In the course of dissecting the latest "conservative fix to ObamaCare" from Avik Roy, Drew M. at Ace of Spades makes a profound observation:
Here’s the dirty little secret politicians and health care wonks either won’t admit or only acknowledge silently to themselves in the dark of night…you can’t provide health insurance and health care services to people who can’t afford it without bankrupting the country and/or redistributing money and access from those who would be able to afford it under normal circumstances. And once you start providing “insurance” to people who have conditions that will lead to claims before they pay any premiums and those premiums are unrelated to the health care they will consume, you have created something that isn’t actually “insurance”.
If as a society we want to provide these products and services to people who cannot afford them, let us be honest about what we are doing here….enforced charity. Let’s just call it that and get on with the business of redistributing money and resources from those who have it to those who don’t in the most direct way possible.
What we actually got was a trillion dollars of regulations, plus a billion-dollar piece-of-crap website, serving as a smokescreen for a gigantic Medicaid expansion the American people never would have supported, if it had been presented to them honestly. So, of course, it wasn't.
We also got a regime of subsidies designed to continue the process of subjugating the Sainted Middle Class by turning them into welfare dependents. People who make a very good living will qualify for ObamaCare subsidies, without which they couldn't afford the health insurance ObamaCare makes dramatically more expensive through its mandates. It's that first hit of welfare heroin that will turn a formerly independent middle class into junkies, hooked on direct transfer payments that can be threatened whenever the Ruling Class thinks they're getting out of hand. Your ObamaCare subsidies will be taken hostage if you dare to call for reduced government spending.
"Honest charity" is something the Left has been working to destroy for generations. All of the goodies people get from Uncle Sugar are "entitlements" now. This cleanses them of the stigma associated with charity, which implies responsibility. The recipient of charitable assistance is expected to be responsible for his life, get back on his feet, and quickly reach the point where such assistance is no longer necessary. There is joy in seeing someone who needed a helping hand, once upon a time, grow strong enough to lend such a hand to others in need.
Entitlements, on the other hand, are forever. It's not charity - the opinions of the people forced to pay for it are irrelevant. They have nothing to say about the funding they provide, or what the almighty State does with it. Few burdens of responsibility are placed upon the recipients. Attempts to track exactly what the beneficiaries are doing with food stamp benefits, for example, never seem to get anywhere. This mindset makes the system very easy to defraud, but even for the most honest of its beneficiaries, the effects are corrosive. And even though entitlements don't carry the responsible expectations of charity, there is a great deal of power and control embedded within them, as can be seen from the gigantic bureaucracy that has grown around ObamaCare.
Drew briefly discusses the idea of "guaranteed income" as a way to trim away the bureaucracy: if we must have an immense welfare state, far beyond any sane notion of a "social safety net" for the temporarily disadvantaged, why not get rid of the micro-managers and simply guarantee a minimum income level for everyone? The bureaucracy would be entirely concerned with verifying that people qualify for the money they receive; after that, spend it on what you want, and accept the consequences.
As it happens, "guaranteed income" was the objective of the notorious Richard Cloward and Frances Fox Piven, whose Cloward-Piven strategy of manufactured crisis was initially proposed as a way to overload and collapse the welfare system, replacing it with a guaranteed annual income, which they believed would eliminate poverty. This belief is the sort of refined idiocy that you can only acquire after sustained exposure to academia. Of course simply paying people X dollars because they're breathing wouldn't eliminate poverty. Some people would use the money wisely, but many would not. They'd make bad decisions and end up as impoverished as ever. Left-wing ideology blinds people to the truth about income: the work people do matters as much, not just to society but to the workers themselves, as the money they receive. People tend to rise or sink to the expectations of society.
For that reason, it might be that a guaranteed income welfare plan would clear away the weeds of welfare bureaucracy, but they would come back soon enough, because it would quickly become apparent to the Ruling Class that their benevolent control was vitally necessary. Likewise with "conservative fixes to ObamaCare," which would only partially restore market forces to health insurance. Bureaucratic inertia would return and smother those market forces soon enough, perhaps leading to the sort of systemic collapse that would pave the way for single-payer socialized medicine, as ObamaCare's architects planned all along.
Back in May, when the VA scandal was gobbling up all the headlines (man, that was like five scandals ago!) Kevin Williamson at National Review wrote an excellent piece about how bureaucratic central planning leads inevitably to disaster, because the forces bureaucracy seeks to control are not as predictable as politicians want us to believe, especially in an enormous country like the United States. Williamson offered the hideous catastrophe at the VA as a perfect example, since it was an outcome absolutely no one wanted: not Left or Right, Obama or Bush. No one's political interests were served by what happened. But it happened anyway:
Our political discourse assumes, sometimes implicitly but often explicitly, that there exists a predictable, linear, straightforward relationship between the formal enactment of a given policy and the real-world outcomes that will be experienced as a result of it. This is a convenient fiction, and sometimes even the authors of that fiction roll their eyes at their own work, as when the Congressional Budget Office scored the Affordable Care Act and then added the caveat that its analysts did not believe that the policy would be implemented the way the law’s authors intended and the White House promised, thereby communicating that its report should be consumed only in saline solution.
Politics is mostly words about words, but it has real-world consequences, and death is not an uncommon one. The truth, which in Washington is an unspeakable truth, is that almost the entirety of our conversation about politics is predicated on a fundamental error in our understanding of reality. Unlike a certain Entity with Whom presidents and senators sometimes seem to confuse themselves, politicians cannot speak reality into being. (“Let there be . . . health care.”) The situation at the VA should not surprise us; what did we expect, having no way of even knowing what we should have expected? This outcome was at least as likely as any other, and certainly more likely than one in which reality matched policy through some obscure divine office unknown to us.
Big Government liberalism sells itself through a combination of moral imperative - we must DO something! - and the alleged managerial skills of the State - only government geniuses have the power and wisdom to get anything done! The latter assertion is utterly laughable, slapstick black comedy, after a string of fantastically expensive disasters, from the VA to ObamaCare. I would answer both of them by asserting the superior morality and wisdom of liberty. The amazing power of a distributed intelligence - millions of people seeking opportunity, cooperating voluntarily, trying their own ideas and learning the painful lessons of failure - can run rings around blind, stubborn, ideologically-tainted government plans, devised by people who are almost completely insulated from the consequences of their errors.
How best to access that distributed, nonlinear wisdom of liberated millions? It may sound simplistic, but here it goes: Make everything as cheap as possible, and let everyone earn what they have.
This is the Wisdom of the Cheap. When cost accurately reflects supply and demand, resources are allocated wisely. Only realistic commitments are made, so they can be kept. Workers earn dollars as clean as possible of coercive manipulation, and spend them on goods and services delivered as directly as possible. Like a computer disk cleansed of bad sectors, the cooperative mind of America would function far more efficiently, and it would far outpace anything a collective mind could achieve. Ideas that must be sold tend to have far higher quality than those which are imposed.
As to health care: make it clear as a bell that insurance is not the same thing as medical care. Make them both as inexpensive as possible, with the broadest competition (from such relatively simple reforms as permitting insurance to be sold across state lines) and the least separation between consumer and doctor. Let people buy the insurance they think they need; let health care providers compete for their business. And with that accomplished, when there are inevitably people who can't afford the care they need, the charitable cost of such care will be clear and easily paid, without layers of confusing bureaucracy or hidden wealth redistribution. There won't be a hundred hidden lines siphoning money from the veins of taxpayers. Government should not feast upon the productive like a swarm of ticks. Americans are a generous and compassionate people. Tell us honestly what the truly needy require, make the cost of that charity straightforward, and we will pay it.
Does every wing of our politics truly want the most prosperous possible America? Nobody benefits politically from a run-down economy, right? I disagree. I think the academics who drive left-wing thought have long desired a weaker, poorer general population, more confused about the true cost of everything around them, because such a populace is easier to control. They need the elite to guide them, in everything from the complex business of health care, to what should be the fairly simple matter of obtaining food. Everything more expensive, all systems incomprehensible, no way for even the Middle Class to secure the necessities of life (which the Left constantly redefines to include new things) without government assistance... that's Utopia! If we embrace the Wisdom of the Cheap instead, we wouldn't need zillion-dollar government with hundreds of overlapping agencies. Clearly, that's a terrifying prospect for some.