What We Won't Get From Sunday's Healthcare Vote

by: Craig Pirrong

Whatever happens this afternoon (or this evening) in the healthcare vote, the entire spectacle brings to mind what Mark Twain once wrote:

It could probably be shown by facts and figures that there is no distinctly native American criminal class except Congress.

Or perhaps this one:

I never can think of Judas Iscariot without losing my temper. To my mind Judas Iscariot was nothing but a low, mean, premature, Congressman.

(There are more: all, sadly, fit.)

And this, uttered by lawyer Gideon Tucker:

No man’s life, liberty, or property are safe while the legislature is in session.

As dysfunctional as the American healthcare system is, we will pine for the merely dysfunctional if Obamacare passes. The procedural chicanery and will to override the clear sense of the American people will make things worse, not better. If only Congress were subject to the Hippocratic Oath: First, do no harm. (But then what would they do with their time?)

There are ways of amending the system that would largely rectify the sources of dysfunction in the current system.

The first would be to eliminate the immense tax advantage to employer-provided insurance, which subsidizes the consumption of health care (driving up costs), contributes to job-lock, and increases the risk of becoming uninsurable due to pre-existing conditions. The second would be to eliminate mandated coverages, which inflates the cost of care, and makes it rational for some to decide not to purchase insurance–because they would have to pay for things they don’t want or need. These measures would also encourage people to purchase high deductible, high maximum limit catastrophic coverage policies, and to self-insure (i.e., pay for themselves) against routine expenses. This would also help control costs.

Other knotty problems, notably the pre-existing condition issue (to the extent not resolved by the above two measures) would probably require some form of subsidy, along with measures to prevent opportunistic gaming of the system; but addressing that issue does not require all of the other elements of the pending legislation, and should be focused on when the system equilibrates to the elimination of employer provided coverage and coverage mandates.

Besides damaging the health care system, the legislation that hangs in the balance will wreak tremendous economic damage.

Pay no attention to the blarney about the CBO budget scoring. (Did it come out on St. Patrick’s Day?) First, for the effin’ billionth time, it’s the total amount of spending that is important, not the budgetary impact. The budget impact is a government-centric measure; we should focus on a citizen-centric measure. The important question is: Is what we as citizens are getting worth a trillion dollars over the next ten years? (And it will almost certainly cost more than a trillion, if historical experience in these estimates is any guide, and if one considers the political economy forces that will impel future Congresses to expand entitlements.)

Second, the CBO ignores the inevitable effects of the legislation on economic growth. CBO ignores the pernicious effects of the myriad taxes included in the legislation–and the myriad taxes not specifically included in the legislation that will be necessary to pay for it in the future. Most damaging are the capital taxes, which as I’ve written, are inimical to growth. There are also elements in the legislation that are not taxes per se, but will effectively increase marginal tax rates, thereby discouraging work and effort. In particular, the subsidy phase-outs (the subsidy declines as income increases) dramatically increase effective marginal tax rates.

Worse care. Less growth. What’s not to like?

The ugly process is a mirror to the repulsive substance. To watch the tawdry dealing is to understand that Twain’s Judas Iscariot comparison is spot on. Why would Senators and Representatives need to get their metaphorical 30 pieces of political silver (if only it were 30 pieces, worth about $500!) if the legislation were so beneficial?

And it will not be over after the vote. This will not be the end. It will not even be the beginning of the end. It will merely be the end of the beginning of interminable political knife-fighting. We are well into the Era of Bad Feelings, which will only get worse as the practical implications of this legislation become manifest, and the land mines hidden in the bill begin to explode.

What Tucker said is literally true today, 21 March, 2010. Our lives, liberty, and property are all in grave jeopardy as Congress is in session today.