It's Not Just the Mandate: ObamaCare's Other Infringements

ObamaCare supporters were hit with more bad news recently when the Congressional Budget Office announced that the health care law would cost nearly twice the original estimates: $1.76 trillion over ten years rather than $940 billion. Of course, such “unexpected” cost overruns are nothing new for government programs. When Medicare was passed in 1965, it was predicted to cost $12 billion by 1990. In reality, it cost a whopping $110 billion, almost 10 times more than predicted.


But the escalating economic costs of ObamaCare will pale in comparison to the escalating losses of freedom.

The infringement of personal freedom receiving the most attention lately has been the “individual mandate” requiring Americans to purchase health insurance. This issue is at the heart of the current legal challenge before the U.S. Supreme Court. But ObamaCare imposes numerous other mandates and controls, including the following:

  • Insurance companies must offer numerous “free” benefits, including various preventive health services, birth control, and coverage of “children” up to age 26.
  • An Independent Payment Advisory Board (IPAB) of unelected bureaucrats will set prices for Medicare services that will lead to de facto rationing.

The administrative costs associated with complying with these regulations will accelerate the trend of doctors leaving traditional private practice. Instead, doctors will increasingly work for large Accountable Care Organizations where they’ll practice according to government protocols, with their compliance monitored by the mandatory electronic medical records.


As Dr. Donald Berwick (President Obama’s former head of Medicare) once noted:

The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.

In other words, restricting physicians’ freedom to practice is not some “unintended consequence” of ObamaCare, but rather an explicitly desired goal.

Simultaneously, ObamaCare will also squeeze private insurers out of business. In a recent Forbes article, Sally Pipes notes:

ObamaCare effectively forces insurers to pay out more generous benefits but limits their ability to raise the revenue needed to do so. Consequently, many firms will go out of business.

The decline has already started. Aetna has pulled out of the individual insurance market in Colorado and Indiana and out of the small-group market in Michigan. The Iowa-based Principal Financial Group stopped selling health insurance entirely, leaving 840,000 people without coverage. And Unicare has stopped selling policies in Virginia.

Once the private insurance market has been destroyed, Americans will be forced to buy their health insurance on government-run “exchanges” where the government decides which health services should or should not be covered.
Just as the government controls over agriculture in the former USSR led to food shortages and long “bread lines,” government controls over the health sector will lead to longer waits for medical care. Health laws similar to ObamaCare have been in effect in Massachusetts since 2006. Massachusetts patients must now wait an average of 48 days to see an internal medicine physician — double the national average. Under ObamaCare, the rest of the country will soon experience similar problems.


If history is any guide, the government will likely impose additional controls to “solve” the problems created by their earlier controls. As Ludwig Von Mises once noted, controls breed controls. One logical next step would be further “physician mandates.” Some disturbing precedents that have already been proposed in the U.S. and Canada include the following:

  • Oregon will require “concierge doctors” to register as insurance companies, because those physicians accept fees from patients in exchange for the promise of future medical services. This makes it harder for doctors to “opt out” of the government-controlled insurance system.
  • Last year, Canadian health authorities told doctors in Prince Edward Island they’re not seeing enough patients and must accept more.

The escalating economic costs of ObamaCare are bad enough. But they pale in comparison to the coming escalating losses of our medical freedom. As a patient, do you want your doctor to be free to practice according his best independent judgment for your best medical interests, or compelled to practice according to government guidelines, beholden to the state for his livelihood?


The Supreme Court may or may not decide to overturn ObamaCare. I hope it does. But if it doesn’t, Americans will still have one last opportunity to overturn ObamaCare at the ballot box this fall: elect politicians committed to repeal.

Robert Heinlein once wrote, “The human race divides politically into those who want people to be controlled and those who have no such desire.” Right now, the first group controls our health care. It’s up to us whether they remain in charge after November.

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