Andrew Langer

As the President scrambles to delay implementation of Obamacare, while at the same time trying to prevent Republicans from legislating his executive branch goals, opponents of Obamacare are missing a key point: it’s not that Obamacare leads to socialism, it’s that it is, fundamentally, a scam! Yes, a scam, as in, a dishonest scheme. A fraud.

Obamacare, by not only destroying the private insurance marketplace over the long-term, but by also leading to the destruction of free-market medical care, may very well lead to government-run or “socialized” medicine. But, as horrible as that prospect is, it is not the message that is most effective for either delaying the implementation of the law, or in its repeal.

Fundamentally, Obamacare was supposed to do one thing: it was promised as the Democrats’ solution for providing health CARE to millions of Americans who apparently did not have it. But it was premised on a lie: Obamacare doesn’t provide “care” to anyone. It provides insurance. And “insurance” is not “health care” (technically, it’s not even “insurance”—something you invest in to hedge against some future catastrophe).

Health insurance in America is essentially a “cost-sharing subscription service”, a piece of paper that says that you (or someone else) is paying for your potential access to a group of health care providers, and the costs are spread out over thousands of subscribers. But the legitimacy of that piece of paper is predicated on both someone accepting that piece of paper—and medical providers are no longer accepting that particular piece of paper, or the providers that do, can no longer accept more patients, then that piece of paper is worthless. I could hand everyone in America a piece of paper that says they have full coverage under “Andrew Langer’s Health Insurance, Co.” and it would be meaningless since I have no ability to actually deliver health care to people.

This is the scam. Obamacare does not, and cannot work. Not only does it not address the fundamental issues driving both costs and access to health care, it actually exacerbates the underlying factors, leading to an acceleration in the decline of the health care industry in America.

So while the media focuses on the increase in health insurance premiums, which was expected as the industry attempted to ameliorate risk in the near term before their industry is eviscerated over the long term, they are missing the bigger picture, which is too bad because it is a story even the most economically-ignorant journalist can grasp.

Health care in America is a basic macroeconomic problem: supply, demand, and price. As supply decreases and demand increases price naturally rises. And supply is declining—especially in areas of basic, primary diagnostic care (the most important part of a public health policy equation—ensuring that people have a general practitioner that they can see for their wellness exams).

The only way you can increase access to a good and drive down the price for that good is to increase the supply. Not of insurance, but of health care itself. As I said, health insurance is meaningless without the providers to back it up (kind of like currency not backed up by anything of real value). This means creating more providers: doctors, nurses, and physicians assistants.

But Obamacare doesn’t do that. It never did that. Instead it does two key things guaranteed to destroy the practice of medicine:

First, Obamacare drives up patient panels, exacerbating both quality of life issues and problems with liability that physicians face. This, too, is axiomatic. When you drive up demand in an era of declining supply, at supply is constrained. There are a limited number of hours in a day, a limited number of hours in a year. Since Obamacare’s goal was to insure uninsured Americans, this means that the goal of Obamacare was to drive up demand (by something on the order of 20%).

In an era in which medical practices are constrained by having to sandwich appointments into 20 minute increments, a 20% increase in the number of patients handled by a practice means that those appointment times are reduced by 20%--meaning that a 20 minute appointment is now limited to just over 15 minutes!

Second, and more problematic from a health policy standpoint, is the impact that this has on the ability to effectively practice medicine. As difficult as it is to assess a patient’s condition in the compressed appointments already being practiced, short-changing that patient on more appointment time means that the potential for something to be missed rises considerably. Not only does this drive up potential costs, but it opens the health care provider to greater malpractice liability.

So, as the risks of getting sued go up (with no liability reform for doctors thanks to Democrat stonewalling), and as doctors are under increased pressure from simply seeing more patients, you see major quality of life issues creating severe disincentives that serve to discourage young people from pursuing careers in medicine (especially in basic, primary diagnostic care, the core of our health care system), while at the same time you see doctors leaving medical care in ever-increasing numbers.

The decline in supply accelerates!

Now, in the real universe in which we all live, when supply declines and demand increases, the natural result is that prices rise. But since Obamacare’s supposed goal is to keep insurance prices down, the only way to do that is to drive down provider reimbursement rates.

Let me underscore this: you will have fewer doctors, seeing more patients, with increased professional risk (and increased practice costs thanks to other aspects of Obama’s legacy, but that’s a separate issue), and medical care providers are going to be paid less!

This effectively destroys health care in America, since very few people want to enter a profession where you work harder and at greater risk for ever-declining amounts of money. Even altruists won’t enter a profession where their fear of getting sued outweighs any sense of desire to help others.

The only way to do what the left wants: to increase access to health care while driving down the cost of care is to create more care. This means fixing the problems underlying the practice of medicine: who can practice, cost of medical education, regulatory burdens, paperwork costs, and liability reform. Reform those, and you’ll create more medical practitioners. By creating more medical practitioners, and you can have a competitive market in medical care. Have a competitive market in medical care and the price that people pay goes down.

But to offer people a piece of paper and claim that you’re giving them medical care when you aren’t is a lie. It is a fraud. It is, in other words, a scam.

The moral message isn’t that Obamacare is socialism or anti-freedom. It may be those things. But fundamentally, it is immoral to lie to the American people and claim that you’re solving a problem when you are, in fact, making that problem worse. It is immoral to commit a massive fraud on the American people in the name of politics.

That’s the message that policymakers ought to be using.


Andrew Langer

Andrew Langer is President of the Institute for Liberty, an organization that works to ensure that America stays both exceptional and strong.