Health Care Reform

I always get a funny feeling in my gut whenever a politician starts talking about reforming something; the same funny feeling I get whenever I've eaten food that has sat around too long. The promises are always the same: money will be saved, taxes will be lower, deficits will disappear. We will arrive in the Promised Land! Only it never works out that way. Now the federal government is wrapping its slimy tentacles around a sixth of the economy. Is it possible this won't be the train wreck that Social Security, Medicare, Medicaid, and every other thing the federal government touches has turned out to be? Sure. And there really could be a Tooth Fairy (which has to be the creepiest of the lies we tell our children). But we will run the experiment. Again.

The primary effect will, of course, be a further expansion of the government workforce. The purpose of government is to increase government payrolls. If something else is accomplished in the process, well that's fine. But it isn't the primary purpose. The Iron Law is absolute, and this, or something as bad, was inevitable. Government is a one-way ratchet; always increasing, never decreasing. Even in the worst economy in decades, with state and federal revenues falling, no one is suggesting that maybe, perhaps, the public sector should imitate the private sector and make permanent reductions to the payrolls. The best we get are reductions in already-planned increases or in the most dire circumstances, temporary freezes.

The second effect will be a vast increase in taxes or the annual deficits. Or both. Logic and common sense says you cannot increase spending by $1 trillion a year and not increase taxes or deficits. To say otherwise is to reveal yourself as a moron (in the clinical sense) or a liar. They won't be called taxes, of course. They will be called "fees" or "fines," and, like we have found here in the Live Free or Die state, they will be worse than any straight-up tax could ever be. It begins with the Tanning Bed Tax today. Soon, everything you buy will have a hidden tax buried in the price, just like here in New Hampshire where every penny of the insanely-high corporate and real estate taxes comes out of shoppers' and renters' wallets. To pay for the vast increases in Medicaid, states will have to continue adding fees to every encounter you have with a government agency, voluntary or not. Expect higher vehicle registration fees, drivers license fees, library fees (like the $50/year fee for a library card at our "public" library), pet licenses, marriage licenses, etc., etc., etc. Some states will attempt to fight back, or at least do a lot of posturing. But eventually, they will roll over and piss themselves like the obedient, co-dependents they are, the minute some federal bureaucrat threatens their highway money. All of this falls disproportionately on the poor. Plus ça change....

It will be some time before we know the full impact of this bill. Many of the provisions don't kick in for years with the heaviest ones not taking effect until Obama is either safely into his second term, or on a beach somewhere enjoying his retirement from Messiah-hood. Much will be fleshed out deep in the bowels of some government building by unelected and unaccountable government drones slaving away toward their 20-and-out pension; the amorphous They that rule so much of our lives without us ever knowing about it. And like previous expansions of government, it will happen gradually over a generation with the economic effects masked behind a general lowering of living standards that will be blamed on whatever group is out of favor at the time, and aided by the long-term memory loss that has become a permanent part of American culture.

However, the big question I have has nothing to do with taxes, deficits, capitation, or death panels. It is simply this: where in the Constitution is there a right for me to demand money from you to pay for my medical care? This is no idle question; it is defining. This latest "historic moment" is by no means unique in this respect; the same question can be (and has been) asked of much of what the federal government does. The difference I see in the current instance is that the question isn't being glossed over with some tortured constitutional argument. It is simply being dismissed as more "tea-bagger nonsense" to be smirked at by the bi-coastal intelligentsia. This is new and should be of some concern, but it isn't.

As I have said repeatedly. We are on a road. The end of that road is knowable, and is in fact known. In theory, it isn't too late to begin turning the ship. We won't, of course.