The Magazine

Health Reform Breaks Bad

The deceptions and disasters of Obamacare

Oct 21, 2013, Vol. 19, No. 07 • By CHRISTOPHER J. CONOVER
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Breaking Bad is the story of a seemingly well-intended but very misguided man who turned to cooking meth in order to amass enough wealth to provide for his family once he dies of cancer. The consequences of that unfortunate decision—not to mention the lies and deceptions to keep it on track—pyramid alarmingly over the course of five seasons, culminating in mayhem and a head-spinning body count.


Obamacare isn’t a TV drama. But it will unleash its own tsunami of unintended consequences: more than a million jobs lost, an economy increasingly made up of part-time workers, higher health spending (at least a half-trillion dollars just over the next decade), a decline in medical innovation (and attendant loss of life).

While Obamacare undoubtedly will do a modest amount of good, the urgent question is whether the law’s supporters will come to see that the good pales in comparison to the damage. Obamacare may still crash and burn (see Medicare Catastrophic Coverage Act of 1988), or it may endure as a monument to government ineptitude and inefficiency (see U.S. Postal Service, whose deficit last year alone was $15.9 billion, despite being exempt from taxes, regulations, and even parking tickets!).

While there are many cooks who spoiled this particular broth, there’s little question that but for Barack Obama himself, this monstrosity would unlikely ever have been signed into law. Health policy scholars have known a dirty little secret for decades: When it comes to “universal coverage,” Americans have never been willing to put their money where their mouth is. Public opinion polls going back to the 1940s rather consistently show a majority of Americans in favor of “national health insurance” (as it was called then) or “universal coverage.” But such opinions were in response to open-ended questions that gave no sense of how such a program might affect respondents’ taxes. Starting about three decades ago, pollsters began taking a more sophisticated approach that probed the willingness to pay for expanded coverage of the uninsured. If one took the results of such polls at face value, i.e., assumed one could collect the actual amount of taxes respondents said they were willing to pay, the combined amount of taxes would cover only one-third to two-thirds of the cost of universal coverage.

This hard truth was so pervasively known in the health policy community that it was the theme of a Christmas card sent out by Princeton health economist Uwe Reinhardt in the late 1980s: Eighty-five percent purported to favor universal coverage, yet only 20 percent were willing to pay more than $50 a year in taxes to achieve this purpose. In short, pursuit of universal health care was either a fool’s errand (from a political standpoint) or would require the wool to be pulled over the eyes of the American public.

In Barack Obama, reformers found a candidate willing and able to rise to the occasion. Notwithstanding a campaign pledge to “always be honest with you about the challenges we face,” candidate Obama offered Americans the moon: He would cover most (albeit not all) of the uninsured; to the degree higher taxes were required to deliver on this promise, every penny would come out of the pockets of “rich” Americans; not only would middle-class Americans not have to pay a penny in new taxes for this dramatic but expensive new entitlement, the “typical” family of four would save $2,500 a year in premiums (before the end of his first term); and the plan would not add a dime to the deficit.

Another hard truth had emerged from the spectacular failure of the Clinton health reform initiative in 1994: The majority of Americans are generally satisfied with their own coverage and deeply resistant to anything that might threaten it. No problem. Obama had that covered as well: If you like your plan (and your doctor), you can keep them. These were the deceptions that brought us Obamacare. Let us examine them in turn.

Deception #1: universal coverage

Obama’s promise: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American” (June 23, 2007).

Reality: views this as a campaign promise kept since President Obama signed into law a plan that included an individual mandate with few exemptions. And keep in mind this promise, unlike the others, actually was doable. However, the Affordable Care Act will not deliver universal coverage. According to the latest CBO projections, when fully implemented, Obamacare will cover fewer than half of the nation’s uninsured (leaving 31 million uninsured in 2023). Nevertheless, this turned out to be the closest the president came to keeping one of his promises. As we will see, the others missed by a mile.

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