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The Public Option Was Never Optional

One of the first things I said after reading through the provisions of the Patient Protection and Affordable Care Act of 2009 (aka Obamacare) was that it would, ultimately, lead to the public option the President wanted in the first place. If anything has been proven about President Obama, it is that he does not negotiate; he finds ways to get what he wants outright, or he finds a backdoor way to get what he wants without anyone else’s input. Not getting what he wants is never an option, something that is fitting for the first truly post-modern President who denies the existence of nearly every absolute. The only absolute the current President seems to adhere to is the absolutism of his authority over all aspects of American government, including the Constitution.
In light of such an unyielding an authoritarian disposition, many observers seemed flummoxed when the President so quickly accepted the current version of the healthcare law, which does not include the holy grail of the Left: a fully public single-payer system. To many free-market observers, the answer was always obvious: the mandates placed on private insurers under Obamacare are so burdensome they will kill the private insurance market altogether. The costs associated with the “big three” mandates will break-down the functionality of private insurance in its entirety, leaving only the Federal government to pick-up the pieces. Some conservatives have recently claimed that Obamacare is doomed to fail, and they are correct, but they also assume that the failure of Obamacare will end socialized medicine in America. This is where they are wrong. Absent an effective marketing campaign launched to educate the American public, such a failure will lead only to more socialization. The failure of the Obamacare system will not be news to the President or his allies; in fact, I fully believe they planned it this way.
The “big three” mandates undermine the entire actuarial process, wherein insurance companies assess risk and set rational, market-driven costs for healthcare insurance. These mandates include 1.) guaranteed issue (meaning that no one may be denied for pre-existing conditions) 2.) premium cost conformity (whereby caps are placed on premium costs for serious medical conditions) and 3.) expanded coverage mandates (which force private insurance companies to pay for unnecessary medical procedures and medications, including contraception). While most Americans rightly believe that people should not be dropped from their health insurance just because they get sick (that’s the whole point of health insurance, after all), these mandates are insufficient to address the issues at hand, and will actually make the problems far worse. While at first blush ideas like guaranteed issue sound great, there aren’t proper safeguards in Obamacare to ward off widespread abuse. In other words, the guaranteed coverage mandate will provide an incentive for the uninsured to obtain insurance after being diagnosed with an illness, not before. The effect will be that the pool of the insured is much smaller than it is at present, and that this smaller pool of insured people will be much less healthy. This is because most people buy insurance before they need it, because they know that insurance companies will not issue to someone interested in buying only when they need it.
By forcing insurance companies to issue policies to those who intentionally game the new mandate on private insurers, Obamacare raises the costs to insurers exponentially, while removing any incentive for healthy people to buy insurance. The entire concept of insurance is predicated on the purchase of health insurance by many healthy people, to offset the costs of those who become ill while insured. Allowing people to buy insurance only when they are ill undermines the entire concept of insurance, and will ensure that the private health market completely collapses. While liberal commentators claim that the “individual mandate” penalties will prevent this from happening, thus ensuring all people purchase health insurance, they simply are insufficient to incentivize the purchase. While I oppose the entire concept of an “individual mandate,” Washington should at least make the penalty plausible if they’re going to impose one. The current penalty for being uninsured is far less expensive than the projected cost of health insurance premiums under Obamacare (because of all the coverage mandates including contraception), thus ensuring that people will simply pay the penalties instead of buying insurance, until a serious condition makes it economically advantageous to purchase the insurance policy.
The combined effect of these mandates will be the complete dismantling of the private insurance market and the rise of the public option. Private insurers simply cannot bear these kinds of costs, and they will collapse under the weight of them. When they do, Uncle Sam will be there to create a truly national healthcare system in their place. If my conservative brethren believe the American people will revolt against government meddling in the private market in the aftermath, they are ignoring the lessons of Obama’s first term. This Administration is remarkably effective at blaming its failures on the fabricated “greed” and “exploitation” of the private sector, and they will certainly blame the failure of their signature domestic policy proposal on the private sector that it kills. President Obama is a second-to-none class warrior.
Conservatives need to get in the game, and recognize Obamacare for what it really is: a backdoor way to implement a public option while blaming it on the private sector. The Adminstration will kill the private health market, then ride-in with a diminished government-run insurance program and claim that it saved healthcare for the American people. Only by educating Americans to this reality early and often, and putting forth plausible counter-reforms that will truly contain costs, increase access to and the affordability of healthcare, and ensure that all Americans get the care they need, will we turn the tide. The fight over America’s healthcare system is not over, but the Administration is getting close to checkmate and conservatives better guard the king.

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