Bureaucratic Choice

There are several things that made me uncomfortable with Daniel Henninger’s op-ed in the Wall Street Journal this morning. For one thing I think he’s wrong in his central premise:

Electronics, foods, fashion, entertainment, apps, social media, appliances—pretty much anything that escapes the cold hands of a public agency is laid before us in a dazzling, unprecedented array of choices. Despite all the incoming, people learned to navigate the options. Virtually everyone has become adept at customizing a personal milieu that suits them. Given a reasonably growing economy, they’ll be able to sustain these choices.

In this context, the Affordable Care Act gave new meaning to the word “outlier.” Starting with the insurance mandate. Of course most people hated it. They’re living in a world turning more anti-mandate by the minute, and the Democrats are ordering them all into a national health-insurance pool.

Back in 2010, some Democrats talked like it was 1937 all over again. They intoned how for 70 years they’ve wanted to enact a big national health-care law. The Depression—those were the glory days. Or they said ObamaCare’s coverage-for-all would close the policy loop left open 45 years ago with Medicare for the elderly and Medicaid for the poor. So naturally one pillar of the Obama health-care law was to push more people into Medicaid’s already faceless, frightening maw.

There is plenty of choice, a plethora of choice, indeed, an overabundance of choice in the PPACA. It’s just not consumer choice. It’s bureaucratic discretion.

A report issued in 2010 on the regulatory impact of the PPACA lists approximately fifty places in the legislation that calls for the Secretary of HHS to promulgate, isssue, or formulate regulations on a fixed or indefinite schedule. Each of these would potentially involve multiple individual regulations. I’ve mentioned it here before but that reminds me of the “I’ll fill the rest in later, sir” scene in M*A*S*H. Contra Mr. Henninger, I wish the law were much more monolithic. At least people would know what they’re contending with.

His formulation makes me uncomfortable in another way, too. Isn’t there a difference between cellphones and healthcare? The best cellphone for your purposes is certainly a matter of your opinion. If you think it’s the best cellphone for your purposes, it is. Formulating the healthcare debate as one in which the problem is that there aren’t enough choices not only flies in the face of the basic structure of our entire healthcare system, it promotes the damaging fiction that the problem is with care and not health.

Quite to the contrary, the problem with our healthcare system as it has evolved is that it is almost entirely about care and insufficiently about health.

4 comments… add one
  • steve Link

    I am not familiar with Henninger, but I dont think he is familiar with health care. In the large majority of states, you have one or two dominant insurers, so at present you have little or no choice about your insurance. Most people get their insurance through work, so they dont really have much choice.

    Do we have choice in our care? Depends. Most people are now in networks. You have to stay in network. Most folks are in drug plans that require you to use their listed drugs, or pay extra. OTOH, insurers pretty much pay for almost any really expensive care, think surgery or chemo, that they or their doctor choose, even if it is no better, or even worse, than alternative cheaper procedures.

    “. If you think it’s the best cellphone for your purposes, it is.”

    How do you know what the best care for you might be? Assume that you will be making major purchase decisions under fairly severe stress, often at night with limited time and mostly when you are older.


  • How do you know what the best care for you might be?

    My point precisely.

  • Jimbino Link

    There are taxes, but no Medicare, Medicaid or Obamacare available to expatriate Americans, whether tourist or temporary resident.

  • Icepick Link

    How do you know what the best care for you might be?

    That’s right, just turn it over to the nice man in the white coat. (Or woman.) Let them make all the choices for you. And then, when the shift change comes, some other nice man (or woman) in a green scrubs will come in and make a bunch of choices that may or may not have anything to do with the choices the first person made. Repeat until you’re dead or released from the hospital. And then all these nice people that were making all of these marvelous choices for you (and don’t forget, it’s the MIDDLE OF THE NIGHT FOR THEM TOO, and they may well have had less sleep than you and it isn’t like THEIR job is stress free) will charge you or your insurance provider for everything they can think of.

    And if you go back next year, they’ll do it all over again, but this time the price will have gone up 8 to 12% because of underwear gnomes.

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