You Can't Handle the Truth

Holman Jenkins of the Wall Street Journal has a few questions about ObamaCare. Since I doubt he'll get the answers he seeks from the White House, I have agreed to play the part of Professor Ditherton Wiggleroom to the best of my ability.

Got it? Then here we go:

Why implement the mandate in a way that forces many people to buy insurance at inflated prices (a bad deal) in order to subsidize others? Isn't a universal principle of good governance that subsidies should be funded openly and honestly with tax dollars rather than disguised taxes on disfavored individuals?

No. Had we been honest about the subsidies, we never would have been able to pass this historic legislation. Also, this way there are many more opportunities to punish our enemies, which is in my administration the very definition of good governance.

At your 2010 health-care summit, you dismissed what you called "house insurance"—cheap, high-deductible policies that protect people from serious illness or injury but otherwise leave them to fund routine medical care out of pocket. How do you reconcile this with your oft-stated promise that people can keep their existing insurance?

I don't reconcile it. I lied in order to get the legislation passed. I had thought that was clear by now.

More important, how do you reconcile it with the fact that virtually all progress on cost control in the past 20 years has come from cost-sharing to make users more sensitive to the price and value of the care they consume? Are we just going to throw this progress away?

"Progress" is defined as subsidizing my supporters and punishing my enemies, which this landmark legislation allows me to do in ways you haven't even noticed yet.

Your ObamaCare program is supposed to be financed with the mandate-cum-tax on the young plus Medicare cuts, but the mandate is weak and Congress won't deliver the Medicare cuts. Haven't you created another unfunded government program destined to be starved for money in the future as the reality of our fiscal situation begins to bite?

Absolutely I have, yes.

You tout the Affordable Care Act as a triumph over special interests, but the stock prices of the insurance industry have enjoyed a huge run-up. Isn't this because your program, boiled down, just throws more tax dollars at an unreformed health-care system that every analyst, including you, says spends resources inefficiently?

By giving the insurance industry a captive audience paying higher prices for fewer services, we were able to bring insurers on board to help pass this historical legislation.

You cite RomneyCare as a model, but RomneyCare was enacted by a GOP governor and Democratic legislature with overwhelming public support. Wouldn't there be greater buy-in now from the public if your plan actually had been bipartisan, not to mention greater buy-in from the opposition party, aka Republicans, who are certain to become a governing party at some point in the future and responsible for carrying ObamaCare forward?

I won. And the ACA is the settled law of the land.

Your Affordable Care Act is a nice break with precedent in one way—it reserves its visible subsidies for the poor. Shouldn't we apply this excellent principle to Medicare and the giant tax benefit for employer-provided insurance? Isn't our problem that too many middle-class Americans are programmed to treat health care as a free lunch?