The Affordable Care Act (“Obamacare”) quite possibly did more good than harm, and it was enacted with good intentions, but it hasn’t caused health insurance premiums to decline. Instead, they’re going up far faster than inflation. This probably isn’t surprising anyone: the Satanic Trinity (healthcare, housing, and tuition expenses) have been an exponentially-growing choke pear in middle-class orifices for decades. However, it wasn’t supposed to happen.

It’s time to point out a failure: the individual mandate, or the requirement that everyone purchase health insurance. I predicted that it would fail. The problem with health insurance isn’t just one thing– a litigious society, lobbying and corruption and corporate greed, poor coverage, an artificially low supply of doctors due to AMA chicanery, overspending by drug companies and (increasingly) hospitals on marketing– but an “all of the above” problem. Shit’s complicated, and a legal requirement that people buy a shitty product doesn’t, all else being equal, make the product less shitty. It makes it more shitty and far more expensive. Add a $1,000 per year penalty for being uninsured and, guess what, health insurance premiums are going to increase by $1,000. This is what happens in practice, even though the theory says otherwise. According to theory, individual mandates bring premiums down by removing adverse selection from the insurance pool. Without an individual mandate, the young and healthy opt out (especially with the ridiculous premiums that exist now) and the sick buy insurance. This makes premiums high. The goal of an individual mandate is to make the insurance pool national and, because healthy people expected to have low health costs are now included, reduce the overall premium.

Despite the high premiums, health insurers offer shitty products. The “cover everything” plans are gone, and people who get seriously sick are going to be paying a large percentage of the costs out of pocket. Why does this exist? The truth about our medical system is that it has a strong similarity to American and European witch hunts in the 15th to 18th centuries. The primary motivation for witch hunting was economics: if a person (usually an elderly woman) was judged to be a witch, the property was forfeit and disbursed between the clergy and the successful prosecutor. Who tended to have considerable stored wealth without the strength or power to defend it? Old people, often women, who lived alone. So who were the favored targets of witch hunters? That same set of people. Witch hunting no longer exists, but that economic source (middle-class retirees who’ve amassed nest eggs in the hundreds of thousands of dollars) remains and there are plenty who wish to get at it. The least respectable elder-poachers are the telemarketers and matchstick men who prey on the lonely; more respectable, but targeted toward the same end, is our “healthcare-industrial complex”: the hospitals, insurance bureaucrats, and lobbyists who use “medical billing” as an excuse to get at that last $250,000 from a person who (often being at death’s door) is completely unable to defend it (and before the children are aware that it exists and that their inheritance is being swiped).

The concept of an individual mandate is telling, though. It shows that many young people choose not to buy health insurance. And why? It’s not just that it’s a shitty product, but indicative of something else. Medical bankruptcies have become a “yeah, that happens” phenomenon, but this is indicative of something more severe that has happened in the past 20 years: we’ve de-moralized personal finance. By this, I mean that it’s no longer embarrassing to be in debt, and that it’s no longer viewed as shameful or unethical when people take on debt that they can’t possibly repay, or take on debt and have no intent on paying it back. I actually see this as a severe long-term threat to the fabric of society. Don’t get me wrong: I’m glad that there are forgiving bankruptcy laws in order to give second (and third) chances to people who fuck up… and business bankruptcy is a different affair altogether, since good-faith business failure is fairly common. What I find disturbing is that the system has become so unfair and capricious– people start out with large “student” debts because of the protection racket run by organizations that have given themselves airtight access to the middle-class job market, and can end up with unpayable medical bills for the “crime” of having bodies in which cells occasionally divide the wrong way– that a large number of people under 35 no longer see financial failure as a failure to keep their word, but as mere bad luck. That’s not because there is anything wrong with them as people- there isn’t– but because it accurately reflect the world that previous generations have left for them. The Boomers have created such an anti-meritocracy that this sort of de-moralization of personal finance, as brutal as its effects on the economy (see: 2008) may be, makes sense.

There actually is one way to solve the adverse-selection problem in the health insurance pool, and a host of other issues as well. The right way to impose an individual mandate is to (a) tax people and (b) give them “free” healthcare that is paid-for by taxes. I prefer the single-payer strategy, but a public-option that competes these shit-house private insurers into oblivion would also work. It may have the strictly rhetorical weakness of being equated to “socialism”, but it has what, at least, deserves to be an advantage in debate: it would actually work.