Arbitrary Power, Dictatorship, and Health Care

Officials may gather whatever taxpayer information they decide is necessary. “The secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle" (Sec. 321). Section 412 requires employers to submit “such information as the commissioner may require” to multiple federal agencies.

The bill institutionalizes such coercions by establishing over one hundred new commissioners, boards, committees, and programs, each with its own area of control. (For a list, see here.)

America is not a dictatorship. These bills are available for us to read, and we are able to discuss them openly, to agree or to disagree, and to speak and write about them in forums both public and private. But we will not be free to escape either the regulations which a faceless bureaucracy will write in order to enforce its edicts, or the decisions made by such bureaucrats over our lives.

If you are an employer, you will not escape punishment if a bureaucrat decides that your health plan is not “acceptable” and that you must be fined for your failure to meet his decision. If you are an individual who does not want to purchase full-coverage health insurance, but would rather buy catastrophic insurance that covers hospitalization only, your decision will not be “acceptable” and you may face a government audit and a new tax.

Do you have a serious disease? Does your doctor wish to readmit you to the hospital? A bureaucrat will decide whether or not you get treatment, based on a statistical analysis of the number of such readmissions by the bureaucrats: “excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the secretary) of discharges for such applicable condition for the applicable period and such hospital” (Sec. 1151).

The scope of power here extends to the very definitions of terms within the law. This leaves the meaning of the law fluid and subject to the will of the bureaucrats. Section 1151 continues: The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the secretary among conditions and procedures for which (i) readmissions (as defined in subparagraph (E)) that represent conditions or procedures that are high volume or high expenditures under this title (or other criteria specified by the secretary).”

No, America is not yet a dictatorship. But we can ask ourselves whether the essence of such a dictatorship -- and its institutional foundations -- are not being built into federal law now. The scope of action available to federal administrators is widening today at a blinding speed. No proper reform of health care -- or any other area of life -- can be accomplished by the progressive, open-ended empowerment of government officials against defenseless American citizens.