Categories:
Economics of Health Care
Politics and Economics
A tempting speculation: The Supreme Court’s vote on Obamacare will have larger effects on policy than the American public’s vote on the presidency. My thinking: If Obama wins, there will be divided government, and if Romney wins, he’ll be too moderate to push for any major change or reversal of policy changes since 2008. Either way, the presidential election won’t matter much. If the Supreme Court invalidates Obamacare, in contrast, a massive government program will go down in flames.
My main doubt about this speculation: If the Court merely overturns the individual mandate, the ultimate policy effects are hard to foresee. New legislation? Repeal? Socialized medicine by stealth?
Your thoughts?
READER COMMENTS
John Roccia
Apr 10 2012 at 12:09pm
I suspect you may be right – but what does that say about the state of our system that a single supreme court decision matters more than the presidential election?
There are a lot of people that claim that the president doesn’t really matter much – that he’s more of a Zaphod than anything else (his true purpose being not to wield power, but to draw attention away from it). While I don’t agree that the President doesn’t matter at all, I certainly believe we’d all be better off if more people paid attention to their local Congressmen and women than they did to the President.
In fact, what do you think would happen if we just didn’t have a President? Leave the rest of the system as is; give veto powers to Governors on a state-by-state basis and appoint a commander-in-chief during wartime. Would we be better off?
Robinson
Apr 10 2012 at 12:11pm
I agree with this so strongly that when I read the title of the blog post, I thought “He’s saying it’s not the SC Obamacare ruling?”
Randy
Apr 10 2012 at 12:57pm
Socialized medicine by stealth, definitely. But then, that’s what Obamacare is too. It was a major step contemplated in a time of economic growth that may have proved to be too big a step in a time of recession. But the economy is likely to improve and the process will then resume. Because a large part of the population wants socialized medicine and they will not be denied. The cost to them will be far greater than they can imagine, but still, they will not be denied.
ColoComment
Apr 10 2012 at 1:01pm
“…if Romney wins, he’ll be too moderate to push for any major change or reversal of policy changes since 2008.”
I would agree except that I believe that Romney in the White House would happily sign just about any legislation pushed by a Tea Party-invigorated and fiscal conservative-dominated Republican House and perhaps a Republican or very close Senate.
Once upon a time, long, long ago, Congress legislated and the President signed or vetoed. The Presidential bully pulpit is a more recent invention.
Chris
Apr 10 2012 at 1:04pm
Nonsense.
GOP Congress would repeal Obamacare via reconciliation. Obama would veto repeal; Romney wouldn’t.
2012 POTUS election matters massively — and that’s before you even consider SCOTUS appointments in the event that Ginsburg/Scalia/etc retires/dies before 2016.
Tom West
Apr 10 2012 at 1:35pm
The cost to them will be far greater than they can imagine, but still, they will not be denied.
Probably, but if Canada is any guide, they’ll end up getting pretty reasonable health care for a *lot* less. They’ll get their “Corolla” healthcare while pining for the days of “Lexus” healthcare that was growing increasingly unaffordable.
(The biggest loss may come from vastly less R&D spending, but people rarely miss things that didn’t happen…)
John Thacker
Apr 10 2012 at 2:01pm
Tom West:
OTOH, if Medicare (and Medicaid) is any guide, it won’t cost a *lot* less. Medicare and Medicare cost as much more than comparable programs in other countries as the other US health programs.
The US system also costs considerably more than other employer-based hybrid systems, which includes not only Singapore but also France and Germany.
It’s possible that somehow an entirely socialized system would somehow save a lot of money, but I think I’m reasonable in expecting a US socialized system to spend like how Medicare does now, and still be far more expensive than in other countries.
Glen Smith
Apr 10 2012 at 2:14pm
If history holds, the Republicrats would just try to re-brand Obamacare as Romneycare if Romney wins. If Obama wins, they’ll just try to sabotage Obamacare unless the SC does that.
Saturos
Apr 10 2012 at 2:53pm
Judging by the pace of the recovery, I’d say the next president matters immensely, if only because of who he might or might not appoint to the FOMC, even by chance. And we will have lower taxes on capital and overall with Romney than with Obama. And we are less likely to get further welfarist expansions of goverment, which are easier to sell under a massive deficit than eg. defense spending. And less likely to see another “stimulus package.”
@ John Roccia: Zaphod rocks! And btw, don’t you sometimes get the nagging feeling that Wikipedia is our version of Deep Thought?
Jeremy N
Apr 10 2012 at 3:58pm
It’s interesting that you don’t think the presidential election matters, but the supreme court decision does when it’s the president who appoints the supreme court. Maybe the decision today matters less than the decision to appoint Kennedy in the 80s/90s, and this election might matter more than you expect in the long run because of the electee’s appointments.
John Roccia
Apr 10 2012 at 4:15pm
@ Saturos: Wikipedia is definitely Deep Thought – ever get the idea that Obama and Romney are the two mice? Republicans are the Vogons, Democrats are the people from “B” Ark… Meanwhile I’m left wanting to go the dolphin route…
Tom West
Apr 10 2012 at 4:29pm
if Canada is any guide
I think I’m reasonable in expecting a US socialized system to spend like how Medicare does now, and still be far more expensive than in other countries.
In other words, Canada *isn’t* any guide. Fair enough.
By the way, why *is* Medicare so much more expensive? Canadian doctors don’t earn that much less, and the difference in Canadian and American hospitals isn’t very large. (They’re close enough that hospitals across the border engage in best-practices studies to learn from each other.)
Does Medicare massively over-prescribe expensive tests? Doesn’t it use ‘death-panels’ to avoid spending fortunes on expensive low-chance end-of-life care? Surely Medicare is big enough that it has decent bargaining power on drugs, etc.
blink
Apr 10 2012 at 6:37pm
For election purposes, which party benefits from a repeal? Does repeal make Obama’s reelection more likely or less likely? Does these possible secondary effects make any difference which one one hopes the Supreme Court rules?
Chris Koresko
Apr 10 2012 at 7:36pm
Tom West: Surely Medicare is big enough that it has decent bargaining power on drugs, etc.
Note that “bargaining power” implies cost shifting, mainly onto other customers of those products, not real cost savings.
Thomas Hutcheson
Apr 10 2012 at 8:57pm
An overturn of the mandate is likely to lead to some minor tweaks to the sign-up process for the exchanges to reduce gaming the system. It will mean faster shift to subsidized private insurance instead of subsidized employer provided insurance.
Daniel Artz
Apr 10 2012 at 9:08pm
Actually, if Medicare and Medicaid are used as guides, then American Healthcare is doomed for the very simple reason that we won’t have any providers. At present, both Medicare and Medicaid reimburse at less than 80% of the cost of service. Any doctor who bills honestly refuses to take on Medicare patients. Those that do take on Medicare patients have to learn the ins and outs of billing for multiple services while avoiding criminal liability for billing fraud. The fact that Medicare and Medicaid account for approximately 40% of the total medical care market, and reimburse at less than 80% of cost, means that good old Uncle Sam accounts for cost-shifting to the tune of about 8% of the total cost of Medical Care, more than 8 times as much cost-shifting as imposed by the uninsured targeted by the Individual Mandate. Given that, I thought that the SG’s Brief in the PPACA litigation was really amusing – the problem of cost-shifting compels the Federal Government to impose the Mandate, but the Federal Government is the single biggest cause of cost-shifting.
Chris Koresko
Apr 11 2012 at 1:02pm
Daniel Artz: I thought that the SG’s Brief in the PPACA litigation was really amusing – the problem of cost-shifting compels the Federal Government to impose the Mandate, but the Federal Government is the single biggest cause of cost-shifting.
If memory serves, I read a journal article half a year ago that argued convincingly that the real purpose of the mandate is to shift costs from the young and healthy to the old and sick. In effect, cost-shifting via the IM is the principal funding mechanism for ObamaCare.
Arthur_500
Apr 11 2012 at 7:43pm
Government will never repeal anything. This boondoggle will be modified a thousand times but we will never get rid of it.
At best (notice I said best not be cause I like it but because it would be the best option) the government legislators would institute a tax and mandate health insurance for all.
Of course the necessary tax would be pretty much equivalent to the average 12% most americans pay for the current income tax rate. Real income taxes would then be 25% instead of the posted 15%. What would happen then is anyone’s guess.
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