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Public policy issues should be discussed first and foremost in terms of their merits. The problem with discussing Obamacare is that most of its proponents seem immune from rational exchange. So we must ask, “What motivates them to support such a manifest public policy mess?”
Recall the rhetoric offered by President Obama in support of his plan. Obamacare would cover the supposed 49 million Americans with no health insurance. (Most of these individuals actually had access to health services or could purchase insurance if they wanted it.) Obamacare would bring down health care costs. It would give individuals access to a wider array of services.
And, Obama famously, loudly, and often argued that if you liked your current health care plan, you would be able to keep it.
So Obamacare mandated that all individuals, under penalty of stiff fines, purchase health insurance. Obamacare mandated that insurance companies beef up their coverage and that they could not charge different rates depending on the health of patients. Government-established exchanges would allow individuals who could not get insurance through their employers or as individuals to find policies to suit their needs. And the government would make sure everyone could afford it—by robbing the rich and healthy to subsidize everyone else.
As Obamacare is kicking in, individuals across the country are being kicked off oftheir current plans. In some cases employers simply can’t afford today's premium payments—payments that are being jacked up by federal mandates. So businesses are dropping coverage for employees or spouses, or making full-time workers part-time so they won’t have to offer insurance.
If Obamacare supporters admit the fundamental flaws in that failed program, they’d have to admit of the paternalist welfare state.
In other cases the insurance companies themselves are booting people out of the system; 300,000 were just dropped in Florida, and CareFirst BlueCross BlueShield will likely cancel coverage for 76,000 customers in Virginia, Maryland, Washington, D.C area. Millions will likely lose insurance. Why are they being kickout off? Mostly, say insurance companies, because these individual plans no longer match the new Obamacare requirements—they don't cover a sufficiently bountiful range of benefits, for example.
Premiums for those still on insurance or seeking policies through Obamacare exchanges define “sticker shock.” In many cases the costs have doubled! And healthy young people, many of whom bought into the touchy-feely, turn-off-your-brain Obama rhetoric, are shocked at what they are expected to pay—the result of having to subsidize their less-healthy elders.
The HealthCare.gov site is a national joke, the definition of a disaster, worse than even the harshest critics imagined. Few folks are signing up through the Obamacare exchanges.
And doctors are disappearing from the market, retiring or running “cash only” practices to avoid the Obamacare regulatory mess.
So how can anyone with a straight face continue to sing the virtues of this fiasco?
First, Obamacare policymakers and apparatchiks place their own political power ahead of any actual results of a program; many supporters felt Obamacare didn’t go far enough, and favored a single-payer program run completely by the government. Subsidies to poorer individuals to allow them to purchase their own insurance—I’m not necessarily advocating this—and tax-exempt medical savings accounts might deal with much of the supposed problem. But this would leave those with a lust for power with too little to control. Better monumental failures like Obamacare than too much liberty for individuals.
Second, for Obamacare supporters to admit all of the flaws in the program would mean acknowledging the fundamental flaws in the paternalist vision of a welfare state with political elites like themselves showering largess on a population of individuals incapable of caring for themselves.
All of the evidence of Obamacare’s failures to facilitate health will do little to sway its supporters because they are morally sick. They are afflicted with “must-control-it-all-itis!”
探討：
Video: How Obamacare Betrays Young People October 1, 2013
Obamacare: RX for Crisis David Hogberg, March 7, 2013
Obamacare’s War on Personal Responsibility Edward Hudgins, April 9, 2012
Understanding Obamacare Compilation of related content by The Atlas Society
愛德華·哈金斯（Edward Hudgins）是哈特蘭研究所（Heartland Institute）的研究主任，也是阿特拉斯協會（Atlas Society）的前宣傳主任和高級學者。
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