Thursday, March 29, 2012

Obamacare: All Unfunded Mandates are not Created Equal

A followup to this post here:
Again, Republican ≠ Conservative

Back in my days as a resource manager in the defense industry, I got to hear some of the worst excuses ever contrived by people who just did not want to do what they were supposed to do.  One of them was the unfunded mandate objection, as if it were some sort of automatic absolution of responsibility.

This is not to say that unfunded mandates are always proper or fair, not in the slightest.  However, the way that federal bureaucrats use the term stands the concept on its head.

One incident was in the Information Technology field where the Congress had proscribed that the whole government would begin keeping better track of all systems that it had, all of the systems that the Congress funded needed to be tracked.  With that came system certifications and compliance measures, along with the requirement that some human being actually check off the blocks on electronic forms certifying that indeed the systems under their domain were in compliance.  To those of us paying the bills, this sounds perfectly reasonable, yes?

Not to one of the bureaucrats.  The powers that be in her directorate had her designated as the "block checker" for certification of a substantial number of systems. I was the next person in the line to certify her work, which she never did, claiming that it was an "unfunded mandate."  This situation went on for at least two years while I was dealing with that stuff and I heard it continued long after I moved onto another project.

Changing duties and responsibilities within a job one is already being paid for can be called many things, but an unfunded mandate it ain't.  If the load becomes too great you can always move on to better conditions or just quit.

This brings me to the latest federal debacle that had potential to be correctly labeled an unfunded mandate (by those who stretch the term), but somehow has escaped that label: Free-riders in the healthcare system.

The Leftist script has gone in generally the same direction for 100 years, beginning with Progressive Teddy Roosevelt in 1912 proposing a national healthcare system based on the German national model and the proposal was continually rejected until Obamacare came along.  This is not to say that bits and pieces were not adopted, and each of them were accompanied with a new list of demands.

In the years leading to the passage of Obamacare, the Left's complaint was that everybody did not have access to healthcare.  The list of victims were the usual: poor, minorities, women hardest hit.  That complaint did not last long when it was revealed that poor minorities were filling up emergency rooms across the country and quite a few of them were uninsured.

As Leftists are want to do, they morphed that complaint into a different lie: Emergency rooms are forced to treat people without insurance, so we need a law to make everybody buy insurance.  As reasonable as that complaint sounds, and the evidence is not a complete lie, it is only a partial truth, rarely does anybody stop to ask who is forcing hospitals to take uninsured patients?

That answer is, of course, the federal government.  Under the Emergency Medical Treatment & Labor Act (EMTALA) of 1986, all hospitals that participate in Medicare must take all emergency patients regardless of means to pay.  The case for this being an unfunded mandate would revolve around the issue of how Congress moved the goalposts on what hospitals are required to do to get Medicare funds, decades after the program began.  The case against: No federal requirement to take Medicare patients or Medicare money.

Many States, like Tennessee, have State hospitals that are open to anybody who shows up and everybody receives the same care, regardless of means.  From personal experience I can tell you that if you show up in their emergency room, they will indeed care for you.  If you give them insurance information, the bill goes to the insurance company.  If you do not have insurance, the bill goes to your house.  I do not know how they handle a failure to pay, but feel free to research that one on your own.

So, where is the problem?  According to the Leftists there was a crisis caused by people who could not afford healthcare getting free healthcare and the hospitals were unfairly burdened with the costs, or passed those losses onto other patients.  (Whenever you see that last bit in a story, it is a rare acknowledgement that business do pass on costs that fails to get factored into any other business.)

There solution to this 'problem' created by government was more government, more regulation (2,700 pages worth), and of course another tax.  In the name of paying for people who cannot afford to pay, who need free healthcare (you know, the people who already get free healthcare), a national socialist solution was struck whereby all Americans would be required to buy healthcare insurance.  And by all Americans, they mean only those who can afford to pay for it, those who cannot afford to pay are exempt.

Simpler version: some people could not afford to pay their emergency room and other healthcare bills in the past, so everybody else (even those who did not have medical bills, through their Medicare tax) covered those losses.  To solve this problem, a massive bureaucracy was created to make the people who can afford to pay for healthcare cover the bills of those who cannot pay.  Added bonus: All those people who paid for routine medical services in cash are now required to pay an insurance company.

Another added bonus: A mountain of actual unfunded mandates for the States.

The next time someone brings up the issue of "free-riders" in the healthcare market, ask them who created the free-rider system in the first place.  If they respond with anything besides EMTALA, direct them to the nearest internet connection for some self education.

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