strong arm

Force Is the Left Hand of Entitlement

By: Jane M. Orient, M.D.

Politicians love to boast of the benefits they shower on favored constituents with their right hand. But as with the amazing feats performed by magicians, the unwary audience is watching the wrong hand.

It may seem that in government the right hand often doesn’t know what the left is doing. However, it is surely obvious that the goodies in the right hand did not materialize out of thin air. They had to be taken from somewhere.

Usually that somewhere is taxes. Even doctors know that. For example, while bemoaning the coming cuts in their pay from Medicaid, some ventured to say out loud, at a medical society meeting, that there is an answer to the problem: we just need to raise taxes.

The very same left-leaning doctors had just finished agreeing that many Medicaid patients come to the doctor only because they are lonely or bored. They add that this is all right with them because they get paid even though the visit was unnecessary.

With healthcare reform (“ObamaCare”) there are some frank tax increases. But even the Democrats in the 2008 Congress probably wouldn’t have passed a recognizable tax increase large enough to fund the enormously expensive bill. Instead, they gave us an insurance mandate. They insisted this wasn’t a tax, although the Obama Administration insists that it is a tax after all—if that’s what it takes to get a court to find it constitutional.

In 2014, assuming this law survives, we’ll have a clever sleight of hand that casts the redistributionist, now-you-see-it-now-you-don’t tax/nontax, as a subsidy. If you, by their criteria, can’t afford the high premiums on the comprehensive policy that is required, you get a subsidy to buy it—a negative tax. Otherwise, you have to pay the full cost yourself. So, is the absence of a subsidy a tax, or the functional equivalent of a tax? Aren’t subsidies and taxes mirror images, like left and right hands?

Say that the court finds that it isn’t a tax, for purposes of invoking the taxing powers of Congress, but is instead a way of regulating interstate commerce, the alternate constitutional justification. Wouldn’t it be unprecedented for Congress to penalize inaction under the Commerce Clause?

One advocate for ObamaCare wrote to the Wall Street Journal that “countless” types of personal inaction violate the law. Most of these, however, are “if…then” situations, contingent on a previous action. “Failure to put out your campfire” assumes that you lit a fire. “Failure to wear clothes when out in public” assumes that you decided to go out; you are not required to wear clothes in the bath. “Failure to file a tax return” assumes that you have taxable income—and that one took a Constitutional amendment. The only thing close to “If you are alive, then you must buy a certain specified type of health insurance” is “If you are a male who has reached the age of 18, then you must register for the draft.” Is the insurance mandate a form of conscription? It forces us all to pay for care that we might not want to buy, or be willing to provide, without third-party payment.

The left-handed logic used by the Administration in court is: “If you are alive, you will get sick or have accidents, and use medical care, and the rest of us might get stuck paying for it.”

Why not an individual responsibility mandate? Rather like a mandate that if you have children, you must feed them. And if you take food from the grocery store, you must pay for it. Why do people get to stick “the rest of us” with their medical bills?

With medical care, we have seemingly accepted the concept of collective responsibility—and entitlement. Under this concept, any person who is sick or injured is entitled to be taken care of. If others do not provide the care voluntarily—that’s called charity—then the government must force someone to pay.

The method might be a straight tax. Or it might be a mandate to force everyone to prepay into a collective pot called insurance. Both require force.

We see the benefits that the politicians and magicians want us to see. What their left hand does is invisible and deceptive. How much it takes, how much it wastes, how much it corrupts, how much it restricts freedom, and how much harm it does—all this has been hidden in smoke and mirrors.

Americans must demand a look behind the curtain.


Jane M. Orient, M.D., is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.

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