The Hudson Institute’s Christopher DeMuth writes in the Weekly Standard on the practical reality of ObamaCare as it is being implemented.
Obamacare will never achieve its promise of affordable health care for all paid for with improved efficiencies in health insurance and medical care. The initial troubles and compromises have revealed that the program improves “access” mainly by herding millions of people and firms into insurance they do not want or need. A great many will simply refuse, having little to fear for the time being, with the result that government expenditures will be far higher than projected. It is equally clear that the variety and quality of medical care will be seriously restricted for all concerned.
Collaterally, Obamacare is introducing a new form of government—improvisational government, characterized by continuous ad hoc revisions of statutory law by executive decree. This is a reversion to a primitive form that long antedates our Constitution and rule-of-law traditions. Transported to the modern world, it leaves the private sector in a state of constant uncertainty and subjection.
He notes that most of the response to the statute has been reflexively partisan — unified, unyielding and unthinking Republican opposition and near-unanimous Democratic support. As DeMuth sees it, the former is predictable; the latter lamentable. As each day passes, and more about the actual operation of the PPACA is revealed, it becomes increasingly clear that the PPACA itself challenges core liberal values, and yet few liberals raise any real concerns. (And, no, I don’t consider pre-election posturing about insurance renewals to be an expression of genuine concern about the operation of the statute.)
Serious liberals are those for whom the primary purpose of politics is to protect personal liberty and advance social equality. Their liberalism has been the motive force of America’s political history—which is the saga of extending legal and political rights, social status, and realized liberty to ever-wider groups, and legislating “welfare state” protections against the social and economic vicissitudes of life. They have been eclipsed in recent decades by those who call themselves “progressives”—who borrow the language of liberalism but are in practice devoted to enlarging and valorizing government itself rather than the liberty and equality of citizens. Critically, progressives predominate among Democratic party and interest-group activists whose careers consist of acquiring and deploying state power. But serious liberals are still prominent in intellectual and university life and in the party itself; they may be said to be the party’s conscience. . . .
Serious liberals were silent or supportive during the Affordable Care Act’s legislative debates, bitter enactment, and initial implementation. That was understandable, for the effort promised to dramatically expand health care availability and to correct several evident injustices, such as the unavailability of insurance to those who have developed serious maladies; and Republicans were working hard to stop it and might well have succeeded. Then, when the troubles first appeared earlier this year, it seemed natural to many liberals to attribute them to fixable technical glitches and executive incompetence. But now that the program’s true nature and future course have come into sharp relief, it is time for serious liberals to find their voice. For Obamacare’s two central features are as inimical to liberal values as to conservative values. The first is monopoly and the suppression of diversity and competition. The second is extreme concentration of power, exercised continuously in monitoring and directing the activities of millions of citizens. . . .
Obamacare is not an outright government monopoly, but it achieves the same dreary results through standardization and regimentation. It establishes a profusion of regulatory controls over prices, entry, and services in insurance and medical care, policies whose systematic anticonsumer perversities have been documented by generations of economists of all political persuasions. (Not long ago, the elimination of entry and price controls in competitive markets was a bipartisan project, championed by Edward Kennedy as well as Ronald Reagan.) That some states operating their own Obamacare insurance “marketplaces” are already moving to ban the private sale of individual and small-business insurance is one example of the program’s tendency toward explicit monopoly.
But the most harrowing aspect of Obamacare is that it vests political executives and government administrators with sweeping discretionary power, free of conventional checks and balances. It gives federal officials the authority to set insurance prices without any of the economic and legal standards that govern regulation of public utilities. It gives obscure committees authority to decide on the kinds of medical services doctors and hospitals are permitted to deliver from one patient to the next. It gives political operatives the ability to force private institutions to dispense free birth control pills, and potentially many other things, as tactics of electoral campaigns. It has federal and state officials running “marketplaces” and advertising campaigns and sales promotions—all with the style and mindset of business executives, but with coercion as well as persuasion at their command. The unsettling appearance of what I earlier called improvisational government—with the president and his subordinates revising Obamacare’s statutory requirements, and even their own implementing regulations, by press conference or web posting—is an authentic expression of the statute’s basic ethic, which is the ethic of executive will.
It’s a welcome development that ObamaCare implementation has helped remind conservatives of the dangers posed by unilateral executive authority, particularly in domestic affairs. What’s regrettable is that ObamaCare has also caused so many on the left to forget them.