Support First Things by turning your adblocker off or by making a  donation. Thanks!

Amid occasional stories of success (a personal friend who had previously been unable to afford health insurance can now afford a subsidized plan in California) the disastrous launch of the Affordable Care Act has revealed itself to be life-upending disaster for millions who are discovering that—thanks to the narrowest, and thus most easily negated of “Grandfathering” provisions —policy holders who liked their insurance cannot keep their insurance. If they like their doctors and hospitals, they cannot keep their doctors and hospitals , either.

Forced from their insurance and seeking new coverage within “Obamacare exchanges,” those trying to replicate the policies they are losing are experiencing sticker shock; their premiums and deductibles have become anything but affordable as new policies force buyers to pay for coverage they neither need, nor want. As Larry Kudlow vented on CNBC recently :

As a 60-something, relatively healthy person, I don’t want lactation and maternity services, abortion services, speech therapy, mammograms, fertility treatments or Viagra. I don’t want it. So why should I have to tear up my existing health-care plan, and then buy a plan with far more expensive premiums and deductibles, and with services I don’t need or want?

It didn’t have to be this way. The Affordable Care Act may have been designed to be a socialized monstrosity of health care displacement and governmental control, but it need not have been. Creating a means whereby people who wanted health insurance could purchase it (and younger people in good health could choose limited, catastrophic coverage, or none at all) needed only two things: a willingness to put common sense over politicization, and a genuine respect for the notion that people understand their individual needs better than anyone else.

Common sense, and respect for the people they have ostensibly been elected to serve, are currently in short supply in our nation’s capital. The Affordable Care Act was passed by one political party while it was in control of two branches of government and feeling disinclined toward discussing (or even acknowledging) design alternatives.

That’s a shame because creatively exploring and expanding upon just a few of these framework ideas might have solved the problems of the uninsured without severely disrupting much of anything:

A) Begin where you are: Why should all roads lead to Washington DC when local communities are best able to identify those in need and to reach out? In 2000, then-Mayor Rudy Giuliani, went to the New York City Council with the simplest of plans: Take a pro-active approach and reach out to the uninsured who are not even aware of what programs already exist , which helped to insure several hundred thousand in New York City alone. Before upending anyone, get the right people enrolled into the appropriate, existing programs.

B) Invite-in can still avoid federal intervention: Healthcare infrastructure is all about managing risk by spreading it. If the most economically efficient plan is the one covering as many people as possible, then why not create extensions that offer the uninsured the opportunity to buy into the very same insurance plans offered to any state’s government employees, which are usually excellent?

C) Open the markets: Perhaps because it is both the simplest and the most commercial of ideas, and the least political, there appears to have been no discussion of allowing insurance to be sold across state lines, which would have immediately broadened the market competition and thereby lowered costs for everyone, across the board. Rather than opening coverage availability, the ACA appears to narrow it. Writing in the Wall Street Journal about her Obamacare-inflicted need to find new doctors and new hospitals for her cancer treatments Edie Littlefield Sundby says:

Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines. It would seem the ACA would have the effect of geographically trapping people, effectively keeping them from pursuing new in-state opportunities and adventures for fear of again losing insurance and having to re-start the research and purchasing process. It is another narrowing, rather than enlarging, effect of Obamacare.

While not pretending to any sort of expertise, this column has just offered three alternatives, common sense ideas meant to solve the initial problem we were told necessitated the ACA: getting affordable coverage to people who needed it, including those with pre-existing conditions—which many group policies do cover. These are only frameworks, of course, and doubtless there are dozens of other ideas that can and should be explored, and quickly.

As this unpopular policy we call Obamacare begins to crumble from the weight of its own incompetent over-reach and mendacity, the opportunity may soon arise for policy reform, but if other voices do not have alternative plans already designed, thought through and set for discussion when an urgent solution is called for, there will be no option left in the political imagination but a single-payer program—managed by these same incompetents—and a nation full of frightened, uninsured people willing to turn to it.

Elizabeth Scalia is the author of Strange Gods: Unmasking the Idols of Everyday Life and the managing editor of the Catholic Portal at, where she blogs as The Anchoress . Her previous “On the Square” articles can be found here .

Become a fan of First Things on Facebook , subscribe to First Things via RSS , and follow First Things on Twitter .

Comments are visible to subscribers only. Log in or subscribe to join the conversation.



Filter Web Exclusive Articles

Related Articles