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|America's road to health care hell|
A few old white men yelling on television at the many town hall meetings popping up all over the nation gives the White House an excuse to dismiss the constant noise as "food fights," but beneath that fašade of confidence there sits a shaky presidential staff.
Down to human-like popularity numbers, Obama simply cannot politically afford a total defeat on health care such as his Democratic predecessor Bill Clinton and spouse encountered shortly after they took up residency on Pennsylvania Avenue.
As he did with the stimulus package passed early in his tenure, President Obama waited for the liberal element in the Democratic House of Representatives to come forward with a proposal, after which both the Senate and the president himself reacted. With the stimulus package, that approach put dollars proposed to be spent on pet liberal causes like ACORN at a negotiating advantage. Once passed through the House, the billions thrown at Democratic supporters could only be reduced by the Senate and the president, not eliminated entirely.
The health care proposal coming out of the House is more than 1,000 pages long, and calls for sweeping changes in the health care structure of the United States. It puts the federal government directly in control of health insurance by establishing a federally owned and operated health insurance company that will surely run all private companies out of business. The bill requires every citizen in America to buy health insurance, just as states require all drivers to buy liability insurance on their cars.
Then, once the government has forced everyone into its health insurance program, it will turn around and negotiate rates with health care providers, including the major drug companies, hospitals and doctors. This, in theory, will drive down costs for everyone.
To pay for the expansive federal takeover of the health care insurance industry, which is what the House bill amounts to in a nutshell, there would be an income tax surcharge on incomes now pegged at $500,000 a year and above. In addition, certain assumed savings in Medicare and Medicaid programs will be implemented, in theory combining additional taxes on the wealthiest one-half of one percent of Americans with cuts in expenses for treatments to the elderly and the poor.
The proposed reductions in costs for Medicare and Medicaid have brought huge protests from senior citizens at the various town meetings covered by national television. So much so that Obama felt compelled at his own highly orchestrated town meeting to begin the media event by reassuring senior citizens that "nobody is talking about doing away with Medicare benefits."
If that's so, then what's all this stuff in the House bill that assumes cuts in Medicare costs?
Well, explains the White House, just because costs go down, it doesn't necessarily follow that services will also decline. The "savings" assumed from Medicare in the House bill result from two assumptions: (1) The addition of 30-40 million people paying health insurance premiums as required by law will substantially reduce the cost to the average taxpayer already paying into the system; and, (2) The new policy of the federal government negotiating health care costs, especially the cost of prescription drugs, will substantially lower Medicare costs.
These are far-reaching assumptions with which the Congressional Budget Office in a highly publicized committee appearance rejected as implausible. In fact, the CBO has flatly stated that unless Medicare costs are controlled in some way, there is no financial means to pay for universal health care coverage.
This observation gets very close to the most difficult issue facing the elected politicians in charge of federal health care costs. A huge number of congressmen and senators have evolved substantial power by regularly pushing for and obtaining increases in Medicare and Medicaid coverage.
The elephant in the living room, the big one not even the president seems willing to confront, is the reality that the politicians in Washington themselves are the ones responsible for the hugely escalating costs of Medicare and Medicaid. By constantly increasing coverage under those programs, and constantly making it easier to qualify for them, Congress has created an artificially high demand for medical services. Under the inexorable laws of supply and demand, inflation inevitably results.
It is the classic case as described by the cartoonist Walt Kelly through his famous swamp possum character Pogo: "We have met the enemy, and he is us."
Real efficiencies in American health care can only result if the politicians in power are willing to release their influence in the name of a rationally functioning system. That will never happen.
What is likely to happen is a compromise coming out of the Senate Finance Committee that abandons a federal health insurance company in favor of some sort of regional cooperative organized along the lines of the Rural Electrification Association, the father of the "not for profit" electric cooperative. Mandatory coverage is highly likely to be in the compromise proposal. But there will be nothing to curb the built in tendency of Congress to expand Medicare and Medicaid coverage. Thus, even if the bill does not propose an increase in income taxes, a tax will ultimately result from an even more expensive system than the one already in place.
Wish I had better news in the crystal ball. But I see higher taxes coming, with no benefit other than an increase in the influence of those who run the government. The road to hell is paved with good intentions.
Jeff David owns and publishes The Livingston Parish News, an award-winning newspaper located in Denham Springs. David is a past president of Louisiana Press Association and National Newspaper Association.