For almost 80 years, the federal government has been in the rights-producing business, especially as regards health care. The elderly, the indigent, low-income children, and veterans have all been brought under the federal umbrella. The people still on the outside looking in are primarily those who refuse to buy insurance or those for whom the economics of insurance cannot account. Insurance is a bet between insured and insurer made amidst uncertainty about when and whether calamity will strike. People with preexisting conditions cannot qualify for insurance for the same reason that a person whose house is burning down cannot get homeowners’ insurance: The calamity is not in doubt.
Rather than provide the uninsurable with separate access to health care—such as veterans enjoy, for instance—Obamacare seeks to fit this square peg into a round hole. People who cannot logically be incorporated into the economics of insurance are nevertheless forced into it. In requiring this, Obamacare behaves in effect much like the AAA or the NIRA. To make these people eligible for insurance, the federal government must manage the intimate details of the health insurance industry, and by extension all of American health care. Dollar for dollar, this has meant a heavier hand than ever envisioned by the New Dealers in the early 1930s.
The real danger of Obamacare is that it combines the micromanagement of the AAA and the NIRA with the rights-based approach of Social Security and Medicare. The former doesn’t work in practice, while the latter is politically unassailable. Thus, Obamacare may turn out to be a policy that does enormous harm to the country but that simply cannot be eliminated.