What do Hollywood celebrities, Los Angeles students, Oprah, librarians, Magic Johnson, and the website Funny or Die have in common?
The Obama administration has asked all of these noted healthcare experts to sell the Patient Protection and Affordable Care Act (“Obamacare”) to a stubbornly skeptical public. Despite repeated contrary proponent assurances, many remain unsold on the vast transfers of power from private or local actors to the federal government on healthcare decisions Obamacare entails.
For example, 700 references appear in Obamacare’s legislative text to the secretary (of Health and Human Services) “shall,” 200 to the secretary “may,” and 139 to the secretary “determines,” according to health care writer Philip Klein. This grants our current secretary, Kathleen Sebelius, undefined and discretionary authority over the entire healthcare industry.
Yet despite all of these new powers—more likely because of them—the implementation of Obamacare has not proceeded as neatly as advocates hoped. Some states declined to expand Medicaid and run the insurance exchanges integral to the program; insurance companies are raising premiums or leaving state markets entirely; and the Obama administration itself delayed key parts of the legislation, most notably the employer mandate that compels businesses above a certain size to provide employee health insurance.
But the Obama administration’s most pressing practical concern is young people. Obamacare needs the low risk from the healthier (who tend to be younger) to offset the higher risk of the less healthy (who tend to be older) so that their health costs come down. For young people, it’s a terrible bargain. Hence the promotional campaign the administration began this summer to convince them—and everyone else—to buy insurance.
Successful persuasion would enable Obamacare to work a bit more smoothly. But, more important for Obamacare proponents, it would firmly ingrain Obamacare and the Department of Health and Human Services in our culture, allowing government healthcare to transcend politics. An instructive precedent for this already exists in the British National Health Service.
Founded in a flurry of post-World War II leftism that also included the nationalization of several industries, the single-payer NHS now employs 1.7 million people, making it one of the world’s single-largest employers. It also serves millions more, and has consequently dominated that country’s politics ever since. One Margaret Thatcher aide called it “the closest thing the English have to a national religion”; Thatcher herself, arguably the modern West’s most pro-market leader, once declared that “the NHS is safe in our hands”; and today’s Conservative-led UK government has repeatedly spared the service from budgetary discipline. The NHS has grown into such a cultural behemoth that politics can hardly touch it; recall the NHS segment in the 2012 Olympics opening ceremony meant to celebrate British culture. Earlier this summer, moreover, Britons celebrated the 65th anniversary of the NHS on July 5 as proudly as Americans celebrated the Fourth of July the day before.
Until recently, some programs in the United States—Medicare, for example—resembled the NHS. Nothing quite mimicked it in scale. But Medicare alone has already cheapened our political discourse. Few viable politicians even talk about reforming it, and fewer still intend to restructure it meaningfully.
Transforming healthcare-related political discussions nationwide on this model would ensure a left-of-center political culture in the United States, preventing honest debate on the size and scope of government. Such a stultified political culture will dominate this country’s future unless those who still hold to the principles of the Fourth of July can prevent the line currently separating it from July 5 from being permanently blurred—even if Magic Johnson says it ought to be.
