This is the way the Obama government operates, and this is the kind of fear they strike in civil servants to intimidate them from doing the right thing. Sadly, this was Obama’s behavioral pattern throughout the ObamaCare debate. In the beginning, he set up false premises to establish a false need for his particular fix, he distorted the facts all the way through the process, he badgered, bullied, and demonized his opponents, he refused to budge or compromise, and he blamed his opponents for the very tactics he was employing.
Universal healthcare was a crown jewel for Democrats and, in their minds, both a historical jinx and an avenue to political hegemony. In their penchant for misreading and revising history, they have assumed their failure to pass HillaryCare was the primary reason for their loss of Congress in 1994—much more than the Republicans’ Contract with America. In part they were right: HillaryCare did have a lot to do with their thrashing, but not in the way they thought. The lesson the liberals took away from that experience was that if they had succeeded in passing this socialists’ dream they would have ushered in a new era of Democratic dominance, if for no other reason than it would have created a major entitlement on which more and more voters had to depend on Democrats to sustain.
Today’s Obama liberals weren’t about to repeat those mistakes. But liberals, as usual, misread the reality. Voters, whom Democrats characteristically underestimate, did understand socialized medicine, and they rejected it, as well as the high-handed and secretive manner by which the Clintons attempted to shove it through—with the same arrogance Obama later evinced.
Sure, Obama succeeded in passing his bill, but it was not because he correctly read the tea leaves. Americans flat out rejected socialized medicine every bit as much as they did in the 1990s, but he was able to hang on to the congressional majority Democrats won in November 2008 long enough to shove the bill through Congress via legislative trickery. Barring unforeseen events, Obama’s despicable abuse of power in this process should play a great part in the Democrats’ coming electoral smackdown in November 2010.
Already state legislators representing half the nation have introduced bills to exempt their residents from the dysfunctions of ObamaCare. Idaho, Utah, and Virginia have passed laws, while Missouri will vote on a referendum to nullify the provision man-dating participation in the healthcare system. As the Washington Times editors wrote, “It is a testament to the health of our democracy that so many states are fighting back.”50 In addition, attorneys general from at least fourteen states as well as the National Federation of Independent Business will challenge the law, arguing that it’s unconstitutional for the federal government to force its citizens, under penalty of law, to obtain insurance coverage.51
EXORBITANT COSTS AND QUALITY OF CARE
One of Obama’s central premises in demanding universal healthcare was his oft-repeated statement that Americans spend more on healthcare (one and a half times more per person) than citizens of any other country, “but we aren’t any healthier for it.” His corollary statement drips with bitterness toward this country: “We are the only democracy—the only advanced democracy on Earth—the only wealthy nation—that allows such hardships for millions of its people.” Do you get that? America is immoral for allowing these hardships. Almost everything in his two statements is wrong.
While America does spend more on healthcare than any other nation, that’s not necessarily a bad thing. We get what we pay for, and we get the best. Of course, there are exorbitant costs in many cases, but as we’ve demonstrated, these will only increase further under ObamaCare. One major reason medical costs have risen dramatically in recent decades is that the introduction of employer-provided insurance interfered with market forces. When Americans didn’t have to pay out of pocket for their medical care, the costs became invisible to them and demand soared, while the normal functioning of price was taken out of the equation. Further interfering with the operation of the market, obviously, was the advent of the various government programs now in place for medical care.
Another major reason Americans have higher medical costs is that we demand the best in medical advancements and in treatment of deadly diseases—and we get it, which is why people from across the world want to come to America for treatment when they get seriously ill. According to Cato’s Michael Tanner, most of the world’s best doctors, hospitals, and research facilities are located in this country. Eighteen of the last twenty-five Nobel Prize winners in medicine are either U.S. citizens or work here. U.S. companies have developed half of all the major new medicines that have been introduced on the market over the last two decades. Americans have played major roles in some 80 percent of the most important medical advances of the last three decades.
While Obama happily cites biased statistics showing America to have poorer quality healthcare than it really has, the fact is that comparative statistics on infant mortality rates and life expectancy are skewed and misleading. Other nations often exclude high-risk, low-birth-weight infants in tabulating their statistics on infant mortality, while America includes them, which greatly distorts the numbers in our disfavor. Life expectancy numbers, likewise, are misleading because of extra-medical factors, such as violent crime, poverty, obesity, tobacco, and drug use. But when you isolate and compare—apples to apples—our outcomes on serious illnesses like heart disease and cancer, the United States easily outperforms the rest of the world.52 America has the best quality healthcare in the world, but ObamaCare will make it worse. As Heritage Foundation expert Robert Moffit says, the uniform experience of other nations proves that you can’t deliver universal access to high-quality health care.
Consider Obama’s other central reasons for promoting Obama-Care—the numbers of uninsured, the inadequate patient choice, and access to care—and you will see not only the distortions in the premises, but also the fraud in his promises to fix the very problems he mischaracterizes.
THE UNINSURED CANARD
As we noted, Obama finally had to revise his false claim of 47 million uninsured Americans to 30 million because the higher number included millions of non-citizens, among others. Let’s look more closely at the actual numbers. In the first place, Obama conflates health insurance coverage with access to healthcare. All Americans, by law, have access to emergency room care. Plus, many of the uninsured lack coverage by choice—they can afford it but choose not get it, as explained below, but they still have access to care if they need it. Finally, the poorest Americans are eligible for government assistance for healthcare.
The Cato Institute’s Michael D. Tanner noted that the Census Bureau’s latest figures show 45.6 million Americans lack health insurance. But Tanner says we must account for the fact that only some 30 percent of the uninsured lack insurance for more then a year, 16 percent for two years, and less than 2.5 percent for three years or more. About half are uninsured for no more than six months (some have said four months). Much of this, says Tanner, is due to changing jobs and switching coverage through different employers.53
Putting aside the issue of the temporarily uninsured, if we begin with the 45.6 million number, we must first subtract 10 million people who are not U.S. citizens, including an estimated 5.6 million illegal immigrants and 4.4 million legal immigrants who are foreign citizens. Additionally, some 12 million are eligible for Medicaid and the State Children’s Health Insurance Program (S-CHIP) but haven’t enrolled. (For all the handwringing about the millions of uninsured children, this figure includes 64 percent of all uninsured children and 29 percent of parents with children.) Tanner notes if these people went to the hospital for care they’d be instantly enrolled, and thus it’s essentially fraudulent to say they’re uninsured.
There are also millions among the “uninsured” who can afford health insurance but choose not to buy it. These are referred to as the “young invincibles”—those who have decided to gamble on their good health and forego the expense of health insurance. Healthcare expert Sally Pipes wrote that almost 18 million people fall into this category
and earn more than $50,000 annually, and almost 10 million of those make more than $75,000 a year.54 Former CBO director June O’Neill prepared a study finding that 43 percent of the uninsured have incomes greater than 250 percent of the poverty level ($55,125 for a family of four), and the income of more than a third of them exceeds $66,000. Another study, produced by Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford, found that almost 75 percent of the uninsured could afford insurance but choose not to get it. Moreover, writes Tanner, most of these uninsured are in fact, as noted above, young and healthy: the CBO says some 60 percent are younger than thirty-five, and 86 percent claim to be in good health.
There is overlap among these different categories, making it difficult to determine accurately the number of U.S. citizens who are chronically uninsured and both ineligible for government assistance and unable to afford coverage. Estimates vary, but Sally Pipes estimates the number of these “chronically uninsured working poor” at about 8 million.55
If Obama were truly interested in providing health insurance for these people who fall through the cracks, he could do so with dramatically less cost and without wrecking the quality and access of healthcare for the rest of Americans. Many of these chronically uninsured could be aided by portability reform—by tying insurance to the person rather than the job. One Health Affairs study in 2003 found that only 12 percent of the uninsured were chronically so, with the rest falling in and out of coverage. Many experts maintain if you enacted portability reform—like we do in every other insurance market—the number of uninsured would drop drastically at a reasonable cost to taxpayers. As for any remaining uninsured, we could provide aid at a fraction of the cost of ObamaCare, and without destroying the quality, quantity, and choice of care.
CHOICE AND ACCESS TO CARE
In economic terms it is axiomatic that when you increase demand (which ObamaCare will do by force of law, among other things), and control prices (which ObamaCare will do out of necessity and the sheer force of government inertia), you will end up with rationing. In fact, ObamaCare sets up a board that will make decisions about our choices of care, and the bureaucrats will base their reimbursements on obedience to the prescribed choices. As much as anything else, these realities expose the fraud in ObamaCare. It was promoted on the basis of increasing access, as we’ve detailed. And yet, for all its “fixes,” ObamaCare, after forcing people to procure coverage, will reduce access and quality because it will result in rationing. The choices for care will be made by top-down bureaucrats instead of those who know best: the doctors directly treating the patients. Obama said he wouldn’t interfere with the relationship between doctors and their patients, just as he was pushing through his bill that would empower bureaucrats to direct these very decisions.
But Obama’s own words betray his true intent on controlling healthcare choices. Not only does he favor bureaucratic intervention in intimate decisions between patients and their doctors, he has an embarrassingly unsophisticated perspective concerning it. Recall his statement, “If there’s a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half-price for the thing that’s going to make you well?”56 Or how about this gem from Dr. Barack: “We’re going to start encouraging paying doctors not based on how many tests they take, but based on the quality of the outcome—does somebody end up healthy.... If you go to the doctor you get one test. Then (you are) referred to a specialist, you get another test. Then maybe you go to a third person, the surgeon, you get a third test—it’s all the same test but you’re paying three times. So . . . we’ll pay you for the first test and then e-mail the test to everybody. Right? Or have all three doctors in the room when the test is being taken.”57
Obama appointed Donald Berwick, CEO of the Institute for Healthcare Improvement, to be the administrator for the Centers for Medicare and Medicaid Services (CMS). According to Robert M. Goldberg of the Center for Medicine in the Public Interest, the role of the CMS will be expanded under ObamaCare to define “the quality of health care for every insurance plan, set reimbursement rates for physicians in Medicare and Medicaid, and decide what treatments are more ‘valuable’ than others.” Goldberg surmises, “Berwick will get control of the practice of medicine.”
The CMS will have the sweeping power “to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced” as part of ObamaCare’s strategy of “retaining costs through controls on specialist physicians. Based on the government’s premise that they often make wasteful treatment decisions,” ObamaCare “will subject doctors to a mix of financial penalties and regulations to constrain their use of the most costly clinical options.”58
It would be disturbing enough for any person to have such broad authority, but Obama’s choice—Donald Berwick—is not just any person. Like Obama, he believes in radical wealth redistribution and that socialized medicine is an ideal vehicle to achieve it. Don’t take my word for it, take Berwick’s: “Any health care funding plan that is just, equitable, civilized and humane must ... redistribute wealth from the richer among us to the poorer and the less fortunate,” he said, adding, “Excellent health care is, by definition, redistributional.” Berwick also idealizes the ineffectual, scandal-plagued British healthcare system, condemning America’s system for running in the “darkness of private enterprise.”59
Writing of Britain’s National Health Service rationing, Berwick said, “You plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them.” Goldberg notes that in 2008 Berwick’s pet British system “denied cutting edge cancer drugs to 4,000 people, forcing thousands to remortgage their homes to pay for treatment. Love is blind. With regard to Dr. Berwick’s devotion to the NHS, it’s deaf and dumb as well.”60
ObamaCare’s architects ultimately intended to ration care because that was the only way these command-control types knew to reduce costs. They are philosophically on board with Obama’s idea that a bureaucracy’s payment determination can’t be influenced by a person’s spirit and “that at least we can let doctors know and your mom know that... this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.”61 They believe in substituting their value judgments for the freedom of choice of American healthcare patients as to whether they need care. Under a free system, a patient can spend as much or as little on healthcare as he wishes. But under a government-run plan—for which ObamaCare lays the groundwork—the government will reduce, deny, and ration care based on a compassionless bureaucratic chart designed by “compassionate” liberals. So while ObamaCare may marginally decrease the numbers of uninsured—though that’s not guaranteed—it will greatly reduce access to quality care.
All government-run healthcare systems ration care, either directly, by denying or limiting certain types of treatment, or indirectly, by imposing cost constraints through budgets, waiting lines, and/or limited technology. One million British people are awaiting admission to government-run hospitals at any given time, and shortages result in the cancellation of some 100,000 operations annually. New Zealanders experience similar troubles. Swedes can wait for heart surgery up to twenty-five weeks, and 800,000 Canadian patients are on waiting lists.62
Moreover, an Investors Business Daily poll found ObamaCare will cause up to 45 percent of doctors to retire early. Similarly, the National Center for Policy Analysis reported that ObamaCare “could impact physician supply in such a way that the quality of health care would suffer. The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.” Why? Because it would make practicing medicine “more trouble than it’s worth.” This reduction in the physician workforce, according to the doctors surveyed, could “result in a significant decline in the overall quality of medical care nationwide.”63
/> Perhaps the most ominous predictor of rationing in ObamaCare involves so-called end-of-life counseling. Sarah Palin took a lot of flack for arguing that various provisions in the healthcare bill, including end-of-life counseling, could establish “death panels.” Regardless of whether ObamaCare would lead to death panels, one is entitled to ask why such a provision is in the bill at all. What business does the government have insinuating itself into intimate, end-of-life matters? The answer is quite clear: it has no business at all making such decisions, but as the government takes over more and more of the healthcare system, it gains a bigger interest in containing costs in every part of the system.
Furthermore, ObamaCare, as noted above, also expands the role of the CMS over healthcare decisions. These provisions, together with the fact that a number of the bill’s architects, such as Obama’s close advisers on the matter, Tom Daschle and Ezekiel Emanuel, firmly believe in rationing care to the elderly, makes speculation about death panels more than plausible. But there’s more.
Before ObamaCare was passed, Democrats slipped into the stimulus bill a provision to establish a $1.1 billion fund for a Federal Council for Comparative Effectiveness Research, a brainchild of former Democratic senator Tom Daschle. Former New York lieutenant governor Betsy McCaughey warned about this panel when the stimulus bill was being considered. According to McCaughey, the council was based on ideas Daschle had sketched out in his 2008 book Critical: What Can We Do about the Health Care Crisis, in which he explained that such a panel is meant to empower an unelected bureaucracy to make hard decisions about healthcare rationing that elected politicians might lack the courage to make. He suggested Americans would be better served if they passively accepted “hopeless diagnoses” like Europeans do. Daschle’s argument, said McCaughey, was that “seniors should be more accepting of the conditions that come with age instead of treating them.” Yet Obama claims conservatives are hyperventilating over this issue.64
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