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Obamacare

6 min read

Part of Health and medicine.

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Every episode (4)

Who argued it

Casey Mulligan · Jeffrey Singer · Manny Klausner · Larry Klayman

Immigration Reform · Trump Administration · Tariffs · Medicare · Enumerated Powers · Commerce Clause · Supreme Court · Libertarianism

Background

The law and the 2012 election

In an April 2012 episode, attorney Larry Klayman told Bob Zadek that Obamacare would probably be declared unconstitutional, but that Republicans were not unhappy about its passage because it gave them a political issue in 2012. Klayman said they protested but did nothing really to propose an alternative, and that the American people are left and given short shrift while the two parties enrich themselves Who’s Looking Out for Us? (2012). Zadek framed the discussion around Klayman’s litigation over Justice Elena Kagan’s participation in the deliberations, noting that Klayman had gone into court on the issue.

Klayman said Kagan, as Solicitor General, had advocated Obamacare and did legal analysis about whether it was constitutional, and that Obama chose her to be a Supreme Court Justice because he was packing the court. He said she refused to recuse herself, and that Freedom Watch filed a motion to have her recuse herself or be disqualified. He also said Chief Justice Roberts issued an annual report stating that Supreme Court Justices do not have to follow the rules of ethics of other judges in the federal system, and that those rules may be unconstitutional. In Klayman’s account, Roberts was saying the court is above the law and does not belong to the American people Who’s Looking Out for Us? (2012).

Government’s entry into healthcare

A 2013 episode with Judge Jim Gray presented a historical account of government involvement in medicine. Zadek said that prior to World War II the healthcare delivery system was 100% private, with no Medicare, Medicaid or mandated anything, and that the system worked well; Gray said it was the best healthcare system in the world. Zadek attributed the first government entry to World War II wage and price controls, under which employers could not give raises and instead asked Washington to let them provide free healthcare insurance as a benefit, which the government made tax-free. He described a second leg in the late 1970s, when the federal government required hospitals not to turn away anyone from emergency rooms simply because they could not afford it We Are All Libertarians (2013).

Gray added that Richard Nixon had wage and price controls in the early 1970s and that Lyndon Johnson and Medicare were a major factor. He said that today good quality healthcare at reasonable competitive prices can be found in LASIK eye surgery and cosmetic surgery because the government is not involved, and that emergency rooms have closed because they must accept whomever comes in. Gray proposed that government spend money on doctors, medicines, hospitals and nurses instead of administration, bureaucracy and fraud, with people who cannot take care of themselves going to a government clinic, possibly on private contract similar to Kaiser Permanente We Are All Libertarians (2013). Zadek said Obamacare, the so-called Affordable Care Act, is basically going toward having the Department of Motor Vehicles run healthcare, and that it will die of its own weight.

Doctors and the two-tiered system

A September 2013 episode with Dr. Jeffrey Singer, described as a general surgeon in Phoenix and an adjunct scholar at the Cato Institute, turned to the effect of Obamacare and Medicare on physicians. Zadek said most discussion of Obamacare had focused on patients, and that there had been almost no discussion in the general media of how it affects doctors. Singer said he had been in private practice since 1981 Will Americans Accept Second Class Medicine? (2013).

The episode’s summary states that Medicare’s price controls and complex coding system and the mandates of Obamacare have transformed doctors from independent entrepreneurs into data entry technicians and hospital employees, and that a two-tiered system is emerging in which a cash-based free market is being reborn as a reaction to inefficiencies and rationing in government-run healthcare Will Americans Accept Second Class Medicine? (2013).

Repeal and replace

In a 2017 episode, Zadek told Austin Petersen, an announced candidate in the Republican primary to run against Senator McCaskill in Missouri, that he had always felt Republicans made a profound mistake by adopting the phrase repeal and replace. Drawing on the Articles of Confederation and the Philadelphia convention, Zadek argued that Republicans would do better to say let us fix Obamacare, and that once people got together to fix it the fix would be to repeal and replace it. He predicted it would probably never be repealed or replaced but would be fixed repeatedly, so that in the end it would have been repealed without the label Federalism and the Flat Tax: The Austin Petersen Plan (2017).

Petersen agreed that repeal and replace is problematic from a public relations standpoint and said he tries to avoid it. He said his health insurance had been canceled twice, that a month earlier he was told he could no longer purchase his current plan in the individual marketplace, and that instead of paying $411 a month next year he would probably have to pay $700 a month or more. He cited eye surgery as an example of the free market working: because eye surgery is not covered by most insurance plans, the cost of getting your eyes fixed has come down and the quality has come up, from something like $10,000 or more to about $500 an eye. He said there is no perfect system, that Bernie Sanders had a doctor from Canada on a radio show who admitted the wait to get care can sometimes be up to a year, and that it is time to repeal Obamacare, targeting liberal Republicans rather than conservatives in the Senate Federalism and the Flat Tax: The Austin Petersen Plan (2017).

Across episodes

The topic appears in all four episodes, but the episodes show no single argument developed across them: the 2012 episode treats Obamacare as a judicial and electoral question through Klayman’s recusal litigation, the 2013 episodes treat it as the latest stage of government intervention in medicine through Gray’s history and Singer’s account of physicians, and the 2017 episode treats it as a political slogan through Zadek’s and Petersen’s exchange on repeal and replace.

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