A Conspiracy of Debacles: the Advent of Single Payer?

I don’t believe much in conspiracies. For one thing, they require secrecy and belief in the other guy not to spill the beans. Often, information connected with conspiracies has value, economic value or simply psychic value (“I already knew it yesterday!”) Hence, the frequent betrayal. Moreover, people in general mess up, the conspiratorial group tends to amplify the mess. For all these reasons, mention the conspiracy against Julius Caesar and I will tell you it’s not obvious it happened. I am skeptical about conspiracies in general but I can make exceptions.

Today, in December 2013, my skepticism is vacillating. I am skeptical about my usual skepticism, you might say. The reason is that I have never seen a governmental debacle of the magnitude of the current roll out of the Affordable Care Act (It’s “Obamacare.” Don’t even try to correct me on this. I heard the president with my own ears claim the nickname.) The present demonstration of incompetence is so out of proportion with everything I have experienced in my life that a part of my brain is whispering to the other that it can’t just be simple incompetence. To begin with, it seems to me that an average nerdy company would have done a better job of the electronic exchanges: WSJ says 12/12/13 that in all of Oregon 44 people have enrolled. (My friend Scott from Silicon Valley will correct me if my assessment of the ease of setting up the exchanges is wrong.) Furthermore, in an operation of this complexity and of this magnitude at best, some degree of failure was to be expected. Any normally prudent person would have set up a fail safe mechanism, a second chance device, or, at least, readied a large lifeboat. None of the above exists it seems. I have trouble believing in a simple oversight.

Beyond the electronic failure -which is guaranteed to induce sneering hostility in the young who use EBay and Amazon with their eyes closed – the same people desperately needed to join, there is the deleterious substance of the reform: Many people find themselves saddled with larger premiums, higher deductible and often both. I don’t know how many. I don’t think anyone knows how many. It does not matter but those reporting that they are so affected are not, cannot all be Tea Party fanatics.

Even the main redeeming virtue of this disaster has been largely withdrawn. I heard that the Congressional Budget Office had estimated that 30 million people would still be off the health insurance roles after the whole Obamacare law is implemented. It’s as if a malignant hand had deliberately withdrawn the last consolation from the disaster: It will make you poorer; it might leave you with a doctor you don’t like (“might”); it leaves you exposed without health insurance although you used to have a plan with which you were satisfied; and it won’t even help that much those it was supposed to help.

Digression on Tech. source note: The first numbers come from an editorial in the 12/12/13 Wall Street Journal. The notion that millions of non-insured will remain uninsured even under the best hypothesis is all over the media. I am not able to cite a precise source. Make a note that I will not consider any lazy and irresponsible denial of this assertion. If you think that’s not true, that I misheard or heard well something false, just say so here, explain why you are sure it’s wrong, and sign your name. I will publish any denial in bold letters. Girlish snickering is not welcome.

By the way, I don’t want you to think that I am implicitly legitimizing the Democratic claims about the number of real uninsured. I never bought the “millions of uninsured” argument. Two reasons. First, it confused “no insurance” with no “health care.” It also confounded and confounds “inefficient way to deliver care” with “the poor dying on the hospital lawn for lack of care.” More importantly, I became convinced that the poor, powerless abandoned souls imagery the Democratic Party uses to characterize the uninsured is largely an invention. Many of the formerly uninsured are people already legible for existing programs who were not enrolled, many children of the irresponsible and incompetent, for example, probably some isolated older people. Other non-insured are clearly rich enough to afford health insurance and simply don’t take he trouble to buy it. Others, mostly young people who are not rich, make the rational calculation that they are quite unlikely to become seriously sick. They engage in low-stake gamble about their proximate health. Once you added the three subgroups of the uninsured, the pathetic-sounding category “ uninsured” melted to little, to next to nothing.

I can ignore my disbelief about this for the time being. I just assume that millions of Americans thought the reform was necessary for reasons of compassion toward the more vulnerable among us. Absent or diminished this justification and this rationalization many of the same Americans will feel disappointed or even cheated. (I am charitably ignoring the claim that the scheme would make health insurance cheaper.)

Now, let’s project ourselves only four to six weeks, to the 2014 State of the Union Address. By that time, by law, most everyone is supposed to be covered. The insurance companies have continued withdrawing plans that are non-compliant, or that they fear may be judged non-compliant with the new law. The number of people between insurance plans has grown from an estimate of 4 million (the WSJ 12/12/13) to ten million. There are reasons to believe that the numbers of those left out will yet grow. The forty or fifty millions original uninsured remain mostly uninsured. The young that the new law unaccountably counted on to finance the new project stay away in droves. The fine they incur, after all, is not much higher than the beer bill for three average parties. Discouraged by the mess, the shamble, the unpredictability, small businesses nearly all shed their health coverage.

In this scenario, in a matter of weeks, the number of Americans without legally required health insurance rockets up to some large proportion of the population, perhaps to one American in four, even one in three. At that point, according to the implicit liberal narrative, we have a national life-and-death disaster, an event that makes Katrina look like a Cajun picnic. According to the same implicit narrative which the Democratic hierarchy cannot suddenly denounce, people are going soon to begin dying in the streets. What was but recently a controversial reform has become a national emergency.

What’s a normally compassionate, responsible president to do under the circumstances? I mean any president?

The answer is blindingly clear: In this emergency, the president will announce that all Americans not otherwise covered are now under the existing, reasonably functional Medicare program. And, he will leave the accounting for later. And this accounting will not seem like much of a new problem because it’s just an enlargement of an old problem. (“The devil we know….”) The president could decree on such a radical measure without fear of much criticisms from the opposition. What Republican official will have the fortitude to insist that proper constitutional form must take precedence over the imminent distress, and possible death from neglect of millions? Which elected Republican will have what it takes to face the first media story – true or false – a single story of a youngish person dying for lack of care?

Many ordinary Americans will opt for the simple solution: Instead of digging around for an elusive insurance plan that suits them and that is also compliant, they will ask to join Medicare. Once nearly half of Americans are covered by Medicare, the private insurance companies will quietly surrender. Some will begin to specialize in luxury coverage for the very rich. Others will just re-focus on areas other than health care. Many will simply go bankrupt and then vanish (as happened in other countries under similar circumstances). Soon, the US too will have a single payer government run health insurance system. The Obama administration will have reached the Graal of all liberals since F.D. Roosevelt.

This would be an easy conspiracy to carry out because it does not require that explicit instructions be given to the co-conspirators. Hence, there is no possible leak, no chance of getting caught red-handed. It’s also a conspiracy that does not require extraordinary skills but only the subtle encouragement of government’s normal low standards of performance. Much of the deliberate sabotage of a real implementation of the new law would only have to take the form of inaction, for example, of the administrator in charge of the reform. This does not require talent but good nerves, or indifference. Ms Sebelius, the person in charge of implementing Obamacare has been reported by conservative media to have had no (zero) meetings with the president. If they are wrong, the real number must still be very low, lower than you would expect given the centrality of the scheme to the Obama presidency. That is if the president really wanted the implementation of the 2,000+ pages of the Affordable Care Act to go smoothly. If!

The most successful socialist revolution socializing more than 15% – and growing- of the largest economy in the world will have been achieved quickly and without much real opposition. Hurrah!

Now, this is all speculation. I am just connecting the dots. I hope I am completely wrong, that we are all facing an ordinary debacle, one due entirely to gross but innocent incompetence.

Personal note: I have seen the French single-payer system at work under trying circumstances. My subjective evaluation is that it works quite well. On the objective side, there is the fact that French men live two years longer on average than American men. (Yes, I too would like to believe it’s the red wine but I know to keep my inner child in line.) My objection to a government health sector is of a moral and political nature: We just don’t need more government; we need much less government in order to be free. Besides, one should not take for granted that we can do well whatever the French do well. Take ratatouille, for example, take pâté de campagne, etc.

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17 thoughts on “A Conspiracy of Debacles: the Advent of Single Payer?”

  1. When you truly consider what the ACA accomplishes, it does only one thing well, that is to collect data on anyone who clicks on it, and everyone is required to at sometime or another. Think how much damage can be done to the democrats enemies with all that information. With the IRS, and others already using politics to influence elections, and others targeting states that are red, how much more damage can be done with all the information they have collected so far. God bless you!

  2. I hope you’re right Jacques. I’ve had 14 years of single-payer in Canada and I’d never go back to the old system in the US. Well, strictly speaking each province has it’s own system, I belong to the Ontario system. They say even a broken clock is right twice a day, with luck this is one of your accidently accurate predictions.

    1. Terry :You are a sore loser, as usual. Didn’t you notice that I said only good things about the French single payer system? Except that it’s an important part of the French system of state slavery that accounts for general moroseness, economic stagnation, cultural sterility, and the desire of a high percentage of the young to emigrate. As for Canada, it irritated me because of its apparent virtuousness until recently. Fortunately, there is the mayor of Toronto and I like them better all of a sudden.

      Should I understand that you hope I am right in imputing massive deviousness to the president and to his handlers?

      1. “Should I understand that you hope I am right on imputing massive deviousness to the president and to his handlers?”

        Yes.

    2. Correct me if I’m wrong, Dr Amburgey, but wasn’t the single-payer system in Canada implemented through the democratic process?

      That is to say, wasn’t the Canadian single-payer system sold to the Canadian people as a single-payer system, rather than as something else?

      I ask because it seems to me that you are implicitly supporting the idea that the ends (socialized medicine) justify the means (blatant deception).

      Although co-blogger Warren also suspects foul play in this matter, I think this whole debacle is simply democracy in action. I’m also not convinced that single-payer is not a good step towards a much better, much more decentralized and market-oriented system within the next decade (political scientist Mike Munger has a great blog post on just this topic).

      1. @Brandon

        I believe that’s true but it happened before I moved here

        “I ask because it seems to me that you are implicitly supporting the idea that the ends (socialized medicine) justify the means (blatant deception).”

        Yes, but in Jacques’ fairy tale everything happens by popular demand so it all works out in the end. Especially since Republicans are quite willing to go along with everything.

  3. I have a 51 year old brother in law who has not health insurance. It is not because he is uninsurable due to pre-existing conditions. It is not because he is poor. He has a house, RV, and boat. It is because he chooses to not spend the $300 per month premium to be included on his wife’s group health insurance through her work. Would he have paid for coverage if it was only $220? I doubt it. How about $150? I don’t know the magic number. Let us face it, it is just no fun paying any premium for insurance of any kind. That is why healthy young people do not want a premium added to their monthly expenses because that takes away from their entertainment budget. It is only when you need care that you wish you had health insurance. We will always have uninsured people as long as there is a choice.

    1. @Cowboylawyer
      I think it’s safe to say that we will have uninsured people as long as we have choice and the Emergency Medical Treatment and Active Labor Act (from back in 1986) which requires any hospital participating in Medicare “…to provide emergency care to anyone who needs it, including illegal immigrants, regardless of ability to pay.”

      Nothing like a free-rider problem produced by statute. It’s not surprising that some among us worried enough about free-riding in health care to propose a so-called individual mandate. I don’t know that it was the first but I think the most well known was Stuart Butler of the Heritage Foundation in 1989.

      http://healthcarereform.procon.org/sourcefiles/1989_assuring_affordable_health_care_for_all_americans.pdf

  4. Terry: You keep invoking my name to blame every burr under your saddle. It’s a shortcut to analysis, I guess.

    You don’t know if the Canadian system was implemented through a democratic process because it happened before your time? If I reported you had said that I would be taxed with something awful, again! No one, but no one makes that sort of confession deliberately!

    Brandon: I admire your optimism (no tongue in cheek) but, of the many examples we have a single payer centralized systems not one has ever come out of heavy statism, I think. To see if I were wrong on this impression, I would look toward Switzerland, first.

    Conservatives have been largely wrong in defining the shortcomings of “socialized medicine.” It’s very bad for the patients in some places. It’s quite good in other countries. The problem with the French system, for example, is that it’s very comfortable with little by way of known shortages. The problem, I said, is that it’s comfortable. As I implied above, if it were very bad, it would show up in mortality figures . (The alternative is to believe that health care quality does not affect mortality, or not much, an interesting perspective in itself.) The current generation of 40-year old French people have zero knowledge of the cost of medical procedures, of surgery, of almost anything connected with their health. They have some idea of the costs of medication because they often pay a set % of the cost, maybe 20%.

    The generous and satisfactory French system is simply treated as another unfunded obligation. Every so,often an administration does something dramatic about it. A few years back a government decreed that the hotel tax would be imposed on hospital stays. (Would I have the imagination to make this up?) NFW!

    1. @Dr. P

      “You don’t know if the Canadian system was implemented through a democratic process because it happened before your time? If I reported you had said that I would be taxed with something awful, again! No one, but no one makes that sort of confession deliberately!”

      I’m always willing to say ‘I don’t know’. I know people that prefer to make stuff up when they don’t know but I prefer the embarrassment of ignorance to mendacity. When Brandon talks about the democratic process I assume he means an electoral process. For all I know the health care system in Canada is due to judicial decision. I can go look if you and/or Brandon are interested in it’s origin.

  5. Keep in mind that Provinces are much more consequential in Canada than States are in the US. In 1946 the Saskatchewan Hospitalization Act guaranteed free hospital care for much of the province. In 1950 Alberta jumped on board. In 1957 the federal government passed the Hospital Insurance and Diagnostic Services Act which promised that the feds would foot 1/2 the bill for any provincial system that met 5 standards. By 1961 all 10 provinces had systems. In 1966 the feds went for universal health care. Things were pretty much finalized by the Canada Health Act of 1984.

    Although things were legislated at both provincial and federal levels it was 100% legislated.

  6. Good research, Prof. Terry. All you needed was a kick in the butt to get you out from behind your screen of ignorance ( It was before my time, like the Revolutionary War, of course I know nothing about it.) Because of the current American context – the starting point of this discussion – you might have told us that no deception was involved at any point in the Canadian development of one -payer health system, if that was the case, or only a little deception. Of course, the fact that the national system began as provincial (more local) initiative makes all the difference in the world. If the Obama administration had taken another route, a more democratic route instead of slamming down a 2,000page+ law that no one, or few, had read before passing it (according to the Speaker of the House) through an unusual voting procedure, it would enjoy today more benefit of doubt, more indulgence. If there were a democratic smell to the law (instead of its Democratic authoritarian stink), more people (including me) would be willing to say, “Well, they are trying; nobody is perfect; give the guy a chance. ” It seems to me that proponents and supporters of Obamacare don’t grasp the difference between clumsy sex and rape.

    And you are implicitly accusing me of mendacity. Please, come up with an example of my mendacity and please also don’t confuse laziness or misunderstanding with mendacity which means lying. And since we are on the subject of the English language, it’s still “its origin,” not “it’s origin.”

    Oh, that was bitchy and I am so ashamed!

Please keep it civil (unless it relates to Jacques)

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