So, I often get myself in trouble for ascribing unflattering motivations to people with whom I disagree. But I come upon that honestly, so to speak. I assumed that most people writing about public policy or international affairs are reasonable intelligent and well-informed, and thus when they make demonstrably false arguments or patently idiotic ones, I assume they must have some hidden agenda. In some ways that is the nicer assumption that the alternative, which is that they just don’t know what they are talking about.
Anyway, an example of this is the right-wing meme that the Affordable Care Act represents a “government takeover of health care” and that since health care will soon represent 20% of U.S. domestic GDP, that this represents a creeping form of socialism since the government will control such a large sector of the economy. This is, of course, an idiotic position. But are people making this argument ill-informed? Or just cynically playing political hardball? I really don’t know.
What’s interesting to me, though, is that even if we were to grant the premise, the reality is that killing ACA would do nothing to change the supposed problem.
First, regardless of whether ACA stays or goes, health care spending is certain to increase as a share of GDP. Whether you get to 20% of GDP in 2023 or 2025 or 2021, that is the trendline irrespective of ACA. Indeed, I often joke darkly that if current trends continue, our grandchildren will all be working in the health care field… well, except when they are getting treated. But treating and getting treated will be the sum-total of human activity in the United States come 2075ish.
Second, regardless of ACA, government expenditures on health care will continue to rise, remaining at the roughly 50% level of total health care spending. ACA increases the ratio slightly on one side — the increased subsidies — but decreases it (in theory) on the other by slowing the rate of growth of Medicare. But either way, roughly 50% of health care spending will be by the government under Medicare, Medicaid, the VA, and Tricare.
Third, despite the length of the bill, the footprint of ACA on health care is both smaller and lighter than existing programs. ACA is, in the final analysis, less socialist than Medicare or Medicaid or Tricare, and way less than the VA which is, in fact, the only real example of socialized medicine where you have not just a single payer, but a government provider. The case that ACA represents a government “takeover” of health care reflects, I guess, a notion that regulation is equivalent to ownership, or something. But of course, the reason a mandate and subsidy to private insurers first arose was an a direct alternative to a single payer plan. But note, even a single payer plan is not socialism. The modes of production remain in private hands, they just are paid by the government. Some may call this socialism. But by that logic, all government contracts are examples of socialism. Is the defense industry an example of socialism as well? But ACA isn’t even a single payer plan, it is a subsidy to individuals for them to buy private insurance which will then pay private health care providers. If that is socialism, then what is the VA?
See, the argument about government takeover is essentially one of control through regulation. But health care is already highly regulated. Indeed, the entire economy is subject to significant regulation. Call that socialism if you want, but then your problem isn’t with ACA, but with government regulation. And again, getting rid of ACA does nothing to get rid of that.
I get that some people see ACA as the straw that broke the camel’s back, but the reality is that getting rid of ACA does nothing to overturn the basic facts that (1) Health care expenditures will continue to rise, (2) the government share will remain at roughly 50% of those expenditures, and (3) that the entire health care sector is heavily regulated and impacted by government programs.
You want to fight socialized medicine? Well, go after the VA first, then Tricare, then Medicare and Medicaid. But going after the least socialized part of the system strikes me a weird place to focus one’s energies.