Repeal and Replace (Part 1)

I will start off my blogging with a controversial topic.  I am not a supporter of the Patient Protection and Affordable Care Act (PPACA), colloquially known as Obamacare.  

One criticism constantly leveled at critics of PPACA is that nothing is offered as a replacement, and the status quo in US health care had serious problems.  I think most observers will accept this to be true, though with some disagreement about what the most important problem is (access for the left, cost for the right).  

Therefore, I offer this upcoming series of posts as my detailed criticisms of PPACA along with a possible replacement.

I will admit right now that it's a reasonable position to favor a largely private health care system, taking most of the government intervention out of it, and to expect from that a relatively good result.  My own personal expectation is that we'd see many of the benefits of free markets (higher quality and lower prices) and a relatively good safety net of mutual aid societies and charitable care provision.  This, however, is only an expectation based on my understanding of markets, our history, and my optimism about the decency of Americans generally speaking.  I will allow that my expectation could be very wrong.  I also allow that this position is extremely unpopular and will never come to pass, at least not in a sudden transition from the current system.  Therefore, I will not argue such a position here.

Furthermore, I insist that we do have obligations to others, and while civil society is my preferred (and I'd argue optimal) medium for meeting those obligations, there is no need to rule out government involvement per se.  That said, we should also recognize that government has its limitations.

My criticism of PPACA are five-fold:

1) Costs are not effectively controlled, neither on the supply or demand side
2) Many people will remain uninsured or underinsured
3) The subsidies create severe implicit marginal tax problems
4) The health system becomes increasingly byzantine 
5) Mandates to cover certain products or services are levied on businesses and organizations which oppose such products or services on moral grounds

In the next post I will discuss the problem of cost control.