In his brilliant exposition of why sweeping policy changes often have unintended consequences, the late sociologist Robert K. Merton wrote that leaders get things wrong when their “paramount concern with the foreseen immediate consequences excludes the consideration of further or other consequences” of their proposals. This leads policy makers to assert things that are false, wishing them to be true.
Which brings us to President Obama’s many claims about his health-care reform. Take his oft-expressed statement that if you like the coverage you have, you can keep it. That sounds good—but perverse incentives in his new law will cause most Americans to lose their existing insurance.
This was brought home to me when I asked the CEO of a major restaurant chain about health reform’s effect on his company, which now spends $25 million a year on employee health insurance. That will jump to at least $90 million a year once the new law is phased in. It will be cheaper, he told me, for the company to dump its coverage and pay a fine—$2,000 for each full-time worker—and make sure that no part-time employee accidentally worked 31 hours and thereby incurred the fine.
This reality is settling in at businesses across America. A Midwestern contractor told me he pays $588,000 for health insurance for 70 employees, contributing up to $8,400 a year for a family’s coverage. If he stops providing health insurance, he’ll pay $2,000 per employee in fines, and the first 40 employees are exempt from fines altogether.
It’s also dawning on employees that they will lose their coverage. Some will blame management; many more will blame those who wrote this terrible legislation.
Employees who lose coverage get to select a policy from a government-sponsored insurance marketplace called the “exchange.” This will be subsidized by taxpayers. Depending on his income, a worker will have to pay between 8% and 9.8% of the cost.
But there are a few hitches. Employers now pay for employee health plans with pre-tax dollars, but workers who buy into one on the exchange pay with after-tax dollars. Families making less than $30,000 and individuals making less than $15,000 a year will be dumped into Medicaid, widely viewed as second-class health care.
Either Mr. Obama was stunningly blind to these perverse effects when he promised people could keep their coverage, or he felt that admitting his plan would collapse employer-provided health coverage could keep it from passing. Either way—self-deception or deliberate deceit—health reform is going to turn out far differently than was promised. And because more workers will be dumped into subsidized coverage, taxpayers are likely to pay much more than the $1 trillion-plus price tag claimed by ObamaCare advocates for its first 10 years.
Well, maybe so.
But let’s not lose sight of what’s important here: everyone is going to covered (whether they like it or not)! And healthcare is now free!
The rest is just so many flies biting at the ankles of Historic Reform™. And in the end, no one will remember the buzzing of the flies — because flies die in short order, and what’s crucial here is that the groundwork has been laid for a glorious future of institutionalized Nannystate pragmatism, which will have taken the place of such antiquated notions as Natural Rights, religious faith, and individual autonomy (premised on a small and constrained government). Finally, the best people will be in charge of the rest of us.
Progress! God is dead. Long live the State.
– Just as about 52% of Americans seem to want it.