My sense is that conservative Christian objections to Obamacare in particular, and to the expansion of government in general, are driven not only by the unfortunate policy specifics, but also by more general concerns that are fundamentally and legitimately theological. More specifically, such opposition is funded by real if often inchoate convictions about theological anthropology, theology proper, and ecclesiology.
First, there is the undeniable fact that the expansion of the welfare state undermines individual responsibility. Christian conservatives know from Scripture and experience that human beings generally behave self-centeredly and tend to prioritize short-term gratification unless there are normative and institutional structures in place that provide discipline and incentive to do otherwise. Moreover, conservatives know from experience and common sense that when government subsidizes behavior the nation gets more of that behavior. It was precisely this recognition that lay at the heart of the successful welfare reform in the 1990s.
Second, there is the problem of secular, statist idolatry. The modern welfare state is the Leviathan that puts itself in the place of God as that which meets cradle-to-the-grave needs of people. In fact, there is now a host of sociological evidence indicating that the decline of Christianity in the West can be correlated rather precisely with the expansion of government.
Third, there is the fact that the “therapeutocracy” (to use social theorist Jürgen Habermas’s memorable term) of the modern welfare state has little tolerance for faith perspectives that oppose its edicts or compete with it for the allegiance of the populace. Thus it seeks to undercut the mediating structures (churches and voluntary societies) that Tocqueville so eloquently recognized as essential to the preservation of genuine democracy. How else are we to understand the way that the Obama administration has persistently been picking unnecessary fights with people of faith, whether it be the efforts to marginalize Christians in the military, the bizarre arguments of the Obama administration in a recent court case (Hosanna-Tabor Evangelical Lutheran Church and School v. Equal Employment Opportunity Commission) that the free-exercise clause First Amendment does not protect a religious organization’s right to choose its own leaders, or the contraceptive mandate of Obamacare?
I’ll agree that we need to have a good and substantive discussion about healthcare reform. But sentimental soundbites from the Evangelical left about “care for the poor” do not contribute much to that endeavor.
Insurers participating in the public exchanges are limited their provider networks to contain costs. For example, Blue Shield of California’s “network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.”
When government inserts itself (more) into a market, it results in lopsided and unanticipated responses. I expect Congress will attempt to tie off this “loophole”—which will naturally result in even higher costs and tighter regulation. After all, Obama promised I could keep my doctor if I wanted. Surely he wasn’t being disingenuous.
Trader Joe’s has won kudos for offering its health care, dental and vision plans to part-time workers at a reasonable price — a rarity in an industry known for low pay and scant benefits. But with low-wage workers eligible for tax subsidies to buy health insurance next year, the company has apparently calculated that offering medical coverage to part-timers who work 18 hours or more is no longer worth the cost.
I explained that just because he had health insurance didn’t mean he had to use it in every situation. After all, when people have a minor fender-bender, they often settle it privately rather than file an insurance claim. Because of the nature of this man’s policy, he could do the same thing for his medical procedure. However, had I been bound by a preferred-provider contract or by Medicare, I wouldn’t have been able to enlighten him.
Most people are unaware that if they don’t use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the “list” price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.
So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a “self-pay” (or uninsured) patient. I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasonable upfront cash price for the outpatient surgical/nursing services. He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance
The administration has opened the door to rampant fraud. It remains to be seen how many low-income workers end up walking through that door. Tax compliance is contingent on taxpayer perceptions of fairness, and Obamacare is about to create many individual situations that are grossly unfair. In light of the 20-25 percent overpayment rates in the EITC and school lunch programs, is it realistic to expect overpayments on the exchanges—especially in their very first chaotic year of operation—to be any smaller? Taxpayers beware: You ain’t seen nothing yet.
In The Wall Street Journal, Scott Gottlieb writes that the 340B program was meant to help about 90 hospitals buy drugs to treat the poor. Now 1,675 hospitals qualify.
"One of the rationales behind the Affordable Care Act was that the law would end the gimmicks that distort incentives and drive up costs. In the case of the 340B program and its effect on cancer treatment, the law has only further distorted an already expensive gimmick."
A soon-to-be-opened call center meant to help teach the public about ObamaCare is under fire for offering many of its new employees part-time positions — in turn denying them benefits under the very law they are helping to implement.
In case the health insurance industry is too complicated, consider a simpler analogy: Suppose the Obama Administration passed the “Affordable Snacking Act,” and required movie theaters to limit the price of a large popcorn to only 25% of the price for an adult matinee ticket. Does anyone really think the outcome of this would be merely a massive reduction in popcorn prices across the country? Or, is it more likely that theaters would do a combination of the following? (a) Reduce popcorn prices, (b) slightly increase ticket prices, (c) cut back on expenses at the snack counter, by laying off workers (leading to longer snack lines) and reducing the size of a “large popcorn,” in order to compensate for the loss in profitability of that portion of the business.
The same holds in health care insurance. In reality, there is a whole spectrum of customer service that a company can provide; this is partly what the “administrative expenses” cover. If the federal government forces a particular insurer to cut back on this spending, the outcome isn’t merely going to be lower salaries for the fatcats. There may also be layoffs in clerical positions, fewer people manning the phones to deal with inquiries about coverage or understanding a recent bill, and so forth. In short, people will become even more exasperated with the quality of “free market” health care, and will be that much more receptive to total federal control down the road.
Come to think of it, maybe these consequences weren’t so “unintended” after all.