Command economy – Instead of allowing dispersed buyers and sellers to determine their own economic activities according to the laws of supply and demand, a higher authority would issue commands determining the overall direction of the economy following a master plan.
Frank Dikötter, Mao’s Great Famine
In March 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), AKA ObamaCare, into law. Near the end of 2013 as the jaws of ObamaCare begin to close Americans now find themselves immersed in the chaotic economics of health care unfolding through an arcane command system that the President hopes is his great legacy.
The Democrats, apparently drunk from celebrating Obama’s improbable 2008 election and their impressive congressional majorities, asserted their “higher authority” and rammed through Congress an insanely complicated piece of legislation that none of them had read or even remotely understood. Details be damned and contamination by Republican input be eschewed, this was to be a “master plan” that would make health care affordable to all Americans. A decades-long aspiration of Democrats was universal health care. It now, they could boast, was the law of the land: the U.S. had had finally and proudly achieved the moral stature of Fidel’s Cuba, long and much admired by the American Left.
To call the vast, incomprehensible compendium of dense, turgid legalize set forth in thousands of pages of ObamaCare a “plan” in any regular sense of the term, however, attributes far too much intelligence, rationality and foresight to the legion of nameless, backroom, pettifogging hacks who drafted it. But whatever one decides to call it, the ACA’s primary function is to strictly order the behavior of buyers and sellers of medical services and to allocate the resources of health care for 300 million people through coercion and a dizzying maze of regulation rather than through the mechanism of the market.
The not–so-affordable Affordable Care Act is dream work of command economics that could be admired by the defunct apparatchiks of the former Eastern Block, infested throughout with thousands of “shalls” and “shall nots.” For example, in (SEC. 2713 42 U.S.C. 300gg–13 Coverage of Preventive Health Services) “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for— …” and on it goes for paragraphs seemingly intent on incomprehensibility. These “shalls” and shall nots” pile up page after mind numbing page, and at the end of any attempt to peruse the whole document the only understanding that even the most astute reader will take away is that he now stands bewildered and helpless, at the mercy of an impenetrable Kafkaesque bureaucracy.
But to get at the heart of command economics: “The Secretary of the Treasury, acting through the Financial Management Service, shall administer the collection of penalty fees from health plans that have been identified by the Secretary in the penalty fee report provided under paragraph 3.” (Sec. 1104) Here we have ACA in its most elemental, punitive form and function, making a real contribution to the better health of Americans.
The extent and detail of the regulations and requirements thus contained in the entire act is truly staggering. No single individual could ever begin to comprehend all that is allowed, required and forbidden in this legislative bog. If Americans were actually required to read the complete legislation and then asked to vote in a plebiscite as whether to accept or reject the act, it is hard to imagine that it would not be overwhelmingly repudiated as the design of some Rube Goldberg in an advanced state of dementia. A political system that produces laws like the ACA is in full, abject surrender to the faceless, unelected occupiers of regulatory agencies with vague, arbitrary power that make us helpless, frustrated and miserable and keeps them forever employed.
Consider as just a snippet of how the regulation works SEC. 2715 [42 U.S.C. 300gg–15]. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS that sets forth the “rules” for formulation of the documentation for insurance consumers. First, the documentation has “appearance” requirements: it must “not exceed 4 pages in length and…[must] not include print smaller than 12-point font”. The “language” of the documentation must be such as to “ensure that the summary is presented in a culturally and linguistically appropriate manner and utilizes terminology understandable by the average plan enrollee." It is a sour tasting irony to have the anonymous hacks who wrote this monstrosity that the legislators never read ordering someone, anyone, to "utilize" understandable "terminology."
Just this tiny fragment reveals an insidious descent into servitude and a future that brings far reaching control over and manipulation of our lives by individuals who are politically untouchable. What we see in ACA depressingly resembles the work of the corrupt autocrats who for decades ran the Soviet Union and turned a huge, resource-rich country into a third world slum. So much for the ‘dictatorship of the proletariat’: ours is a ‘dictatorship of the “font size”’ equipped with a language police enforcing an “understandable terminology” for the “average” man, and directives that impose “appropriate” measures of “cultural” and “linguistic” sensitivity in written business communication, “appropriate” being whatever some Kommizarette in the federal bureaucracy in between coffee breaks at the moment decides it is. The level of generality and leeway for the government enforcers to interpret what is “culturally and linguistically appropriate” is about the same as it would be for “enemy of the people.” A government that asserts this micro-managing range of control over its citizens is one that can do whatever it wants. Citizens no more, we are now mere subjects. Subjects are passive creatures who are subjected to the arbitrary dictates of their superiors. This was the intent from the beginning, the creation of a massive edifice of arbitrary power.
Lest there is any doubt it is the government regulators, not the buyers and sellers, that determine the cost of the services and that health care will be a government run enterprise, see ‘‘SEC. 2794ø42 U.S.C. 300gg–94 ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS. ‘‘INITIAL PREMIUM REVIEW PROCESS.— “The Secretary, in conjunction with States, shall establish a process for the annual review, beginning with the 2010 plan year and subject to subsection (b)(2)(A), of unreasonable increases in premiums for health insurance coverage…. The process established under paragraph (1) shall require health insurance issuers to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase.” (my bold) It is comforting and reassuring to know that our business people must run through a gauntlet of unelected bureaucrats who, following some “process for an annual review”, get to determine what “reasonable” means and who can enforce whatever whims they entertain. No one but the most impossibly naïve can imagine that the power given to the “Secretary” will not be augmented over the years and will not at some time be abused.
ObamaCare is not and has never been the product of anyone hoping to make it easier for Americans to afford health insurance or to make the health care industry more efficient and effective: it is rather the consummate work of cynical opportunists and power grubbing ideologues and a prime example of 21st century velvet authoritarian politics. The desperation of the Republican right wing to resist and defund ACA is steeped in the perceptive realization that unless it is quickly overturned ACA will entrench itself and rapidly metastasize in its domination over the lives of Americans.
ObamaCare has been intended as a monument to Obama and it delivers on his promise shortly before the 2008 election to “fundamentally transform the United States of America.” A different approach to making health care more affordable would have been to make a more modest and gradualist effort with input from the opposition party and a garnering of greater popular support. But Obama from the beginning has always disdained the opposition Republicans -- his "enemies", as he prefers to call them -- as stupid and greedy, essentially unworthy to participate in the process. Transformation is what he wanted and promised and transformation is 21st century argot for revolution. Obama’s goal has always been to overturn the status quo not to fix or improve it.
But with the approach of 2014 the ACA “master plan” bearing all the marks of the “higher authority” of its creators collides with reality. With some relish the reviled critics observe at the very beginning of the law’s implementation the hugely symbolic crash of the 400 million dollar HealthCare.gov website three years in the making. Moreover, President Obama now has to experience the deserved embarrassment from the full exposure of his repeated lie that satisfied policy holders would not be forced form their coverage, a lie that registers on the far end of the "Whopper" scale. The implementation appears to be unfolding in modes of disaster that even the Republicans did not envision. ObamaCare could become the best I-told-you-so, Obama’s detractors ever imagined.