Fraser Forum

Does Obamacare save lives? A closer look into a passionate proposition

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Most Canadians likely aren’t intimately familiar with the Affordable Care Act—also known as Obamacare—which President Donald Trump vows to replace. But the consequences of Obamacare, which include regulatory burdens and reduced access to care, resonate with any Canadian who has endured long health-care wait times and can serve as a lesson for Canadian policymakers.

Recently an American cancer survivor claimed on CNN that Obamacare saved his life saying the program, which socializes the cost of those dealing with pre-existing conditions, provided access to care when private insurers would not. While one can't help but empathize with someone who is ill or recovering, the proposition is emotionally and politically loaded, and crumbles under closer inspection.

First, it presupposes that without Obamacare, Americans with pre-existing conditions wouldn't have access to care, which is unlikely to be true. What is likely true is that care would probably not come as cheaply because other people wouldn't pay for it (in the form of higher taxes and premiums). With that said, there are myriad low-cost delivery options in the U.S. —doctors and hospitals in the U.S. routinely negotiate with uninsured patients according to their ability to pay, community health centres specialize in providing primary care to uninsured patients, while Medicaid is a social health-care program for Americans with limited resources.

Second, the proposition raises the question: under what circumstance is it okay to coerce other people into paying for what you want to buy? Is it okay for anything you want? Like a car or house? Or just health care? If so, what about paying for care that gives one extra year of life at the age of 75? How about a month of extra life at the age of 80? And who makes that decision—bureaucrats or people?

In other words, part of the growth in government in the U.S., Canada and beyond, is seemingly due to this philosophical shift away from objective principles and natural rights, to subjective welfare rights bounded only by how much one can get away with.

Third, Obamacare has hurt other people's access to care, not just through higher premiums and higher out of pocket expenses, but also through smaller networks and higher cost drugs, putting their lives at risk.

Fourth, without regulatory burdens imposed by public health care, the price of care would likely be a lot lower. In this freer market environment, a patient with a pre-existing condition wouldn't have even needed insurance, as paying out of pocket for care would amount to buying a car—an expense, but not a bankrupting one. In effect, the proposition argues this: America has a bad health-care system, and the only way to get care within that bad system is to make the same presumptions, which produced this bad system in the first place.

Fifth, one naturally tends to believe regulations will save lives, including people with pre-existing conditions, because this is what is "seen." Yet one also tends to completely ignore the costs; what is "unseen." For instance, many alternatives to private delivery that seek to address the issue of pre-existing conditions, namely single-payer, have caused many people to die while waiting for care. Canadians have long suffered through long wait times before care is provided. Only recently have these unseen casualties had a voice.

Likewise, regulations in the U.S. designed to protect consumers have resulted in delays in approval for life-saving drugs, effectively causing hundreds of thousands of people to die while waiting for treatment. Are these unseen victims of government policy—many more in number—not equally worthy of our empathy?

Sixth, taking the longer view, the higher taxes and regulation needed to prop up socialized medicine lower economic freedom and, in turn, economic growth. Despite all the buzz about its "market" exchanges, Obamacare has served to reduce competition and increase concentration in the industry. Innovation and risk-taking may be similarly dampened by this anti-market environment. Thus, using the hand of government to help people with pre-existing conditions will make future generations relatively poorer, reducing their ability to have healthy and prosperous lives. Is it better for one person to live today or two tomorrow?

Thus while one empathizes with others and their suffering, policymakers must consider the cruel reality—there is no free lunch. We don't live in a perfect world. Someone has to pay for something, it just comes down to who, where and when. The proposition that Obamacare saves the lives of those with pre-existing conditions is understandable and worthy, but loaded—it presumes socialism is good and necessary, and one's answer to this claim must fit within that box.

Instead, a wise society, for the betterment of the most people, ought to consider what lies outside the box—the road not taken of market-driven health care, competition and lower prices. That’s a lesson for both the United States and Canada.


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