The fourth annual enrollment season for ObamaCare begins tomorrow. Officials expect few to sign up, leaving The Affordable Healthcare Act ailing. The deeper problem is that neither political party understands free markets.
On November 1, consumers in many counties will see higher premiums and fewer insurers. Aetna, Humana and UnitedHealth have curtailed their participation in the exchanges, as have many of the nonprofit insurance cooperatives, created with federal money, have shut down. The Affordable Care Act is in a bit of trouble.
The problem is too few healthy young adults are signing up and too many “high-cost enrollees”—older, ailing, and/or poor people—are. The insurance exchanges have enrolled more than 80 percent of the potential exchange population with incomes below 150 percent of the federal poverty level. But they have enrolled only 17 percent of potential customers with incomes from three to four times the poverty level.
This is unsustainable. Federal officials have a solution—sign up more young adults. That’s unlikely to happen. The offerings are still too expensive for them. Nor does it get at the root of the problem, which is neither party properly understands free markets.
John Fletcher Moulton did. In a 1924 essay in The Atlantic Monthly, he pictured society as a sphere. Inside “are three great domains of Human Action.” On one side is “the domain of Positive Law where our actions are prescribed by laws binding upon us which must be obeyed.” The other side is “the domain of Free Choice which includes all those actions as to which we claim and enjoy complete freedom.” In the middle, between these two, “is the domain of Obedience to the Unenforceable.”
This is where people act in good conscience, doing what they ought to. Think of a healthy marriage. Kathy and I have been married for 35 years. We have been faithful to one another. No law could have compelled that. And while we have always been free to be ourselves, our freedom has yielded obedience to what is ultimately unenforceable.
This is what makes a nation flourish. Moulton called it “the real greatness of a nation… measured by the extent of this land of Obedience to the Unenforceable.” The larger the middle domain, the greater the nation. And therein lies the root of the problem.
The domain of Obedience to the Unenforceable is always under attack. Free Choice and Positive Law invariably seek to enlarge their domains. Moulton called these domains “encroachments on the middle land.” This is why The Affordable Healthcare Act is ailing. The Republican Party seeks to expand the region of Free Choice. It is calling for reducing federal regulation so that insurance would cost less. Republicans see free markets as rooted in Free Choice. This appeals to self-interest, shrinking the middle.
The Democrat Party seeks to expand the region of Positive Law, also shrinking the middle land. It is calling for more government. This includes the public option and a single-payer arrangement, which could take the form of Medicare for all. Democrats typically see free markets as rooted in Positive Law. However, this will ultimately prove to be coercive. Law, by its very nature, is coercive.
I believe in free markets. But healthy freedom occurs when a nation does what it ought to. Democrats get high marks for caring about the vulnerable, those unable to afford health insurance. Coercion is not the solution, however. Republicans get high marks for better understanding market dynamics. But self-interest is not the solution.
The remedy is rebinding our nation to act as it ought to. Rebinding comes from the Latin religio, our word religion. Doing what we ought to do—expanding the domain of Obedience to the Unenforceable—requires religion. Jesus did offer freedom—“if the Son sets you free, you shall be free indeed” (John 8:36)—but not a self-interested sort of liberty, nor a coercive one. The Apostle Paul defined it well. Christians have not been set free so that we can “indulge the flesh.” We’re set free is to “serve one another humbly in love” (Gal. 5:13). Flourishing freedom yields flourishing free markets.
Even Bill Clinton describes the current configuration of ObamaCare—trying to get hard-working young people to underwrite older folks—as the craziest thing in the world. The solution is people of good conscience coming together to establish a healthcare system that expands the domain of Obedience to the Unenforceable. This where free markets flourish, making a nation truly great.