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The Daily Debate - 8/14/2013

By Robert Tracinski

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August 14, 2013

1. Finding Out What's In It

2. The Law of Intended Consequences

3. Dispatches

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1. Finding Out What's In It

Another week, another new discovery about what's in ObamaCare—long after we passed it.

One of the things that's in it is a massive exemption for religious medical-sharing arrangements.

"It's gotten little attention, but it's true: The individual mandate in the Affordable Care Act requires all Americans to have health insurance or face penalties, but members of medical-sharing ministries are exempt from the individual mandate that will be enforced beginning in 2015.

"It's there because of the work of then-Congressmen Tom Perriello, a Virginia Democrat and Sens. Max Baucus, a Montana Democrat, and Republican Charles Grassley of Iowa, who fought to add the exemption to the law. It's the same principle that allowed for the Amish to be exempted from the individual mandate—with the crucial difference that it's a lot more practical to join Medi-Share than it is to become Amish."

Boy, conservatives are going to love this. They get to totally opt out of the hated individual mandate, and all they have to do is to profess to be Christians, which they hardly need any encouragement to do.

And they really do get to opt out of everything.

"Here's how it works: To join Medi-Share, members must pledge their Christian faith and promise not to drink, take drugs, or have sex outside of a traditional marriage. A reference from a minister may also be requested. Certain pre-existing conditions render applicants ineligible, while chronic issues such as obesity sometimes lead to acceptance into the program contingent on undergoing wellness counseling.

"The coverage doesn't include products of 'un-Biblical lifestyles,' such as contraception or substance rehab, or some preventive medicine, including colonoscopies and annual mammograms. Those policies lead to lower costs for all members, Meggs said.

"When you have a medical bill, you submit it to the organization. If it meets the eligibility requirements and your annual medical expenses have exceeded the threshold in the plan you signed up for, the bill is 'shared'—that is, covered."

The catch is that this is technically not "insurance," because Medi-Share is not legally required to cover anything. It will pay for your care if it has enough money in the till, but if the money isn't there, your only appeal is to the Big Guy himself. Of course, you might say that the same is true of regular insurance, so the only difference here is that there is no government regulator monitoring Medi-Share to ensure its solvency.

If you think that's not such a great loss, considering the recent track record of regulators when it comes to ensuring solvency, then you can appreciate the positive side of the ledger. Medi-Share is an exemption, not just from the individual mandate, but from every important aspect of ObamaCare. There is no "guaranteed issue" for pre-existing conditions, the plan is allowed to "cherry pick" a healthier demographic with a relatively clean-living lifestyle, and they are exempt from regulations which mandate coverage for contraception and certain kinds of preventive screenings.

Talk about a way to supercharge ObamaCare's "adverse selection death spiral": give one of the nation's healthiest demographics—respectable, clean-living, middle-class folks—a way to completely escape ObamaCare and its insurance exchanges. And if anybody ever tries to shut it down, they can argue, quite plausibly, that it's a violation of religious freedom.

It almost makes me sorry I'm an atheist.

It also makes me think it's going to take a pretty big act of faith to believe that ObamaCare is going to work, when so many can take advantage of this kind of end run around it.

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2. The Law of Intended Consequences

The other thing we seem to discover every week is another key part of ObamaCare that has been "delayed" for a year because it is suddenly discovered to be unworkable. This time, it's the law's limits on annual out-of-pocket expenses.

Yet as I pointed out recently, the Democrats are now trying to place the responsibility on Republicans to fix all of the problems with ObamaCare, presumably so Republicans can shoulder the blame when the law fails.

But Megan McArdle argues that at least one key provision will prove very hard to fix.

"I'm kind of surprised to hear a lot of liberals agree that the 30-hour rule is bad policy, and even more surprised to hear that it would be easy to repeal or reform. In fact, while I opposed the law, I find it easy to see why they designed an employer mandate for all employers who worked more than 30 hours, and difficult to imagine how it could be reformed.

"Let's start with the reason for the employer mandate—two reasons, actually. The first is that President Barack Obama promised that if you like your insurance, you'll be able to keep it, and while this was not true, they wanted it to be at least kinda true. Even before Obamacare passed, the majority of U.S. citizens had insurance through either the government or their employer, and those people were satisfied with their insurance. The administration wanted to discourage employers from dumping those people onto the exchanges to take advantage of subsidized coverage, from whence they would march on Washington with pitchforks and torches, demanding the heads of the politicians who passed the stupid law that took away their employer-provided health insurance.

"This hints at the second reason that the employer mandate was included in the law: to keep the cost down....

"Legislators wanted to make employers offer insurance, without suffering any loss of full-time jobs, so they tried to make it very difficult to accidentally creep into part-time status with a tiny reduction in hours (presumably made up by an hourly wage boost). But this created a different problem: Now if you can't afford to offer your employees insurance, you have to reduce their hours a lot."

So here's the dilemma. Either you impose a de facto ban on full-time employment for low-income workers, or you move the "full-time" cut-off to 35 hours and risk creating a de facto 34-hour work week and cutting off a huge source of revenue to fund ObamaCare.

How you fix that, I have no idea. Or rather, I do: you can repeal the whole law.

Now here's the bigger irony. While they criticize Republicans for being insufficiently invested in the success of ObamaCare, it turns out Democrats aren't all that into the law, either. They aren't invested in its success but view it as a mere stepping stone to a fundamentally different system.

Here is the latest from Senate Majority Leader Harry Reid.

"'What we've done with Obamacare is have a step in the right direction, but we're far from having something that's going to work forever,' Reid said.

"When then asked by panelist Steve Sebelius whether he meant ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it, Reid said: 'Yes, yes. Absolutely, yes.'"

All right, let's get clear on exactly what he's saying. ObamaCare is a system of government-sponsored, government-subsidized, and government-regulated insurance. What Reid is saying is that he doesn't think it's going to work and that insurance as such has to be abandoned (in favor of "single-payer," i.e., the government paying for all health care directly).

So while they complain that Republicans aren't helping them to fix ObamaCare, leading Democrats think that it's never going to work and will eventually have to be thrown out altogether.

In that context, what does it mean to say that ObamaCare is a "step in the right direction"? If Reid thinks health insurance is the problem, then a step in the right direction would be a step toward eliminating health insurance.

So here's what seems to be happening. The Democrats passed a deeply flawed health care law, then flipped from defending it to presenting themselves as the people who will "fix" all of its many problems. Now Harry Reid is sending up a trial balloon for the next stage. When ObamaCare fails, they will conclude that the problem is insurance itself, and the only way to fix it is to eliminate insurance and have government take over paying for all health care directly.

Which is to say that they are doing exactly what I predicted four years ago.

"When you understand what this bill does, you can see why the Democrats would be happy to compromise and drop the public option—for now. This bill so comprehensively wrecks private health insurance that pretty soon a 'public option' will seem like the only alternative, and they will already have put into place one of the new taxes needed to pay for it. If the left's goal is to impose socialized medicine in America, this bill does it in the most callous and destructive way possible. It smashes private health care—then leaves us stranded in the rubble, at which point we will be expected to come crawling back to the same people who caused the disaster and ask them to save us."

When this happens, I'm sure we will be told that all of the problems created by ObamaCare are "unintended consequences" of well-meaning legislation. But this looks more like an instance of the Law of Intended Consequences.

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3. Dispatches

What finished off Detroit? Its municipal income tax, which basically pays taxpayers to move to the suburbs.

Secularism can save Egypt.

Apparently, it's not just Oprah. Switzerland is xenophobic.

The bad Marxist "science" behind Russia's anti-gay pogrom.

The origin of the iPhone's ubiquitous tri-tone text message alert.

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—Robert Tracinski

The Daily Debate

edited by Robert Tracinski

Brought to you by RealClearPolitics.

Robert Tracinski is also editor of The Tracinski Letter.

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