Commentary: Medicaid Expansion Wrong Even with Reforms

Previous articles by me and others have explained how there is essentially no chance that the Obama administration will accept key reforms proposed by Republicans in the Michigan Legislature as conditions for accepting the Obamacare Medicaid expansion.

But what if lightning struck and the feds did approve the reforms, would it then be OK to accept the expansion?

Not if one shares the self-government, free enterprise beliefs and principles on which Mackinac Center policy recommendations rest. Here’s why:

This bad law is vulnerable on many fronts: legal, political, administrative, technological, perverseness. While outright repeal is unlikely under the Obama administration, it is possible Congress — including the Reid Senate — will be forced to open the law for amendment, at which point who knows what favorable changes the then-current climate of public opinion would allow (or demand).

We are barely six months from an implementation that no one thinks will be happy. There will be many painful consequences, and even launch-pad explosion can’t be ruled out.

With this context, those who share our principles have a duty to contest every step, because this issue is not concluded. A day may come when active resistance becomes counter-productive, but our core beliefs demand we be slow and grudging in accommodating that day’s arrival.

However, no one at the Mackinac Center is defending our nation’s dysfunctional health care system status quo. The problem with Obamacare is that it doubles-down on those dysfunctions rather than fixing the bad policies that caused them. Fortunately, within the broad freedom movement there is a general consensus on the kind of reforms needed to strike at the root of the dysfunctions.

Congressman Paul Ryan’s premium support model for Medicare is part of that. For the non-elderly, voucher-like health insurance tax credits like those proposed by John Goodman and others are another. On Medicaid for the poor, Florida think-tanker Tarren Bragdon is promoting a reform he calls the “Medicaid Cure,” which is actually underway as a pilot program in several counties there.

These and other patient-centered, free-market health care reforms all recognize that policies generating perverse and broken incentives for both consumers and providers are the source of our system’s current dysfunctions. They are all designed to get those incentives right. In contrast, Obamacare worsens the bad incentives and adds countless new ones.

History professor Walter Russell Mead has documented the erosion of what he calls the “blue social model” that prevailed in this country for 60 years after the New Deal, and how “voters are hungry for practical solutions (and) the party that develops real and sustainable solutions can win their trust and support.”

In the coming months regular Americans will start learning in painful detail all the ways in which Obamacare is the very antithesis of “practical” and “sustainable.”

There is a better way, and as the Iron Lady famously said on another threat to our future, “this is no time to go wobbly” on resisting a law we know will make our people less free, less healthy and less prosperous.