Chris Demuth on Obamacare

Source: Weekly Standard
I found a nice Obamacare essay by Chris Demuth, "The Silence of the Liberals: Obamacare is Inimical to Their Values Too," in the Weekly Standard.

The point: Liberals ought to join in the project of constructing a market-based alternative to Obamacare.  We do, in fact, have the same goals, and the question is simple cause-and-effect of what policies will actually produce those goals.

A few highlights with comments (but read the whole thing). We start with a quick reminder of the unfolding train wreck:
Obamacare will never achieve its promise of affordable health care for all paid for with improved efficiencies in health insurance and medical care. ...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.
"Liberals" may not care about expenditures, but surely ought to worry on the last point.

The charge "you have no alternative" is false:
...many prominent Republicans and conservatives​...[and libertarians]...​have come forward with specific proposals for expanding affordable health care more than Obamacare does, while eliminating its many harmful and unworkable features. 
This is an important point. The alternatives will advance "liberal" values, and give people of modest means better care at lower cost than Obamacare. They "go further and aim higher."  This is not the usual narrative of "people need" government help vs. stingy budget hawks. This is about a better way to achieve the same goals-- and more.

What are we talking about? In a nutshell,
Tax and regulatory reforms, and targeted public subsidies, would provide portable and renewable insurance, including for those who have developed costly health conditions; would legalize (rather than banish) low-cost insurance for essential medical services..and would encourage direct purchase of routine medical goods and services where insurance has nothing to offer but paperwork
The hitch: this takes political courage.
Are Americans prepared to part with the illusion that everything related to “health” should be available free or far below cost...? Will they distinguish between higher-priced insurance for medical services they don’t need and insurance that leaves them to pay directly for services they do need but are quotidian and noncontingent? Do they understand that competition and innovation are as valuable in health care as in smartphones and coffee shops?
My emphasis, as this is the point I've been stressing most lately. Want cost control? Let the Southwest airlines and Walmart of health insurance enter and compete.
... The conservative reformers are betting that the public, now that it is paying attention, will answer in the affirmative. They may be right, but they need help.
The help we need is from "serious liberals,"
Serious liberals are those for whom the primary purpose of politics is to protect personal liberty and advance social equality.
I didn't realize I was also a liberal!

Now, the two most important and novel reflections on Obamacare.  (Maybe this should come first!)
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.
Expanding on the first theme, which is on my mind but not common in health care discussions,
Obamacare ... 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...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.
More darkly, the second theme, also only beginning to get press:
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...
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.
And that's only the beginning of the dangers of rule by executive decree with no checks and balances or legal recourse. (What large insurer will dare to stand up to the latest White House pronouncement?)

"Serious liberals," libertarians and conservatives, can come together to fix this.
Serious liberals... should dare to join a coalition of reconstruction with the serious conservatives who have already dared to lay their cards on the table. There would be many significant disagreements to be hashed out... But the prospect of letting Obamacare run its course gives both sides a great deal to gain from compromise

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