Dear Uncle Sam,
Forgive me. Although I am a loyal citizen, and despite all the excitement this past week at the Supreme Court, I have not read the entire “Affordable Care Act.” Nor do I want to. I’m not even sure exactly how long it really is, though once any document runs to more than 2,300 pages (which this does), it strikes me that it might be more efficient to skip such niceties as pagination, and just weigh it.
I do know that if you go to the federal web site Healthcare.gov, which I saw advertised on TV Thursday evening (who paid for that, by the way? Was it We, the
Penalty Tax Payers? Or are broadcasters required to subsidize this?), you can find the full text of the law, conveniently broken up into Big Gulp-size sections. These are accompanied by a note that the sections “have been excerpted because presenting the Act in a single PDF results in a very large file which may present download difficulties.” (For real diehards, there is also a link to the full 4+ megabyte PDF file. Beware — I tried it, and had to reboot my computer.)
It is of course possible that right now millions of Americans are cheerfully downloading great wads of this act, poring over it the way the Chinese once studied the speeches of Mao, and preparing to adjust to this extraordinary new world in which government intervention makes everything work so much better. It might well be that I am a surly oddball, raised on those corny old ideas about the astounding benefits of free market competition. Perhaps I am unduly nervous that what this Act will produce is not better healthcare for all, but mediocre medicine rationed at exorbitant cost by a bureaucracy similar to the one that handles airport security.
All that said, however, I do have a few questions. Actually, I have a lot of questions. But to sort them all out and align them with the wildly shifting arguments that have gone into this law would leave me no time to earn the income to pay the tax, or the penalty, or the insurance premiums, or whatever it is we’re now calling it — there seem to be a lot of plans right now to take a lot more of my income, and very little of that seems to be going to my actual doctors.
So, for the moment, I have boiled it all down to three questions (though, in the spirit of our esteemed authorities in Washington, they have subsections):
1) Has President Obama himself actually read this entire law? It is, after all, described as his signature achievement. Has anyone in the White House press corps, or for that matter anyone within shouting distance, ever asked him this question? And if he’s said he has indeed read it, may we know when, and where, and how long it took him to read it? … Or is that a level of detail with which America’s federal elite, with their special healthcare plans, and waivers for their pals, need not concern themselves?
2) If the government can propose to fine me, and end up taxing me, for not buying health insurance, then the analogies to compelling me to buy broccoli or fork out to the IRS are the least of it. Can Washington produce a law requiring that all writers produce a minimum quota of prose in praise of Obamacare, or of Congress, or of the president himself — or be forced to pay a penalty? Which, if challenged all the way up to the Supreme Court, would presumably then become perfectly acceptable under the argument that this is not a fine, but a tax? (I wondered briefly if that might conflict with the First Amendment, but I suppose that could be resolved by leaving writers free to say what they really think, once they have met the quota for saying what they are required to think.)
3) About those emergency-room visits. The president has been arguing that Obamacare will cut down on the cost of high-ticket trips to the emergency room, made by people who don’t have medical insurance, and who don’t pay their bills — leaving the hospitals and the rest of us to pick up the tab. The reasoning here seems to be that once these folks have coverage, they will skip the emergency room and instead get in line to see their appointed doctors.
But is that really what would happen? As the medical profession is increasingly ingested by government bureaucracy, and trips to the doctor become even less connected to actual costs, it’s likely to become ever more difficult to actually see your own doctor — even if you have one. And if your medical expenses are subsidized by everyone else, well, why not go to the high-cost emergency room? There wouldn’t even be the inconvenience of having to stiff the bill collectors. The great faceless horde of taxpayers would pay for it. Of course, that might add up to much more traffic and much longer waits at emergency rooms. Maybe the plan is that the entire country will become one giant emergency room, all of us queuing together and paying for each other? Surely not. Though, as I said, I haven’t read the entire Affordable Care Act. I merely wonder.
Anyway, Dear Old Uncle Sam, I am intrigued by the ability of this great country, or at least the ability of its political class, to redesign the market for medical care to such an extent that right now I have no idea what regimen might apply in years ahead, or on what basis I might be charged, fined, taxed, or otherwise motivated to tailor my interactions with doctors. For that matter, I don’t even know if I will have a doctor, since it appears likely that the bulk of the medical industry will consist of a vast regulatory apparatus. What to do?
Bothered, in the Broccoli Republic