The Corner

A Physician’s Check-up on the One-Year-Old Health-Care Law

A year ago this week, Congress passed nearly 2,700 pages of health legislation virtually no one had read in their entirety. Despite opposition from members of their own party and the majority of Americans, congressional Democrats passed a bill fattened with sweetheart deals that further distorted one sixth of our economy.

Now, a year later, Americans are still reeling from the consequences of that congressional action. Despite a multi-million-dollar effort to boost the popularity of the law, including ads paid for by taxpayers, a majority of the American people still reject the law, and for good reason. A mountain of nonpartisan evidence shows the overhaul continues to wreak havoc on the pocketbooks and health of millions of Americans.

Consider the issue of consumer cost. Cost is the main access problem for most Americans, yet the controversial overhaul slams middle-class Americans with a $813 billion tax increase while directly increasing the cost of health coverage, drugs, and medical devices.

It is not only consumers who will suffer under the law. Under the overhaul, 18 million Americans will be forced onto Medicaid. One tally pegs the cost of Medicaid changes to states, many of which are struggling to balance their budgets, at around $118 billion. As a result, states will continue to spend a disproportionate share of their budget on Medicaid while governors cut other programs to pay for burdensome federal mandates.

For all this spending, the law expands a broken program. Medicaid already denies patients access to roughly half of physicians. And when compared to individuals with no health insurance at all, patients on Medicaid have lower health outcomes, higher rates of infant mortality, and higher rates of complication after major surgery. Promising low-income Americans health care and enrolling them into a sub-standard health program is congressional malpractice.

If an individual escapes Medicaid, they will still be subject to the unpopular mandate to buy government-mandated insurance. This provision is not only unconstitutional, it will be ineffective. The law creates a perverse incentive for millions of Americans to game the system and only buy health insurance when they are sick. Consider Massachusetts: Last year the Massachusetts Division of Insurance said the number of people gaming the system quadrupled from 2006 to 2008. As a result, health coverage costs in Massachusetts today are the highest in the country.

For the more than eight in ten Americans who currently like the health insurance they have, there is more bad news in sight. According to the administration’s own estimate, by 2013 more than half of companies may lose their current health coverage because of the new law, and eight in ten small businesses could lose their current health plans.

Under the guise of “responsibility,” the overhaul fines most employers who do not offer employees health coverage. According to a range of nonpartisan experts, this type of de facto mandate has been shown to lower wages and reduce jobs. In fact, the Congressional Budget Office estimates the bill reduces the number of workers in the labor force by 800,000 over a decade.

While the number of jobs and Americans enrolled in private health insurance will decline, the law massively expands federal bureaucracy. The overhaul empowers the secretary of Health and Human Services with nearly 2,000 new powers and authorities — an astonishing congressional abdication that even former HHS secretary Mike Leavitt warned “puts more power than is prudent in the hands of one person.”

Bureaucrats benefit too. The law creates nearly 160 new bureaucracies which will spawn a new army of technocrats to meddle in the health-care choices of millions of Americans. One particularly egregious example is a panel of politically appointed Medicare czars whose recommendations to cut Medicare go into effect automatically, unless Congress intervenes with similar reductions.

In addition to a panel of rogue Medicare czars, Medicare patients already face uncertainty due to looming 30 percent pay cuts to physicians due January 1 of next year. On top of that, the law slashes $529 billion from Medicare, spending it on new programs, rather than shoring up a program burdened with more than $30 trillion in unfunded liabilities.

Tragically, the law’s $2.6 trillion spending binge only worsens the financial position of Medicare and Medicaid. Today, Medicaid and Medicare already burn through one in five federal tax dollars. The Congressional Budget Office says these two runaway health-care programs already threaten the viability of our economy. But by the end of the decade, running the Medicaid and Medicare programs for a single year will cost roughly $1.4 trillion.

The sum of evidence is clear. The controversial law takes health-care reform in the completely wrong direction toward higher costs, higher taxes, higher spending, and higher deficits. Real reform begins with repealing this monstrosity and putting federal spending on health care on a sustainable path. For the health of American patients and our economy, Congress must repeal this law and replace it with commonsense reforms that empower consumers with more choices, increased transparency, and lower costs.

Tom Coburn, M.D., is a U.S. Senator from Oklahoma.

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