HHS did finally if "conditionally" approve the exchange blueprints of six states this week, though it has yet to release any formal objective standards for conditional approval. Some 24 states are refusing to participate, so the agency will be running a federal fallback exchange that it won't reveal how it will operate.
A federal exchange is a vast undertaking. The clearinghouses will be open to the uninsured but also to small businesses and people who already buy plans on the individual market. On average about a quarter of a state's population are expected to at least browse the exchange options, and the share will be far higher in states with large numbers of uninsured people under 65, like New Mexico (24%), Georgia (22%) and Texas (27%).
If 20% of Americans use exchanges, that's 62 million people. At a House Energy and Commerce hearing on Thursday, ObamaCare point man Gary Cohen all but took the Fifth on how he'll deal with this and other challenges.....
The last entitlement to get off the ground was President Bush's Medicare prescription drug benefit. Those rules were tied up with a bow by January 2005, giving business and government nearly a year to prepare—and that was far simpler than re-engineering 17% of the economy. No one knows where the current magical mystery tour is headed, especially not HHS.
Look, as the young folks say, let me put you some knowledge. Economics from Adam Smith to Hayek teaches that markets function through innumerable decisions by individuals based on their own subjective estimates of the value of things they want in an environment defined by scarcity. Those decisions end up allocating resources through the "invisible hand" of the marketplace, which is an organic process. The word organic is key... you can't impose a market, and you can't impose order on a marketplace, it arises from individuals' decisions over time... in other words, it grows. No single intelligence, no government "plan" can recreate that order, because it's simply too complex, just as life is too complex. We're not God.
The hubris of the Obama Administration in thinking that it could remake 17% of the American economy from the top down is astonishing. To provide some proportion: the American healthcare sector represents a GDP that is only slighly smaller than France's, but slightly larger than Brazil's or the United Kingdom's, and substantially larger than the economies of Russia, India or Canada. It would be the sixth largest national economy in the world by itself! And we are deciding to remake it on the fly using the extraordinarily inefficient mechanism of rulemaking in the federal government's biggest and most f***ed up bureaucracy, the Health and Human Services Department.
I'm scared. How about you?