What’s the difference between waste and the health care you want? Answer: Obama’s health-care rationing bureaucracy. You may want health care that your doctor has prescribed for you. But the rationing bureaucracy in Washington that doesn’t even know you, or your doctor, may decide that your doctor doesn’t know what he’s talking about, or that you are too old for the government to pay for your hip replacement to stop the pain, or to get an expensive triple bypass or a pacemaker operation to save your life. The bureaucracy may decide, as Obama previously suggested to a national audience, to give you a painkiller pill and send you home.

This is how Obama promised last night to reduce health costs, by government health-care rationing, where the government decides what health care you get and when. This is what he meant when he said that “two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health programs.” A questioner then asked him, “When you describe health-care reform, you don’t…talk about the sacrifices that Americans have to make. Do you think…that other than some tax increases on the wealthiest Americans, the American people are going to have to give up anything in order for this to happen?” Obama answered that the only sacrifice Americans would have to make is that “they’re going to have to give up paying for things that don’t make them healthier.” In other words, they will only have to give up waste in their health care.

But how is Obama going to decide what health-care spending is waste and what is the health care that you want and that your doctor tells you that you need? The answer is his new federal health-care board in Washington, which he also touted last night. And then there is the new Federal Coordinating Council for Comparative Effectiveness Research, which was enacted into law in the stimulus bill. Most people probably did not understand exactly what Obama was talking about last night. But he promised before the whole country that this is the way he is going to reduce health costs, by government health-care rationing, where the government, not you and your doctor, decides what is waste in health-care spending.

But a faraway, centralized, Washington health-care bureaucracy won’t and can’t know exactly what health care, out of all the health care services in the country, is truly waste, and what is the health care you want and need based on what your doctor has told you. For the government to even try, however, is going to require giving the government complete control and power over the country’s health-care system.

This is not just speculation based only on what Obama said last night. It is based on what is in the Democrat health bills now pending in Congress, on what Obama’s own Council of Economic Advisors says in a recent report on how Obama’s health plan will reduce health costs, which Obama has touted, and on what other countries do that have adopted the same health policies that Obama is now advocating for America.

– Peter Ferrara is director of Entitlement and Budget Policy for the Institute for Policy Innovation.