John Hood: Say no to implementing Obamacare
RALEIGH — Politicians have been debating health care virtually nonstop since the early 1990s. If you’re tired of hearing about it, I have some bad news about the new year. Health care is going to be a key political issue in 2013.
At the federal level, the budget debate will inevitably center on health care, the fastest-growing category of federal spending. And here in North Carolina, among the first decisions that new Gov. Pat McCrory and the General Assembly will have to make is whether to assist the Obama administration in implementing its costly and unpopular health care legislation.
I expect that state leaders will say no. I expect them to say no to a state-run health insurance exchange for two reasons. First, regardless of the apparent structure of the exchange, all the important policy decisions will be made in Washington, not Raleigh. Second, a federally run exchange has practical and legal problems that, once manifested, will give Republicans and moderate Democrats the leverage they need to rescind or rewrite Obamacare’s most-egregious provisions.
I also expect North Carolina policymakers to say no to expanding Medicaid, which is the single-biggest part of Obamacare in scope and cost. Even in its current form, Medicaid has become a fiscal black hole for state government. Expanding the program would be the ultimate triumph of hope over experience.
Despite more than two decades of intense discussion about health care, there still remains a wide gap in perception of the nature, causes, and potential solutions of problems such as medical inflation and inadequate access. Both sides hold on to much-cherished “facts” that are really highly debatable propositions, or even clearly demonstrable falsehoods.
Many liberals, for example, cling to the notion that American health care, despite consuming vastly more resources than European or Asian countries expend on health care, has worse outcomes. The first part of that proposition, relatively high U.S. spending, is true but exaggerated. Cost is denominated in more than dollars. While Americans pay more to receive more timely service from hospitals or doctors, in other countries the dollar costs are lower but other costs – the time and suffering associated with longer waiting periods – are higher.
The second assertion, that the outcomes of the U.S. health care system are substandard, is simply false. It is true that the average European or Asian lives longer than the average American, but this isn’t due to differences in health care policy. One international report estimated America’s average life expectancy at 75.3 years, ranking us 19th out of 29 countries. But when the data were adjusted for the rate of fatal injuries, such as car crashes and homicides, American life expectancy was 76.9 years – the longest in the developed world.
We obviously have a long way to go to achieve a consensus about what’s really going on in health care, much less what to do about it. Obamacare won’t be the final answer. Investing significant time and money to implement it would be foolish and counterproductive.
John Hood is president of the John Locke Foundation and author of “Our Best Foot Forward,” a book on North Carolina’s economy. It is available at JohnLockeStore.com. Representations of fact and opinions are solely those of the author.