The thrust of her speech seems to have been about making âKansas City the healthiest region in the countryâ or something. But at KMUW radio and at KPR, Jim McLean provides a very brief audio of Sebelius at the luncheon saying this: âAnybody who stands up and says weâre going to repeal this law is just not telling the truth, because frankly there isnât anything to go back to.â
Conservatives might get riled by such a statement, so I Googled it in quotation marks and got exactly one hit, to the KMUW link above. On September 21, the Kansas City Star ran a print column about the speech by Alan Bavley headlined âSebelius Says ACA Is Here to Stay.â It had been posted online the day before as âKathleen Sebelius says Obamacare is here to stayâ:
Sebelius was confident that the ACA was so âintimately entwinedâ into the fabric of the nationâs health care system that it would be impossible to dismantle it wholesale, as some Republicans presidential contenders vow.
Any politician promising to repeal the ACA âis just not telling the truth,â she said. âIt really canât happen.â
The ACA has changed the way doctors and hospitals are paid, how health insurance companies price their plans and how millions of people get health care coverage. If you took away the ACA, there would be nothing left to go back to, Sebelius said.
Iâm reminded of the scene in David Leanâs Doctor Zhivago (1965) when Zhivago and his family learn of the execution of Tsar Nicholas. Ralph Richardson wails: âTheyâve shot the tsar, and all his family. Oh, thatâs a savage deed. Whatâs it for?â The good doctor answers: âItâs to show thereâs no going back.â
As with the Russian Revolution, so, too, with ObamaCare — you see, âthere’s no going backâ because âthere isnât anything to go back to.â
Or so progressives would have us believe. But thereâs no reason to think Mrs. Sebelius knows any more about this than she knew about Healthcare.gov during its disastrous rollout. As a programmer/analyst on old IBM mainframes, I have some experience with system conversions, and one thing you never do is assume that things will proceed without a hitch. Rather, you operate under Murphyâs Law, which holds that âAnything that can go wrong will go wrong.â And the thing is: no one knows what all can go wrong. So, what are ObamaCareâs O-rings?
Murphyâs Law (and plain old common sense) dictates that you always leave a path to go back to the old system that youâre migrating from. In some conversions, you may even, for a time, operate off the new system and the old one simultaneously. So if ObamaCare made it impossible to go back to the old system, Iâd say thatâs a major failing, especially since ObamaCare has been up and running for such a short time, not to mention its problem-plagued implementation.
If ObamaCare has in fact been âso âintimately entwinedâ into the fabric of the nationâs healthcare systemâ that going back would be âimpossible,â was that done deliberately? If so, that goes beyond failure and into malpractice. (Sebelius may have said more than she intended to.)
Just how has ObamaCare âentwinedâ itself so irreversibly into the nationâs healthcare system? ObamaCare is not so much a healthcare reform as a health insurance reform; it hasnât âchanged the way doctors and hospitals are paidâ as much as how insurance companies are paid.
But ObamaCare did not require people to use health insurance; it did not abolish paying entirely out-of-pocket. Otherwise, ObamaCare would have destroyed concierge medicine, and medical tourism to the United States. Some doctors and hospitals simply donât accept health insurance and Medicaid. So ObamaCare didnât affect the cash-only sector of healthcare.
ObamaCare also didnât entwine itself into Medicare; Medicare is a stand-alone system funded by its own dedicated tax. ObamaCare didnât really entwine itself into Medicaid; it merely expanded the number of people on it. Where ObamaCare really did get âintimately entwinedâ is in its new tax credit subsidy system, which means that it got entwined into the IRS.
And the subsidy system may be worst feature of the ObamaCare. At least with Medicaid there arenât government payouts unless people use healthcare. But with the subsidy system, payouts are made upfront, as premiums to private insurance companies, regardless of whether claims are made or not. Surely those upfront payments put an upward pressure on prices.
ObamaCareâs âindividual mandateâ is triggered not by an individual existing, but by an individual having an Individual Income Tax liability. If your income isnât high enough to be taxed by the feds, the mandate doesnât affect you. Thatâs one of the reasons millions are still uninsured in America — theyâre not taxpayers.
But some Americans who owe no income taxes nonetheless file returns. And when they look at the 1040 instruction booklet for 2014 they may be a bit flummoxed. For âLine 61, Health Care: Individual Responsibilityâ on page 50 doesnât state that only those with a tax liability must have coverage. So a filer who owes no income tax for any part of the tax year and who is filing a return only to get his refund will think he needs to buy health insurance or pay the ObamaCare penalty/tax. Again, was that deliberate?
ObamaCare may be too âintimately entwinedâ for its own good, because it is quite vulnerable to tax reform. The FairTax, for instance, eliminates income taxes and our beloved IRS. Donald Trumpâs tax reform exempts huge swathes of Americans from paying the income tax. Such changes would mean the undoing of the subsidy program precisely because it was so âentwinedâ into taxes and the IRS. (Perhaps ObamaCare was designed to be a roadblock to tax reform.)
One of the standard lines of the Left, whether Democrat or Bolshevik, is that their systems canât be undone, theyâre irreversible, here to stay, thereâs no going back. So the Leftâs systems must be âintimately entwinedâ; there can no choice. Where this is most insidious is in the ensnarling of the individual; individuals get hooked on âfree stuffâ — free ObamaCare, free Obama phones, free âObama moneyâ from Obamaâs stash (video). If we donât free ourselves from government freebies, there may not be much hope for Freedom.
Do remember that America actually had a healthcare system before Obama came on the scene, and doctors were regularly performing medical miracles all around the country. Not only that, before the advent of the ObamaCare exchanges, which Obamaâs apparatchiks are careful to always refer to as âthe Marketplace,â we had a market for health insurance. Surely we can go back to that, or go forward to something even better. But first we must get un-entwined.