Over the past year, American elites have spent a vast amount of time discussing proposed reforms in healthcare, arguing about the social and financial costs of producing an apparent social good. In March, Congress approved a law that many observers see as a potential catastrophe, in terms of its devastating effects on our economic future, the growth of national indebtedness, and the long-term impact on the liberty of families and individuals. ObamaCare is a very bad policy indeed, so atrocious that the obvious question arises as to why any reasonable person would have supported it. Of course, we should never underestimate the power of human stupidity, but a larger and subtler agenda is at work here. Healthcare reform actually offers an excellent case study of a principle that is all too familiar to students of crime and justice: It is designed to fail.
The concept of “designed to fail” was formulated back in 1979 in an influential study by leftist scholar Jeffrey Reiman entitled The Rich Get Richer and the Poor Get Prison. Following Marxist theory, Reiman argued that the goal of the criminal-justice system was not to suppress crime but to promote and sustain acceptable levels of social misbehavior, with the aim of enhancing the power and resources of official agencies. Crime, in short, is useful, even essential, for the preservation of state power. Reiman was not postulating a conspiracy theory but exploring the dynamics of agencies charged with tasks that were literally impossible. Yet rather than being discredited or disheartened by their failures, agencies stood to benefit mightily from them and actively sought out still more absurdly quixotic challenges. They were in a no-lose situation.
Take, for instance, the drug war that has staggered on for some 40 years now. Nobody seriously believes that even the harshest criminal-justice response will eliminate illicit drug use, as opposed to merely relocating the most obvious centers of trafficking and use. Hence, the statistics used to measure the Drug Problem remain stubbornly high, forcing ever-larger infusions of public funds and ever-harsher penalties. The beneficiaries are state and federal policing agencies, the prison bureaucracies, and aggressive prosecutors and legislators intent on reducing the civil liberties and property rights of the mainstream noncriminal population. If, by chance, one particular demon drug ever does fade in popularity, justice agencies scramble almost comically to identify some new chemical that can be identified as “the next crack cocaine,” which will in its turn prove an insuperable social menace. And those new funds and powers keep pouring in.
ObamaCare has failure built in at multiple points. From its first years of implementation, it places restrictions and demands on private insurance companies that simply cannot be accommodated if those firms are to survive as profit-making enterprises. In case you didn’t notice, all the actuarial assumptions that have kept the insurance system afloat for some 300 years just got repealed. Most glaringly, insurance depends on maintaining a balance between those who pay for the system without using it and those who actually make claims. That rule no longer applies. Remember all those uninsured people who are required to buy health insurance? The experience of Massachusetts’ comparable law shows that most won’t obey this requirement unless and until they face some horrendously costly procedure.
In response, private insurance firms will be forced to jack up premiums across the board, which may or may not stave off bankruptcy. Within a few years, the private insurance system will have reached such a desperate condition that politicians and the media will declare a national crisis. Facing the total failure of the healthcare system, the federal government will be forced to introduce a single-payer national healthcare system on European lines. As some hack will undoubtedly proclaim, nobody could have foreseen this back in the naive innocence of 2010, but unfortunately, government has to step in to make up for the failures of private enterprise.
Once that system is in place, the dreadful experience of Britain’s national healthcare system demonstrates what awaits us. Hospitals and medical services will be overwhelmed but will have inadequate resources, leading to grim, unsanitary conditions and severe rationing of services, punctuated by sporadic scandals.
Political debate will then focus on the endless demands of the system for new resources and new taxes to pay for them, which can never be sufficient to reverse the cycle of decline. What resources do become available will fund the vast new bureaucracies of the medical-political complex. The more egregiously the system fails, the louder the left demands more intervention and more public funding, and an ever-larger state mechanism. Failure is a terrible thing to waste.