Democrats are in their final sprint to pass the president’s health-reform plan, and allies such as New York Times columnist Paul Krugman are rehashing every argument to promote the effort. In a recent column, Krugman attacks the “myth” that the bill is a “government takeover.” That line — meant to suggest that opponents are fear-mongering about a proposal that simply seeks to temper the influence of insurance companies and give more control to Americans — is much used by the White House as well.
Is Krugman right? Well, consider the recent comments of Andrew Hyman of the Robert Wood Johnson Foundation. Hyman served in the Clinton administration, and the foundation supports the bill. He told the Fiscal Times that “the reform legislation will affect every facet of our health system. It will address how people get coverage, how health care is delivered, and how health care is paid for.”
He’s right: The bill does change every facet of American health care. And every significant change in the massive bill will expand government, without exception.
How? Let’s count the ways.
One, Obamacare creates a new, government-run assisted-care insurance program to compete with existing private plans. CLASS Act, as it’s called, is essentially a new entitlement, and its proponents promise it won’t cost the Treasury a penny. That’s what Washington used to say about Social Security. The CBO, incidentally, predicts CLASS Act will increase the deficit within two decades.
Two, Obamacare creates a Medicare panel to cut payments for ineffective procedures and prescriptions. The panel will override the wishes of patients and physicians, just as it has in countries where it’s already been tried, such as Britain. The British government, by the way, is presently reviewing the mandate of its deeply unpopular committee.
Three, Obamacare expands Medicaid eligibility by as much as one-third, increasing taxpayer liability for entitlements at the exact moment Washington needs to contain entitlements. It’s like deciding to build a swimming pool and gazebo when your house already has a double mortgage and a cracked foundation.
Four, Obamacare gives the federal government the power to specify what every insurance plan must cover, and doesn’t touch the hundreds of state-level benefit mandates that are already in place. And, by the way, it’s a power that Washington will immediately use — both the House and Senate bills contain new mandates.
Five, Obamacare creates dozens of new offices, bureaucracies, committees, programs, and authorities — more than 110 in the Senate bill — to implement the law and develop new regulations, including the Interagency Pain Research Coordinating Committee and the Patient-Centered Outcomes Research Institute.
Six, Obamacare forces states to set up health-insurance exchanges to foster competition. Massachusetts has already tried this, with no reduction in premiums.
Seven, Obamacare substitutes more government for patient choice by gutting Medicare Advantage (an option through which seniors can receive their Medicare benefits in the form of private insurance plans) to pay for new entitlements and new services. Let’s be clear: Medicare Advantage is hardly perfect, and Medicare itself is in need of a rethink, but the responsible step would be to seek reforms in order to reduce the deficit, not to shift the money to create and expand other entitlements.
Eight, with so many subsidies and program expansions, Obamacare will push the government’s share of national health spending well past the 50 percent level forever. Let’s put that in perspective: In socialized health-care systems such as Canada’s — private insurance is still banned in much of that country — government accounts for about 70 percent of total health-care spending.
For the record, the reach and cost of the federal government aren’t the only things that are expanding under Obamacare. So is K Street. Imagine what life will be like in the coming years as lobbyists seek to sway the decisions of the health-benefits super-committee – which is charged with determining the services covered by your insurance — or the Medicare panel, which is authorized to “guide” physicians’ treatment decisions.
So, let’s give Paul Krugman the benefit of the doubt. Maybe Obamacare isn’t a complete government takeover of health care. But it’s close.
– David Gratzer, a physician, is a senior fellow at the Manhattan Institute. He is the author of Why Obama’s Government Takeover of Health Care Will Be a Disaster (Encounter Books, 2009).