looks like a mess.’

Now that it’s passed, we’re finding out what’s in it.

See Also: Another Day, Another Crack In Obamacare.

Or you can just go to Obamacare.com and get all the facts from one place, and not have to think outside the box.

Addition:  At Reason is a telling graph indicating that Obama is just the next in a long line of Presidents who’ve increased spending.  Slowly, our government’s been growing for generations (we’re all guilty in believing in the “greatness” model) and our political class is following the incentives we’ve created.

Glenn Reynolds talks about this here, quite reasonably.  What kind of landing, or readjustment, are we going to have?

Another Addition.  Via Alexandria, a well-researched article at Time on health-care costs.  Why is everything so expensive?

Related On This Site: A Few Health Care Links: “The Individual Mandate Survives As A Tax”From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

From The Weekly Standard: ‘The Sebelius Coverup’

Full piece here.

A bit partisan, and coming from one likely source, but interesting.  There are incentives being created for a few insurance winners, cozying up to those with power and money, who will be more closely tied than before to politics, and politicians and political cycles.  Also, it’s about who controls the data, and whoever that is will need a lot of information about you, and it won’t entirely be up to you how much control over that data you have:

‘In truth, Obamacare’s federal exchanges will be an extremely complicated technical endeavor to set up and run, as (among other things) they would involve compiling massive amounts of risk-selection data on individual Americans. In addition to raising extraordinary privacy concerns, the data involved would be like gold to insurers. To quote my source, “If you can capture this data, you’re going to win.”’

Expect a small number of people to be in control, rewarding themselves, their friends, associates, connections, and punishing their enemies, as usual in human affairs, but now with new State power to ‘tax’ you for not purchasing health insurance.  It’s like a cinch around 17% of the economy, and new areas of your life and liberty, claimed as the necessary solution to solve our problems.

Addition:  See Peter Suderman’s ‘The Doc Fix Economy,’ for how we’ve been kicking the can for quite a while now in dealing with these problems.

Related On This Site:  From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Peter Suderman At Reason: ‘Obama Claims Repealing ObamaCare Would Benefit Insurers. In Fact, They Stand to Lose $1 Trillion ‘

Full post here.

You don’t get to single-payer overnight, you first pass an enormously complicated piece of legislation without the other party’s support, then you get private insurers on board, then perhaps you gradually restrict market activity with endless regulations, enormous and politically dependent bureaucracies, allowing access to fewer and fewer private insurers:

‘It’s not just health insurers. Most of the health system’s biggest and most powerful industries are betting on the law to boost their bottom line. The drug industry cut a deal with the White House to help finance the promotion of the health law. And following the debate, investors in the hospital industry got spooked.’

Health care costs are rising.  Our system is slapdash, and inefficient, tied to employment, and wasteful.  I think this solution is worse than the problem.

Related On This Site:  From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

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Ilya Somin At Volokh: ‘Of Silver Linings And Clouds’

Full post here.

‘Obviously, losing the mandate case was a significant setback. But if we had to lose at all, better this way than almost any other. Whether the positive effects of the decision predominate over the negative ones in the long run remains to be seen. It depends on future events such as the identity of the next few Supreme Court appointments, and whether or not Obama’s health care law can be repealed or modified’

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A Few Health Care Links: “The Individual Mandate Survives As A Tax”

Reason has some links.

Althouse.

National Journal.

Washington Post.

It seems the individual mandate will now be a tax, while the law will mostly stand as it was passed and signed for now.

I still don’t see how we afford another unfunded liability, and how we insure 30 million with a good budget in mind.  People who work for bureaucracies often have incentives to avoid innovation, avoid hard decisions, protect their own, and always meet the budget regardless of performance (among other things).   We will be placing serious restrictions (through the tax) on many people’s freedom, in order to redistribute their tax money to others, while this tax money is funneled through a few (of course what goes on in health insurance companies isn’t lovely, and similar in many ways, but this the ACA is likely a worse evil because there are fewer alternatives, if any).  This will likely increase the size and scope of government a good deal in America, and dramatically change the nature of the social contract.  I’d like to think I’m consistently worried about to whom we’re giving power, why, and how such ideas will end up working in practice.

There will obviously be some winners though, and some benefits.  The “ideal” and more fair, just society however, will remain forever out of view on the horizon…a promise on the lips of those with skin in the game.

My two cents, as it remains to be seen how this will all play out.

Update: The Roberts long-view theory, more here from Paul Rahe, or just the Supreme Court staying out of politics.

Related On This Site: From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

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Ilya Somin At Volokh: ‘Nonlegal Arguments for Upholding the Individual Mandate’

Full post here.

Somin takes on a few of the claims by supporters of the individual mandate.  Such is politics, of course, and perhaps more so as of late:

‘Both parties give short shrift to constitutional limits on federal power because judicial deference has created a political culture in which almost anything goes. More careful judicial scrutiny of Congress’ handiwork might lead Congress to start taking the Constitution seriously again. That result that should be welcomed by conservatives, libertarians, and liberals alike.’

Perhaps.  Comments are worth a read.

Related On This Site: Charles Fried and Randy Barnett among others, testify as to the constitutionality of the Affordable Care Act (Nearly 3 hrs, but likely worth your time.  You can skip to the parts you’d like)……Randy Barnett At Volokh: ‘My Answers to Questions Posed by Senators Durbin and Sessions’…Wasn’t it the executive branch with too much power…not the legislative?: Eric Posner At Volokh Replies To Comments The Straussians are not too happy with that view, as the comments suggest:  From Volokh: Harvey Mansfield Reviews ‘The Executive Unbound’

From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Originalism vs the ‘living constitution?” George Will Via The Jewish World Review: ‘True Self-Government’A Few Thoughts On Robert Bork’s “Slouching Towards Gomorrah”

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From Reason.com: ‘The 4 Best Legal Arguments Against ObamaCare’

Full piece here.

Click through for the arguments against the Patient Protection And Affordable Care Act, the Individual Mandate, and legal arguments against Obamacare (libertarians are leading the charge).

In the discussions I’ve had, if someone believes the idea that health-care is a right and not a commodity (some people argue that it is privilege, morally, but I’ll stick to a commodity, as with a commodity you get what you pay for in a world of limited resources), then they are usually supportive of the Law.

If upheld, I believe we would be inviting the government into our lives in a way we haven’t before, granting it the power to tax and penalize us for our very health itself (few things are more important).  Because few things are more important, and because so many people do not have access to health care, or do have access but we are providing it to them inefficiently, or because some people abuse the care provided and do not have the ability to manage their lives accordingly, or because health-insurance companies are making end-of-life decisions sometimes based on the bottom line and the profit motive (which is what would happen under the new Law), because we’ve tied health-care to employment, or because costs are rising rapidly for all due in part to technology, longevity, and prescription drugs (all of which would become less available long-term under the law)…the supporters of this Law are willing to overlook the power granted to one group of people (their favored political and ideological interests) over other interests left to pick up the costs.

For many of them, the concept of a right is universal enough to enshrine their thinking into law, and the Affordable Care Act, passed as it is, will do.  In digging, I sometimes find much ire against their political and ideological enemies rather than Nature herself, sickness and disease, the natural inequality of human gifts and abilities, and the unequal outcomes we allow in our society.   They want the social contract to mean something quite different.

Of course, the idea that the Act won’t lead to greater fiscal insolvency and massive deficits, at a time when two other entitlement programs are increasingly insolvent, is a non-starter.  It won’t.

The American Interest has a breakdown of the Supreme Court’s schedule here.

Addition: Richard Epstein has more here. More good coverage here. Price controls will drive insurers to compete to provide worst care for the sick, and destabilize health insurance markets by taking away the means insurance companies use to stay afloat.

Another Addition:  The limiting principle.

Related On This Site:  From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

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