Opponents can level plenty of legitimate arguments against the Affordable Care Act (ACA), such as the $2 trillion it will add to the federal deficit in its first two decades or the $1.8 trillion in tax increases over the same period. But perhaps the most compelling case for repeal is a moral one. The health care law crosses ethical lines in the way it was sold and in its ultimate effects.
Top of the list: Thou shall not kill.
The law will kill more people than it can possibly save. Though Congress passed ACA under the banner of reducing premature death among the uninsured, there are serious questions about whether this elevated mortality risk is exaggerated or spurious. The lack of purported benefits, however, won’t spare Americans from having to shoulder the new risks imposed by the law.
For instance, analysis by the Pacific Research Institute found the law’s tax on medical devices will have adverse effects on innovation that will result in the loss of 1 million years of life annually (e.g., 100,000 additional Americans dying 10 years earlier because of a lack of lifesaving technology). This figure easily exceeds even ACA’s most wildly optimistic estimates of mortality reduction among the uninsured. This toll doesn’t include the act’s tremendous cost to our future prosperity, which will cost additional lives.
While reducing the nation’s longevity, the law shortchanges benefits, too: Thou shall not steal.
The Congressional Budget Office’s latest long-term spending projections show the federal government’s share of the economy will surge by 48 percent over the next 75 years. Every penny of the forecasted increase will stem from a vast expansion of federally funded health care entitlements, namely Medicare, Medicaid and subsidies for the new health exchanges. By the end of the decade, analysts predict, costs of the new exchanges alone will exceed $200 billion annually.
To help finance those exchanges, ACA in its first decade diverts $500 billion in resources from Medicare — a program already underfunded by $300 billion annually. That accounting move is akin to taking out a loan when a leaking roof threatens to flood your whole house and then using those funds to build a new garage rather than repair the roof.
ACA not only will raise private health care premiums for Millennials, but by compounding the federal deficit problem in this manner, it also greatly increases the odds that today’s children will not be able to count on receiving Medicare benefits at levels equivalent to what their parents received. In fact, average Medicare recipients who retired in 2011 will collect three times more than they put into the system. Because there’s no conceivable way of sustaining this level of payout for generations to come, it’s tantamount to intergenerational theft.
This subterfuge calls to mind another ethical concern — the dubious manner in which advocates sold ACA to the public: Thou shall not bear false witness.
President Obama and other ACA proponents assured individuals that if they liked their current health care plan, they could keep it. In reality, 35 million workers with employer-based coverage are likely to lose their plans once employers realize it will be far cheaper to pay the penalty than to provide the coverage mandated by ACA. Tens of millions more will remain in their current plans but with richer benefits and, therefore, higher premiums than they would have chosen voluntarily.
The law’s Medicaid changes are replete with false promises as well. Too often, recipients discover they cannot find a provider willing to take them because the program’s payment rates are too low and red tape too daunting. Consequently, emergency room use for the average Medicaid recipient is 70 percent higher than for an uninsured individual — an expensive unintended consequence. Moreover, a study of nearly 1 million surgical patients found that those on Medicaid experience worse health outcomes than their counterparts with either private insurance or none at all. ACA simply adds to the burden of this broken system by expanding the number eligible for Medicaid by more than 25 percent. As a result, government researchers forecast approximately 1 out of every 4 Americans may be enrolled in the program by 2020.
We can do far better than this by replacing ACA with real patient-centered reform. Congress demeans itself when it enacts immoral legislation. The chance for redemption is at hand: Repealing Obamacare is the right thing to do.
Christopher J. Conover is a research scholar at Duke University’s Center for Health Policy and Inequalities Research and author of “American Health Economy Illustrated” (AEI Press, 2012).