After ObamaCare (still)

Holman W. Jenkins:

ObamaCare is finally popular with the American people according to a variety of polls, and it’s instructive to understand why. The doing is Donald Trump’s and the Republicans’, and not in a way that made ObamaCare a sensible program.

Thanks to their effective repeal of the individual mandate, nobody is forced any longer to buy ObamaCare or pay a tax penalty. ObamaCare’s user cohort now consists almost entirely of willing “buyers” who receive their coverage entirely or largely at taxpayer expense. It also consists of certain users who take advantage of the coverage for pre-existing conditions and stop paying once their condition has been treated.

So why is ObamaCare growing in popularity with the 94% of Americans who don’t use it? Because it’s there if they need it.

In every larger aim, the Affordable Care Act has predictably failed. It was supposed to ramrod efficiency through the health-care marketplace. Instead, it has become just another inefficient program bringing subsidized medicine to one more arbitrarily defined subset of the population.

Donald Trump listens to his briefings, apparently, because he cut to the heart of the issue with a recent tweet pointing out that, for most people, ObamaCare was not “useful.” He’s right. For a family of four not benefiting from a subsidy, notes insurance industry veteran Bob Laszewski, a policy can cost $15,000 with a $7,000 deductible. In other words, “they have to pay $22,000 before they get anything.”

Nonetheless, this column once maintained that a reformed ObamaCare, with its now-defunct individual mandate and its half-impulse to confine handouts to the needy, was potentially a better program than the menagerie of programs we have now. ObamaCare, in theory, could replace them all, including Medicare and the tax giveaway for employer provided insurance.

Alas, the idea of sweeping health-care reform seems to have gone out with the Bill Clinton and George W. Bush administrations. Two obstacles stand in the way. Nothing says “I care” like promoting more health-care spending, so U.S. politicians are addicted to dishing out incentives for Americans to consume medical attention whether or not it does them any good.

Secondly, how to climb down from any existing set of subsidies without provoking some vital bloc of voters has proved the unsolvable equation of America’s gridlocked politics. Notice that even the GOP’s “repeal and replace” campaign devolved into trying to repeal the funding for ObamaCare (e.g., the media-device tax) without repealing the benefits.

If you depend on government-provided health care, the upshot is inevitable: longer waiting lists, rising copays and steeper deductibles as Washington struggles to pay for the medical procedures it has promised you regardless of whether these procedures leave you better off.

Should we abandon hope? No. The saving grace of our funky system is the giant tax incentive it gives employers to preserve profits by figuring out which medical treatments actually keep their employees healthy and which don’t. This shouldn’t be corporate America’s job, but it is. It’s no joke to say many U.S. businesses have more to gain from controlling health-care costs than they do from running their own operations better.

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