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The Onion’s Critique of the Affordable Care Act

It probably needs no introduction; The Onion is a satirical news site that dubs itself “America’s Finest News Source.” Honestly, I’m beginning to believe them.

Often, The Onion’s writers will mask in irreverence an intelligent critique of a prominent issue in America. Their most recent victim was the Affordable Care Act (ACA). The author writes:

As debate continues in Washington over the funding of President Obama’s health care initiative, sources confirmed Thursday that 39-year-old Daniel Seaver, a man who understands a total of 8 percent of the Affordable Care Act, offered a vehement defense of the legislation to 41-year-old Alex Crawford, who understands 5 percent of it.

Jimmy Kimmel reported similar findings when he asked Americans whether they preferred Obamacare or the Affordable Care Act. Apparently, the ACA is far superior.

I must give a disclaimer: my own knowledge of the legislation is most likely only in the teens, percentage-wise. In fact, I doubt that many members of Congress who have been passionately supporting or opposing the Act have a commanding grasp of its specific details. But that’s the point. We should give them, and ourselves—well, maybe not the individuals interviewed by Kimmel—a break; 906 pages of information is a lot to memorize.

Just like the tax code, it looks like health care law is getting more and more complicated. And in the same way that we have to hire someone to do our taxes for us every spring, we now may need to hire someone to help us get health insurance too.

And the consumers aren’t the only people struggling. Since the online exchanges opened up last week, there have been countless glitches and issues with the system. Technical logjams have been customary as a result of insufficient bandwidth, which isn’t all that surprising. Other than 15 states that have opened up their own exchanges, everyone in America who wants healthcare is being directed through a single site: healthcare.gov.

So, is the problem just that Americans are uninformed? I don’t think so. Confusion about the system is widespread. Then, is complexity always bad? Is it wrong to do things on a large scale? Not necessarily.  But it should be avoided whenever possible, because it isn’t the most effective or efficient way of doing things.

Instead, we should revisit several ideas: the classic American doctrine of federalism, the Catholic idea of subsidiarity, and the libertarian theory of spontaneous order.

Although federalism has been slowly on the decline since America’s founding, it was one of the quintessential ideas that made America extraordinary at its beginning. Like the theory of subsidiarity, the idea is that problems can be better solved in smaller communities by the people that are most directly affected. Politically, this means that state and local government take the lead when it comes to passing and implementing laws.

[pullquote]     Is it too much to ask for a health care system that I can understand?[/pullquote]

This makes sense, doesn’t it? People in Mississippi, for example, have incredibly different needs and preferences than people in New Hampshire—the poverty rates for these states are about 20 percent and 5.5 percent respectively. So why shouldn’t problem-solving be localized and carried out by people with intimate knowledge of their communities. That way, a program can be carefully and creatively designed to serve the people that it will actually be serving. In this case, it would be logical for Mississippi to have a more extensive government-backed safety net than New Hampshire.

I won’t definitively support or oppose the former presidential candidate’s initiative, but this is what differentiates the state-run health insurance program that Mitt Romney passed in Massachusetts from President Obama’s Affordable Care Act. A program that serves 6.65 million people is significantly easier to implement and manage than one that aims to serve up to 314 million.

With that many people, all coming from very different cultures and backgrounds, central planning is incredibly difficult, which is why Austrian economists offered an alternative solution—spontaneous order. Lawrence Reed of the Foundation for Economic Education describes it this way:

Spontaneous order is what happens when you leave people alone—when entrepreneurs…see the desires of people…and then provide for them. They respond to market signals, to prices. Prices tell them what’s needed and how urgently and where. And it’s infinitely better and more productive than relying on a handful of elites in some distant bureaucracy.

By no means is the free market system flawless. Some government involvement in the system is necessary—to ensure fairness and create a safety-net for the vulnerable who can’t afford health care. But overall, a free system will be simpler, will make more sense and will work far better than one that is taken over by the government.

Certainly our health care system needs reform, and universal health insurance should be the goal, but is the ACA the best way to do it? It would be refreshing to see a legitimate free-market based alternative (possibly according to these guidelines), but at the very least, The Onion has something right. Is it too much to ask for a health care system that I can understand?