Jenkins: ObamaCareÃ¢â‚¬â€Upheld and Doomed
Regardless of the Supreme Court, fiscal reality will prevail.
By HOLMAN W. JENKINS, JR.
History will judge whether Mr. Roberts saved the reputation of the court or lost his nerve. Many conservatives obviously suspect the latter. Resolved: The government cannot make you eat broccoli, though it may levy a non-broccoli-eating tax on any who refuse.
Associated PressThe Supreme Court in Washington
Yet he may also thinkÃ¢â‚¬â€and would not be wrong to thinkÃ¢â‚¬â€that ObamaCare is doomed in any case. His opinion makes clearer than ever that ObamaCare is a tax programÃ¢â‚¬â€throwing more tax dollars at an unreformed health-care system. ObamaCare is a huge new entitlement in a nation laboring under commitments it already can’t afford. Those who gripe that he just authorized a vast expansion of the welfare state haven’t reckoned with this fiscal reality principle.
GOPers, including Mitt Romney, immediately adopted “repeal” as their mantra. But repealing ObamaCare would just leave us with the health-care system we have, which is already ObamaCare in many respectsÃ¢â‚¬â€an unsustainable set of subsidies bankrupting the nation.
The solution is a tweak. Republicans already are lip-committed to a national health-insurance charter that allows insurers to design their own policies and market them across state lines. Republicans are also lip-committed to a tax reform to equalize the tax treatment of health care whether purchased by individuals or by employers on behalf of individuals.
What would follow is a boom in low-cost, high-deductible plans that leave individuals in charge of managing most of their ordinary health-care costs out of pocket. Because it would be cheap, millions who would opt not to buy coverage will buy coverage. Because it will be cheap, companies will direct their low-wage and entry-level employees to this coverage.
Now these workers will be covered for serious illness or injury, getting the rest of us off the hook. As they grow older, wealthier and start families, they will choose more extensive but still rationally limited coverage. Meanwhile, the giant subsidies ObamaCare would dish out to help the middle class afford ObamaCare’s gold-plated mandatory coverage would be unneeded.
With consumers shouldering a bigger share of health expenses directly, hospital and doctors would discover the advantages of competing on price and quality. This way lies salvation. In the long run, whatever share of GDP society decides to allocate to health care, it will get its money’s worthÃ¢â‚¬â€the fundamental problem today.
Perhaps a not-discreditable sense of the political moment lies behind the chief justice’s opinion after all. The court’s job, he wrote, is not to “protect the people from the consequences of their political choices.”
He may have meant: The chief justice’s job is to get the court out of the way while the body politic still remains suspended between recognizing the unsustainabilty of the current welfare model and deciding what to do about it.
This was always the fatal problem of ObamaCare. Reality could not have instructed President Obama more plainly: The last thing we needed, in a country staggering under deficits and debt, a sluggish economy and an unaffordable entitlement structure, was a new Rube Goldberg entitlement. The last thing we needed was ObamaCare. The nation and the times were asking Mr. Obama to reform health care, not to double-down on everything wrong with the current system.
Even with this week’s Court success, he failedÃ¢â‚¬â€and it’s not as if there wasn’t a deep well of policy understanding in Washington that he could have drawn on to take the country in a better direction. Regardless of any Supreme Court ruling, reality will pass its own judgment on the Affordable Care Act and it won’t be favorable.