It takes the worst parts of the ACA and…makes them worse. Many moons ago, some asshole with a blog told you that, based on the experience of Romneycare, the part that would be bad–because it was politically fraught because it would make healthcare unaffordable–was making people who really couldn’t afford it pay significant healthcare premiums, and then pay additional co-pays and deductibles. So Pete Buttigieg has decided to double down on that aspect of the ACA (‘Obamacare’; boldface mine):
It [Buttigieg’s healthcare plan] tells us clearly that uninsured people who show up to health care establishments will be cared for and that the government will pay for it. Then it tells us uninsured people will be retroactively enrolled.
But does this mean only people who went to the doctor that year will be retroactively enrolled? In that case, it would never make sense for anyone to buy insurance because they could always wait and see if they need it and then get retroactively enrolled.
Or does it mean all uninsured people will be retroactively enrolled, in which case this is just a sly way of saying Buttigieg’s proposal is a supercharged version of the wildly unpopular Obamacare individual mandate?
Jeff Stein at the Washington Post got to the bottom of this question in December and reported that it is the latter: the Obamacare mandate on steroids. Under Buttigieg’s plan, rather than paying a $695 fine at the end of the year if you are uninsured (as in the now-repealed Obamacare mandate), you could pay a fine as high as $7,000. This sort of lump sum shock is going to wreck most of the households hit with it and be even more of a political disaster than the much more modest Obamacare fine, which was itself a bit of a political disaster.
People who forgo purchasing healthcare typically can’t afford a fine in the thousands of dollars. I probably shouldn’t have used double down, but more like ‘order of magnitude down.’ But Buttigieg’s plan gets worse:
In the first part of Buttigieg’s plan, he says he is going to automatically enroll the millions of uninsured people with incomes low enough to already be eligible for free insurance:
Over half of people with no insurance are eligible for either free insurance or an affordable insurance option. Anyone eligible for free coverage in Medicaid or the public option will be automatically enrolled, and those eligible for subsidized coverage will have a simple enrollment option.
Upon reading this, you should wonder to yourself: how on earth is the bureaucracy going to be able to automatically determine, in real time, who the low income people are that are eligible for free insurance?
…Nobody has any idea how you could possibly identify people in real time who slip into eligibility but never go to the welfare office to fill out the forms. This is because it is not possible. Income information is not reported in real time. Household changes are not reported in real time. For as much as the left gets dinged for its belief that the bureaucracy can accomplish great things, it is really highly-targeted centrist plans that reveal the most insane levels of optimism in the capabilities of the bureaucracy.
This is, in a nutshell, what is wrong with “technocracy” as it has come to be known in the discourse. What masquerades as technical competence and a light touch is, more often than not, really science fantasy delusions about what a state can actually successfully administer.
An impossible to accurately administer plan that hits people with thousands of dollars of expenses they can’t afford. What could possibly go wrong?