In fact, Becky will pay, over the course of her life, close to 50 percent of her total earnings “into the health care system for herself and her dependents.” That number is staggering, but Goldhill is happy to explain his calculations. Surely, he writes, there are better uses to which Becky and Uncle Sam could put such an enormous amount of money: a trip to Disney World, say, or an aircraft carrier battle group.
Insurance has so deranged American health care that our policy debate is framed in terms of increasing and standardizing coverage, not lowering cost and thereby improving access through competition and customer accountability. Goldhill is unsparing in his criticism of the 2010 Affordable Care Act (ACA), aka Obamacare, which mandates universal health coverage: “The ACA’s most obvious characteristic,” he writes, “is its continuity with our existing system: a continued reliance on insurance as the funding mechanism for all care.”
Obamacare is “fundamentally an exercise in Rube Goldberg-like financial engineering.” It is “profoundly old-fashioned,” which is just about the worst thing anyone can call a liberal program. It drastically expands Medicaid, “the most complicated program ever designed by the federal government.” It may even have the unintended consequence of reducing the number of Americans with insurance.
The legacy of Obamacare may not turn out to be what liberals expect, which is that it will guarantee health coverage for every American and, ultimately, lower costs. Obamacare’s expense and complexity may only sharpen the contradictions in the insurance-based health system and precipitate its collapse.
What would be the replacement? No doubt, egalitarians would prefer a system in which government pays for all health care and uses price controls and rationing to limit costs. But Goldhill has a different prescription:
Since we are unable to repeal the economic laws of gravity in health care, it’s time to embrace them, to build a more normal system of financing care—and a more normal system of weighing its value and holding its providers accountable.