TCS Daily

ObamaCare: It's Not About Money

By Barry A. Liebling - July 24, 2009 12:00 AM

People have always quarreled about money, and sometimes these conflicts conceal a deep animosity.

President Obama has made Health Care Reform a priority for his first year in office. His website promises that his program will "Reduce costs, guarantee choice, including a public option, and ensure quality care for all." The big claim is that the President's Health Care Reform will be a vast improvement compared to the present system.

Supporters of the President's initiative point out that health care spending is enormous, that the price of health insurance for businesses and individuals is increasing and becoming unaffordable, and that the consequences of failing to bring down costs is dire. They argue that only the government can make things right.

But critics of the President's plan are warning that it will bring about both lower quality health care and will have a more expensive price tag. Free market advocates point out that government health care programs - such as Medicare - not only do not save money but also have ballooning costs that exceed their original forecasts.

It does not help the case for the Obama plan that the Congressional Budget Office has estimated that the proposed program will increase health care spending in the United States - exactly the opposite of what its supporters claim it is intended to do.

Of course, ObamaCare enthusiasts say that the Congressional Budget Office is mistaken, and even if spending goes up for a few years, costs will be reduced in the long run under wise government guidance.

So we have two factions slugging it out. The Obama team, representing the statist approach, insists that its plan will economically make the nation healthier. Free market advocates, the principled opposition to increased government intrusion, are convinced that Obama's Health Care Reform will be extravagant and ineffective.

You might imagine that the way to resolve the conflict between the partisans is to find a fair way to forecast what health care spending would be with and without ObamaCare. But that would miss the point, because the dispute is not really about cost: it is about who will control health care. Statists yearn for a system where the government is in charge, while free marketers want individuals to make their own decisions. Both sides are focusing on health care spending because they know that cost is always important, and saying you are thrifty while your opponent is wasteful makes for a good talking point. But in their attempt to be persuasive the antagonists are deliberately sidestepping the core issue.

Consider the typical attitude of the ObamaCare advocate: he believes that people often make foolish choices and health care is an area where they need to be 'nudged' to make wise decisions. Of course, the assistance should come from experts who are empowered by the government to 'assure the right choice is made.' He understands that when the government becomes the major player in health care it has the power to control costs - by rationing services, if necessary. And rationing does not bother him because he feels that a lot of health care expenditures are currently wasted and there is a need for a more sensible way--other than the unbridled choices of individuals--to decide who gets treated and how.

If the ObamaCare enthusiast believed that total spending on health care would go down if the government refrained from fiddling he would not be impressed. A health care system that is allowed to go its own way, that relies on markets, that is not centrally planned is odious to him. It is worthwhile to spend more money on health care if the result is a system managed by progressives who are looking out for 'the interests of society as a whole.'

And what is in the mind of the free marketer? He knows that each person owns his life and has a natural right to manage it for himself. He understands that the proper role of government is to protect natural rights - not to direct the lives of individuals. He appreciates that people have the capacity to make intelligent choices, and that when some people act imprudently, it is not a justification for a government takeover. He knows that when government extricates itself from meddling in the health care system the result will be more innovation, better services, and less expensive costs. But it is the importance of freedom, not saving money, that is the essential reason to proscribe government interference.

If the free marketer believed that additional government intervention in health care would result in reduced spending he would not be impressed. A health care system---and a human life---that is managed by a central authority is unacceptable. It is worthwhile to spend more money on health care if the result is a citizenry that is self-reliant and not subjugated to the will of the government.

People have always quarreled about money, but the ObamaCare debate is about much more.

Barry A. Liebling, PhD is the president of Liebling Associates Corporation in New York, a management consulting firm specializing in marketing, marketing research, and organizational analysis. His monthly column appears at

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