The Corner

Trouble in Paradise

The Obama administration and congressional Democrats have been doing all they can to keep the medical provider groups on board with their health-care reform plans, and as long as those plans remained just vague promises they seemed to have some success. But now that they’re getting to particulars — like a huge new government role in health insurance aimed at driving private insurers out of the game — the coalition is beginning to fray. Yesterday the American Medical Association, the most significant of the groups the Democrats seek to keep on board, announced it would oppose any plan with a public insurance “option” component. “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” the AMA said. The idea of compelling doctors who take Medicare funds to participate in the new public plan is especially onerous, the organization argued, and it even took it upon itself to remind Congress of its fiscal responsibilities (someone has to), writing in a letter to the Senate Finance Committee that driving private insurers out of business would create a flood of refugees into the public plan, and “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.” Quite right.

The doctors are surely also worried about the broader effects of a greater government role in their profession, worries well described by Scott Gottlieb last month.

It is no coincidence that the AMA’s announcement came just a few days before President Obama addresses a large AMA gathering, on Monday. We’ll see how he handles their challenge, but it’s increasingly apparent that the path to Obamacare is not as clear as it looked earlier this spring. Other major players in this debate, and especially employer groups (concerned about the employer mandate in the drafts now beginning to leak out) and the health insurers (concerned about being strangled to death), are gearing up for a fight. All that combined with the facts that this plan would cost at least $1.5 trillion, create a huge and growing new entitlement that isn’t paid for in any evident way, lead more or less inescapably to serious health-care rationing in the future, and do very little else to control health-care costs should give Republicans something to talk about, shouldn’t it?

Yuval Levin is the director of social, cultural, and constitutional studies at the American Enterprise Institute and the editor of National Affairs.


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