End-of-Obamacare fears a good illustration of why government has to grow?

My Facebook friends are expressing literal terror at the prospect of the repeal of Obamacare. Without Obamacare there will apparently be no health care services available at all to some of the richest people on the planet. I think it is kind of interesting for what it reveals about how people think about government and government programs.

Nobody asks “How did Americans survive from 1630(ish) through 1965 when there was no Medicare or Medicaid?” or “How did Americans survive from 1630 through 2013 when there was no Obamacare?”

It is sort of the same thing with the federal Department of Education, created by Jimmy Carter in 1979. The assumption seems to be that U.S. states, most of which have populations larger than countries with successful education systems (see Finland, for example, with 5.5 million people), couldn’t possibly run schools without federal assistance.

Given the paranoid psychology of so many U.S. voters, terrified that a fairly new government program might be discontinued, can we conclude that growth of government is inevitable? We have a mechanism for creating new programs and handouts, but no way to shut down an old one.


  1. Brian

    February 11, 2017 @ 5:05 pm

  2. Lynn Clark

    February 11, 2017 @ 6:03 pm


    Precisely. Almost every person who manages to get elected to Congress thinks their primary responsibility is to “get things done”, which is a euphemism for “pass new laws”.

  3. tekumse

    February 11, 2017 @ 6:48 pm


    The Department of Education has nothing to do with fact that states can’t do but rather with the fact that many refused to do it for all. The Federal role in education is mostly felt through the enforcement and funding behind things like IDEA (for children with disabilities), Title IX (for equal access), Title I (for students in poverty), and a handful of other programs. The Federal role in education has not really ever been about curriculum or how local and state funding mechanisms are structured. It is pyramid scheme Amway baroness that is making it about that.

  4. Jack

    February 11, 2017 @ 7:02 pm


    I think it is just virtue signalling. The affluent did not benefit from Obamacare and if they were self-employed they were far worse off post than ante. As Christopher Caldwell put it, pre-Obamacare we had the best health care system in the world for 85% of the population. In an effort to add and subsidize a few additional percent of the population the private market for health insurance has been destroyed. Though unless you have to go out and buy health insurance, i.e., you are self employed & don’t receive subsidies, you don’t see it yet because your employer deals with the problem.

  5. Neal

    February 11, 2017 @ 7:05 pm


    People survived for thousands of years without vaccines, indoor plumbing and the internet too. That doesn’t mean it would be a good idea to get rid of them.

    >pre-Obamacare we had the best health care system
    >in the world for 85% of the population.


  6. Anonymous

    February 11, 2017 @ 11:26 pm


    How did they survive? They paid their bills directly for many services, particularly outpatient services. The options for expenditure were fewer: much less imaging, much less laboratory services, many fewer options in pharmacology. Chemotherapy didn’t exist. Many services provided routinely now to outpatients were available only in-hospital to inpatients or not at all because they hadn’t been developed yet. Longer hospital stays for convalescent care were common. Admission days prior to surgery were not uncommon. There was little in the way of intensive care of any kind. There was no protocol for resuscitation as is standard today. There were no drugs for emergently treating heart attacks: oxygen, morphine, rest. If you survived, you would hope not to be a cardiac cripple from dead heart muscle and scarring.
    There were no joint replacements, no cataract lens implants or vascular stents or bypass grafts. This isn’t from 100 years ago; it was 1967, when Medicare Part B was created, two years after Part A. U.S. life expectancy was 72 years.

    There were no laws compelling a hospital ER to admit you for examination and stabilization without the means to pay; that didn’t occur until 1986.

    People got insurance at work. They got things like pension plans then also.

  7. CHenry

    February 11, 2017 @ 11:44 pm


    [I neglected to enter my name, above]

    There were no organ transplants or transplant rejection drugs, no PCR or any genetic medicine, no immunomodulating therapies, no biologic drugs. Medicine then would seem completely alien to the average layperson today and hopelessly inadequate to a professional.

    As someone mentioned above, many at the time did without the few things that were available and lived poorer, sicker and shorter lives as a result.

  8. Craig

    February 12, 2017 @ 12:11 am


    I guess everyone believes the role of the Federal Government is to ensure every citizen (and non citizen) is able to get the very best healthcare regardless of the ability to pay. Everyone is a winner. Once that occurs we will all be truly equal. And it shouldn’t take long to achieve that goal – at least not any longer than the Government’s victory in the war on poverty.

  9. jack crossfire

    February 12, 2017 @ 3:41 am


    No way it’s going to be repealed. The courts are going to repeal the repeal if he ever tries it. The courts are going to block everything he does for the next 4 years.

  10. Tom

    February 12, 2017 @ 6:18 am


    “that didn’t occur until 1986”

    Impossible, that would have been during the Reagan regime.

  11. Tom

    February 12, 2017 @ 6:22 am


    Well, now in JJ/Obamacare world, you can at least get thrown in jail for not being able to afford the insurance. I don’t know how you managed to get medical care before that.

  12. George A.

    February 12, 2017 @ 1:03 pm


    Give a man a fish, and he will come back for more, teach a man how to fish and he will net his own fish.

    We need to enforce term limit on our politician and for any government office job holder. As is, our politician pass laws not necessarily aimed for the good of the Nation, but to keep their jobs and status quo, year after year. They even pass laws giving them self lucrative pay raise [1].

    Obamacare, Medicare, Medicaid, Public Schools, the Military, Welfare, and all other government run programs and laws enacted by government would have been VERY different today — and I’m sure much less costly and better managed — if lawmakers had term limits. Those lawmakers, with term limit, would focus more on getting the job done right vs. satisfying their constituents so they get reelected over and over for life.

    Phil’s question is a valid one; because of how politics work, expect to see government to grow to the point where it cannot deliver any more. Fearful citizens will ask for more and more “fish hand out” vs. for “how to fish”.

    [1] http://www.wbur.org/politicker/2017/01/25/mass-house-approves-pay-raise

  13. CHenry

    February 13, 2017 @ 9:09 am


    “Give a man a fish, and he will eat for a day.”
    Teach a man to fish, and he . . . will feign injury and apply for disability.”

  14. the other Donald

    February 13, 2017 @ 12:18 pm


    The single most effective healthcare action is cessation of smoking, which has saved more lives than any pharmaceutical or surgical intervention. Much of the mortality before 1970 or so was caused or accelerated by smoking. We need a pervasive propaganda campaign for improved diet and exercise – a good start would be equal time with the pill advertising on TV. It is tragic to see children sucking on 30 ounce sodas.

  15. wally

    February 13, 2017 @ 2:13 pm


    But @otherDon, while sensible, that conflicts with what seems to be a large part of our plan for growth: the production and maintenance of fat people. If we have trim, fit children, how many future bariatric surgeons/MRI machine makers and operators/oncologists/pharmaceutical reps, etc do we eliminate? Think of the hit to GDP.

  16. Andrew

    February 14, 2017 @ 11:30 pm


    Other Donald: there is no lack of diet and exercise propaganda, but you’re right that it cannot hope to approach the marketing budget of Coca-Cola alone, never mind Frito-Lay, McDonald’s, Anheiser-Busch, Hostess, Olive Garden, etc.

    And legislation is impractical in the current environment; remember the blowback when Bloomberg tried to limit the maximum size of soda containers sold in NYC? Seems so benign in retrospect.

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