Health Care’s Never-Ending Grocery List


Imagine grocery shopping with roommates. If you live with a vegan, an athlete, and a sorority girl, imagine pooling your various needs into one grocery list. Turns out, you’ll each end up buying way more than you want, because you each have different needs and desires. All you wanted to buy was some asparagus and cereal, yet you’ve ended up paying for Tofutti fro-yo, sirloin steak, and Skinnygirl cosmos up the wazoo. That would be like the contraceptive mandate. Now imagine I’m forced by law to buy groceries, instead of eating out based on when I’m hungry. That’s the individual mandate.

Then multiply that by about 312 million different needs and desires.

While 49 percent of Americans say they think the entire Affordable Care Act is a bad idea (the highest ever, according to an NBC/WSJ poll), legislators in Michigan and elsewhere are endlessly politicking and maneuvering with one another regarding health care exchanges and Medicaid expansion.

It shouldn’t be a surprise that people voted Obama back in, despite the controversial law, and that people are giving him more hell over it in the second term. With 906 pages of mandates, subsidies, and tax credits, “Obamacare” was never going to be as easy a sell as Obama’s reelection.

Where Democrats got their greatest win in the 2012 debates is unquestionably over another type of mandate altogether—the contraceptive mandate. The reason? The conversation about mandates generally became about the moral cost of voting for men ignorant of and potentially malignant to women, versus, you know, health care reform. That’s a no-brainer when put in those terms.

The individual mandate—or “just another health care tax,” as the Supreme Court desires I put it—requires that people buy health insurance coverage. The problem with this is that government now has to subsidize more people who can’t afford the higher cost of insurance—which shifts the burden onto taxpayers. In fact, estimates indicate that 50 percent to 60 percent of new enrollees into Medicaid, should it expand in-state, will have dropped their individual insurance coverage for financial reasons.

You’ll see insurers lobbying for the individual mandate: don’t be troubled—that’s because AHIP believes its essential to maintain the community rating.

What’s the community rating? Oh, just the provision in the Affordable Care Act that insurers can only charge the elderly three times what they charge their youngest customers, even though health expenditures for older members are, on average, six times more costly. It’s getting harder to disguise the fact that premiums for younger workers are going up.

It’s not that wanting to split the grocery bill makes you a bad person—though you might feel like one after observing the results. It’s that proponents misunderstand how best to channel their desire to do good for others. In fact, the new health care law feels less like an exhibition of human kindness and generosity, and more like 906 pages of missed opportunities for change.