Last Monday’s item argued that the crabbed, seemingly arbitrary, targeted form of redistribution inherent in Obamacare’s structure–basically punishing those Americans who make more than 4 times the poverty rate and are unlucky enough to be in the individual insurance market–was peculiarly unappealing. But it’s really not as bad as all that. Politically, it’s worse.
It would be one thing, after all, to tax everyone who made more than 400% of poverty and use the money to finance health care for the poor. It’s another to say that in any particular situation where the government has to charge for a service it can almost reflexively charge those who make over “400%FPL” more than other citizens. The first is standard broad-based redistribution (whatever you think of it). The second is a sort of branding, in which better-off people–and 400% of poverty, $62,040 for a couple, is not that better off–are presumed fair targets for adverse discrimination on any given occasion.
The ultimate extension of this principle is a sort of reversed image of the world Eddie Murphy memorably sketched on Saturday Night Live, in which white people don’t have to pay for newspapers or food etc. the way anyone else does. In this reverse-Murphy world, the affluent pay more for everything. Every individual good is means-tested.** They pay more for health care–why not also for auto licenses and parking violations and pet tags and meals and newspapers? They aren’t taxed–if they stay home and count their money, they’re safe. They’re just punished for their income classification every time they venture out into the community. Redistribution gets turned into a pervasive, day to day form of social inequality and disrespect–an effect multiplied by the apparent assumption by Democrats that the semi-affluent don’t really have a right to bitch about it. They’re supposed to be unseen and unheard–almost non-citizens.
If you want to produce a political rebellion, this seems like a good recipe: social inequality that disses the top 50% of society, including the heart of the middle class. There’s a reason Bill Clinton didn’t think of this.
**–Means-testing is easier when everyone, even the affluent, is at least getting a bit of a good deal, which may be one reason why the current relatively modest means-testing of Medicare has gone down so easily. Also, Medicare (unlike Obamacare’s individual health insurance market) is a broad program that includes all Americans over 65–which makes even a radical means-test would be more like a general tax increase than Obamacare’s discrete discriminatory nickel-and-diming. It would be different, more Obamaesque, if richer people were instead charged more only when they needed an X-ray or culture.
How much would it have cost to structure Obamacare so that even all those over 400% of poverty were (as with Medicare) getting at least a bit of a good deal on the exchanges?