I'm a conservative and would have voted against Obamacare if I were a member of Congress. I think that many of its provisions are silly and have criticized some of them rather loudly. That said, I'm likely to count myself among the winners as the revised health care system rolls out in the next few weeks. And my own experience is a good reason why Republicans should be working for vast changes to the system. I don't deserve the benefits I'll get.
My personal life has some relevance here. While I'm in excellent health, my wife (also in her 30s) is on disability as a result of her chronic asthma and spends between 20 and 30 days per year in the hospital. Furthermore, my son is autistic. Last year, our family medical bills were somewhere over $100,000, almost all of which our insurance (private small employer policies and Medicare) covered.
Since I'm much more likely than average to make use of almost any new benefit that's added to health coverage, new mandates imposed as a result of the law are a feature, not a bug, from my personal perspective. Since I earn an upper middle class income, even a doubling in premiums would be a good investment for me so long as it offers some new benefits. And, most likely, my premiums are going to go down or remain stable anyway under the new system.
R Street already pays some of the highest rates allowable under District of Columbia law for small group plans and, even though we had lots of claims in the plan year that just ended, our premium actually declined slightly after adjusting for inflation. As small group plans like mine move towards modified community rating (everyone pays pretty much the same price), I suspect that we may actually see a small reduction in our costs. Even if average premiums soar, we're the people who will benefit from this happening.
Since R Street's average wages are high by national standards, even our generous health benefits are a pretty small share of overall compensation. Since we provide everyone coverage anyway, we no incentive to hire (or not) based on mandates for benefits. Since I'm the decider for our group plan, I'll be totally in charge of any enhancements or cutbacks to our coverage that may happen.
Even some negative externalities that might impact other people who are similarly situated likely won't affect me. For example, if the (small) cuts in Medicare do degrade services for people like my wife, our wraparound small group policy will make up the difference. Even if Medcaid expansion swamps emergency rooms the affluent suburb I live in will probably have few new Medicaid beneficiaries.
So, I'm likely to get what the President promised everyone: better benefits for the same or lower premiums. This is good for me personally, and probably for R Street's employees too.
But it is exactly why Obamacare isn't a good deal for the country. Although I'm as entitled to public goods like roads, parks, national defense and police protection as any other American citizen, the government shouldn't really have an interest in providing me with any benefit that isn't more-or-less equally available to everyone. I don't deserve much help. (Yes, that includes my wife's current disability checks and at least some of her Medicare premium.) While I'm not rich and don't come from real wealth, I earn a decent income and my parents did too. I can and should take care of myself and what public help exists should be focused on those who actually couldn't figure out how to provide it themselves. But, as people like me benefit from Obamacare -- and, in particular, the community rating provisions -- they'll become a powerful lobby in its defense in the same manner that wealthy Medicare beneficiaries now work to defend the status quo for that program.
The problem isn't "socialism." President Obama doesn't support collective ownership of the means of production -- and, for that matter, I don't think that any major politician in any other developed country does either -- but it is a matter of making even more people clients of the state. And that's bad enough. While the government properly has some role helping those who genuinely cannot help themselves, it saps community and individual initiative when it provides big benefits to those who really ought to be helping themselves. And that's just what Obamacare is doing for me.
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