Obamacare's War With Reality

According to lobbyist Karen Ignagni, the CEO of America's Health Insurance Plans, Obamacare's 1,990 pages can be boiled down to a three-fold promise:

1. Cover Everybody

2. Reduce Costs

3. Keep Quality

That is as succinct a summary as I've heard, and I believe it is an accurate representation of the Change that was Hoped for with the legislation.

Let's leave aside the question of whether Obamacare's central tenet (#1 above) is permissible under the U.S. Constitution. Twenty-six states are challenging the "individual mandate", and the question will eventually be decided by the Supreme Court.

Since wishes aren't fishes, let's measure Obamacare against the realities of human endeavor. Simple geometry demonstrates that it takes two points to create a line and three to define a plane. This is the founding principle of a tripod, which is always steady, simultaneously explaining why there's no such thing as a two-legged stool and why four-legged chairs so often wobble.

It is also the analog behind the universal concept known as the Project Triangle: cost, quality and time. For anything you want in this world, you can only get two of the three: cheap, good or fast. If you prefer fast and cheap, it won't be very good. If you want it good and fast, it'll cost you an arm and a leg. If you want it to be good and cheap, take a seat and read a book, because you won't get it very fast.

Obamacare makes quality a "given"; its steadiest leg. Nobody wants bad medical care. Nobody says "I want the fourth best doctor in town to do my child's appendectomy". But Obamacare as promised has a phantom leg. That "cover everybody" leg is actually a cost component. This renders the scheme a two-legged stool that will collapse because it ignores time. Conflating quality and time can yield only one possible result in this universe: high cost.

Blurring cost with quality is understandable in health care: a pregnant woman can't wait longer than 9 months. When your leg is broken, you can't wait to get it set. If you have cancer, there is a limited amount of time for diagnosis and treatment. People need care when they need it, or their health will suffer. Delayed care is low-quality care.

This explains the budgeting tricks then-Speaker Pelosi played with CBO: "Give me a cost analysis on six years of care with ten years of taxes." Another way she could have specified the CBO score: "Give me a cost analysis, then cut it by 40%."

The reality in every country where socialized medicine has been tried is that costs skyrocket. Then when governments cut costs, care is delayed because there are only so many people trained to provide quality care, and less students in medical schools because doctor pay is declining. Then when patients on waiting lists start dying—this really happens—the governments begin to abandon their schemes and introduce free-market concepts.

I would suggest acknowledging reality and removing current government obstacles to quality care: in-state-only insurance, sky-high medical malpractice awards, employee-only tax deductions and all similar government "regulations" that empower bureaucrats but punish doctors and patients. While quality is essential and costs are consequential, it is the stubbornly sequential time that will always be our enemy here on earth.