Self-proclaimed conservative Max Antonucci’s column on the Affordable Care Act misdiagnoses problems with the legislation, misunderstands the nature of single-payer healthcare and underestimates the viability of free-market alternatives.

The ACA’s implementation has been plagued by so many delays, waivers and exemptions that it is impossible to verify Mr. Antonucci’s claim that “all major aspects of the law are now in effect.”

Here’s what we do know about the ACA: It further insulates consumers from the true cost of care, adds millions to a hemorrhaging Medicaid system and retains the problematic link between employment and insurance. The ACA is a massive wealth-transfer program, with young and healthy individuals subsidizing costs for their older, sicker counterparts.

Mr. Antonucci is correct to fear a single-payer system, but his reasoning is suspect. The problem with single-payer is not cost, as the author suggests, since this approach would succeed in reducing administrative costs. But single-payer would eviscerate health care innovation in the U.S. — an undeniable strength of the current system, despite its flaws. It would also empower federal bureaucrats to decide which procedures and drugs are off limits to consumers. Not quite “death panels,” but eerily Orwellian nonetheless.

To declare the free-market “doesn’t work on health care” presupposes that market-oriented healthcare has been tried and failed, which is simply untrue. The status quo is riddled with regulations, mandates and public financing. Third party payers distort price signals and undermine economic efficiency. Supply is limited by licensure requirements and artificially low medical school enrollment. Prices are set, below market equilibrium, by government payers — which account for approximately half the entire insurance market.

And just because Mr. Antonucci is unaware of free-market alternatives does not mean they do not exist. See Sen. Paul’s S. 2196; or Rep. Broun’s H.R. 4224; or Rep. Rokita’s H.R. 4160.

Most proposals call for some combination of standardized tax relief to purchase insurance; elimination of “first dollar” coverage; robust health savings accounts; block grants to reform Medicaid; means-tested Medicare benefits; portable, individually-owned private insurance; and a cap to the tax exclusion for employer-sponsored insurance.

According to Mr. Antonucci, conservatives have two options: A) relinquish any hope for free-market health care, or B) accept “actual” socialized, single-payer medicine. I fail to see a distinction between these choices. If conservatives relent and choose Option A, Option B will follow close behind.

James Paul

MPA Candidate 2014, Maxwell School

Published on April 15, 2014 at 1:32 am