NCPA - National Center for Policy Analysis

Obamacare IS Socialized Medicine!

December 7, 2016

Senior Fellow Devon Herrick writes at NCPA's Health blog:

Have you ever stopped and considered why the government wants you to have health insurance? The Affordable Care Act (ACA) was supposedly designed to make health care affordable for millions of individuals who could otherwise not afford health coverage or would choose not to enroll due to costs. Worse yet, the ACA was designed to make medical care "affordable" for many individuals by foisting the costs on others who are not at risk of health problems. Obamacare was premised on the idea that benefits one person would never expect to use should be subsidized for others who may need them. That is the very definition of socialized medicine!

 Medical care is a service that not everyone places the same value on. Even controlling for health status, different people will want to see the doctor and pursue medical interventions at different rates. Thus, requiring everyone to have similar health benefits does those who want less medical care a disservice. This was the subject of a recent article in the New York Times column, The Upshot by economist Austin Frakt. In his column, Frakt discussed the problem with "one-size-fits-all" health insurance.  In the process, Frakt also raises a concept similar to what an economist colleague, NCPA senior fellow Gerald Musgrave, discussed with me a few years ago. You cannot buy a health insurance policy that only provides, say, 1990s technology the way you can choose to economize by buying a used car or a pre-owned home.  (As an aside, neither can you choose a hospital that buys its equipment used/refurbished. Much of medical equipment is leased and later sold abroad when the lease is up to avoid competing with new equipment)

For that matter, the ACA does not allow individuals to take out a $25,000 deductible to lower premiums. Nor does it allow individuals to forgo all coverage for medical benefits above, say, $500,000 (or $50,000 which would be enough for about 99 percent of the population). A person who has lead a healthy lifestyle and reaches middle age in perfect health does not qualify for a discount lower than a similar-aged person whose health status is a hot mess. And it doesn't end there.

Someone who does not have Hepatitis or a rare disease cannot agree to forgo high-priced treatments for those diseases. Neither can you buy medical coverage that does not include maternity benefits just because you are male and incapable of having babies. A couple who has undergone a permanent contraceptive procedure cannot avoid coverage that omits family planning or maternity benefits. Let's say you are a Mormon, whose religious beliefs precludes alcohol, tobacco and other addictive substances. You are not allowed to sign a waiver forgoing the right to chemical dependency treatments in return for lower premiums. Neither are Scientologists allowed to forgo coverage for mental health conditions their religion does not treat using medical therapy. For that matter I know of no health insurance plans that will only cover medical care received in foreign countries. There used to be one available on the far southern border of California that only covered Mexican doctors but it's doubtful that one still exists.

The ACA was designed with the idea in mind that demand for medical care should not be a function of income. Moreover, the ACA was designed to spread the cost of medical care across diverse groups regardless of the health risks and preferences of health plan members. It was designed to maximize cross-subsidies, which is precisely what's wrong with the Affordable Care Act (ACA). Under those conditions, it's no wonder premiums in the exchange are skyrocketing.

The "Affordable Care Act" was poorly named; it did not make care affordable. It made health coverage semi-affordable only for those newly-eligible for Medicaid and those earning up to 250 percent of the federal poverty level. The ACA took away the right of consumers to purchase the benefit package and type of coverage they prefer. It also took away the flexibility for insurers to experiment with differing plan designs.  In the process, the ACA made health coverage decidedly unaffordable for millions of people who do not qualify for subsidies and have to purchase individual insurance on their own. It's time to repeal the costly regulations and replace them with something that allows coverage that is truly affordable (and flexible).

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