Overview
Across the episodes of The Bob Zadek Show that touch on the Affordable Care Act, the law is discussed less as a set of statutory provisions than as an emblem of government involvement in healthcare, of congressional delegation to regulators, and of third-party payment. Bob Zadek calls it “the so-called Affordable Care Act” and says it is “basically going toward having the Department of Motor Vehicles run our healthcare as well as the rest of our lives,” adding that it “flat out doesn’t work” We Are All Libertarians (2013). In the same episode he predicts that “Obamacare is going to, in my view, die of its own weight.” The law recurs in later episodes as a live political question, a regulatory scheme, and a constitutional case.
Origins of federal involvement
In the April 2013 episode, Bob Zadek offers a history of how the federal government entered healthcare, which he presents as the background to the ACA. He says that prior to World War II the healthcare delivery system was “100% private,” with no Medicare, Medicaid, or mandates, and that the system worked well. Judge Jim Gray agrees, saying, “We had the best healthcare system in the world” We Are All Libertarians (2013). Zadek attributes the first opening to World War II wage and price controls, which barred employers from giving raises; employers then asked Washington to let them provide free health insurance as a benefit, and the government made it tax-free. He calls the resulting system one in which healthcare depends on where you work. The second leg, in his account, came in the late 1970s, when the federal government required hospitals not to turn away emergency-room patients who could not afford care. Gray adds Richard Nixon’s early-1970s wage and price controls and Lyndon Johnson and Medicare to the sequence. Gray also says that LASIK eye surgery and cosmetic surgery are the two areas where good quality care is available at reasonable competitive prices because the government is not involved.
Delegation and the REINS Act
The January 2017 episode with Sam Batkins approaches the ACA through the administrative state. Batkins explains that a regulator is generally someone in an independent regulatory agency or a cabinet agency who exercises power delegated by Congress, and he cites the Affordable Care Act as an example: the law contained thousands of delegations phrased as what “the Secretary should” or “the Secretary may” do, giving regulators authority to interpret and carry out their own will through regulation A Lame Duck’s Last Stand (2017). Bob Zadek frames the issue as legislators declining to do what they were elected to do and instead giving power to people voters have never met, calling the whole area of delegation questionable because the Constitution gave specific power to specific bodies. Batkins says Congress is starting to realize how much power it has delegated and has introduced the REINS Act, which he identifies as standing for Regulations from the Executive in Need of Scrutiny; under it, any major regulation costing $100 million or more would have to go through Congress first. Zadek interjects that this includes every one, and Batkins agrees, adding that Congress delegated the power initially, sometimes 30 or 40 years ago, but can now review a regulation before it has the effect of law.
Fiscal and political context
In the January 2017 episode with Ivan Eland, the ACA appears as an entitlement that will be difficult to repeal. Eland says that once programs exist it is difficult to get rid of them, and that he fears the same will prove true of the Affordable Care Act The Return of Big Spending Republicans? (2017). He notes that Trump said he did not want to cut Medicare, Medicaid, and Social Security, and that without entitlement reform the deficit would rise because of baby-boomer retirements; he also mentions the Congressional Budget Office, which he describes as a nonpartisan government agency in the Congress that does bill costing.
Premiums and prices
Austin Petersen, in the September 2017 episode, gives a personal account of the law’s effect on his insurance. He says he once had affordable insurance with a pre-existing condition for less than $100 a month with a $1,500 deductible, and that because of the Affordable Care Act he was then paying $411 a month with a $7,500 deductible Federalism and the Flat Tax: The Austin Petersen Plan (2017). He says he was told he could keep his plan and his doctor and that neither was true, and he calls the law a giant corporatist bill that redistributed wealth from the poor and middle class to the wealthy. He also says Claire McCaskill supported Obamacare and was one of the principal architects for the passage of the legislation, and that he would like to see competition introduced into the healthcare system and an end to subsidies to insurance companies.
Dr. Jeff Singer, in the November 2020 episode, describes a price effect of the ACA’s coverage mandate. He says that before the law most health insurance policies did not cover birth control pills, so women paid out of pocket, and that prices for birth control pills were trending down along the same line as over-the-counter medications Dr. Jeff Singer on Prescription Drug Freedom (2020). After the ACA went into effect in 2014 and insurers were required to pay for birth control pills with no out-of-pocket expense, he says, prescription drug prices began rising and birth control pill prices skyrocketed, going up at three times the rate of prescription medicines, while over-the-counter medicines rose only slightly. He attributes this to the disappearance of the feedback loop of consumer purchasing and to manufacturers overcharging a third party. Bob Zadek adds that insurers are determined to make a profit, so premiums rise proportionately, and that government has long since discovered it can pass a cost along to business to bury in the price of a product.
Constitutional litigation
David Kaplan, in the April 2019 episode, discusses the ACA as a Supreme Court case. He says that conservatives who spent their careers attacking the liberal Supreme Court for intervening now rush to the Court and support its intervention in areas like the Affordable Care Act, and he states that Obamacare clearly is constitutional, adding that those who argue it is not barely present plausible arguments Demystifying the Supreme Court (2019). He recalls Justice Brennan, whom he calls the great liberal lion of the Court from the ’50s to 1990, holding up a hand and slowly counting out five fingers and saying that with five votes you can do anything. Kaplan also says that Chief Justice John Roberts showed in the first Obamacare ruling in 2012 that he knew what judicial restraint correctly applied looked like, and that Roberts, now the swing justice after Justice Kennedy retired, understands that the Court’s prestige and therein its power is more important than any particular vote in a particular case.
Across episodes: the same question over time
The excerpts show no single developing argument but a recurring set of concerns across six episodes: Bob Zadek’s history of federal entry into healthcare and his prediction that the law will collapse of its own weight in 2013; Sam Batkins on delegation and the REINS Act in 2017; Ivan Eland on the difficulty of repealing an entitlement in 2017; Austin Petersen on premiums and deductibles in 2017; David Kaplan on the 2012 ruling and judicial restraint in 2019; and Dr. Jeff Singer on birth-control prices in 2020. The later episodes do not revise the earlier ones; they add regulatory, fiscal, personal-cost, and constitutional dimensions to the same underlying objection to government involvement.
What the sources do not cover
The excerpts do not describe the ACA’s statutory structure, its individual mandate, its subsidies, or its Medicaid expansion in any detail. They do not report the holding, vote count, or constitutional basis of the 2012 Supreme Court ruling beyond Kaplan’s statement that the law is constitutional and that Roberts showed judicial restraint. They do not give the outcome of the REINS Act or of any repeal effort. They also do not state the date of the ACA’s passage or the name of the statute beyond the two names used in the episodes.