WASHINGTON -- Obamacare Version 1.0 is dead. The 1,000-page monstrosity that
emerged in various editions from Congress was done in by widespread national
revulsion not just at its expense and intrusiveness but at the mendacity with
which it is being sold. You don't need a Ph.D. to see that the promise to
expand coverage and reduce costs is a crude deception, or that cutting $500
billion from Medicare without affecting care is a fiction.
But there is an
exit strategy. And a politically clever one, if the Democrats are smart enough
to seize it.
(1) Forget the public option. Whatever the merits, and they are few, it is
political poison. It dies by the Liasson Logic, the unassailable observation
by NPR's Mara Liasson that there are no liberal Democrats who will lose their
seats if the public option is left out, while there are many moderate
Democrats who could lose their seats if the public option is included.
(2) Jettison any reference to end-of-life counseling. People see
(correctly) such Medicare-paid advice as subtle encouragement to voluntarily
refuse treatment. People don't want government involvement in a process they
consider the private province of patient, family and doctor. The Senate is
already dropping it. The House must follow.
(3) Soft-pedal the idea of government committees determining "best
practices." President Obama's Federal Coordinating Council for Comparative
Effectiveness Research was sold as simply government helping doctors choose
the best treatments. But there are dozens of medical journal review articles
that do just that. The real purpose of FCCCERs is ultimately to establish
official criteria for denying reimbursement to less favored (because
presumably less effective) treatments -- precisely the triage done by the NICE
committee in Britain, the Orwellian body that once blocked access to a certain
expensive anti-blindness drug until you went blind in one eye.
(4) More generally, abandon the whole idea of Obamacare as cost-cutting.
True, it was Obama's original rationale for creating a whole new entitlement
at a time of a sinking economy and a bankrupt Treasury. But, as many
universal-health care liberals complain, selling pain is poor salesmanship.
(5) Promise nothing but pleasure -- for now. Make health insurance
universal and permanently protected. Tear up the existing bills and write a
clean one -- Obamacare 2.0 -- promulgating draconian health-insurance
regulation that prohibits (a) denying coverage for pre-existing conditions,
(b) dropping coverage if the client gets sick, and (c) capping insurance
company reimbursement.
What's not to like? If you have insurance, you'll never lose it. Nor will
your children ever be denied coverage for pre-existing conditions.
The regulated insurance companies will get two things in return. Government
will impose an individual mandate that will force the purchase of health
insurance on the millions of healthy young people who today forgo it. And
government will subsidize all the others who are too poor to buy health
insurance. The result? Two enormous new revenue streams created by government
for the insurance companies.
And here's what makes it so politically seductive: The end result is the
liberal dream of universal and guaranteed coverage -- but without overt
nationalization. It is all done through private insurance companies.
Ostensibly private. They will, in reality, have been turned into government
utilities. No longer able to control whom they can enroll, whom they can drop
and how much they can limit their own liability, they will live off government
largesse -- subsidized premiums from the poor; forced premiums from the young
and healthy.
It's the perfect finesse -- government health care by proxy. And because
it's proxy, and because it will guarantee access to (supposedly) private
health insurance -- something that enjoys considerable Republican support --
it will pass with wide bipartisan backing and give Obama a resounding
political victory.
Isn't there a catch? Of course, there is. This scheme is the ultimate
bait-and-switch. The pleasure comes now, the pain later. Government-subsidized
universal and virtually unlimited coverage will vastly compound already
out-of-control government spending on health care. The financial and budgetary
consequences will be catastrophic.
However, they will not appear immediately. And when they do, the only
solution will be rationing. That's when the liberals will give the FCCCER
regulatory power and give you end-of-life counseling.
But by then, resistance will be feeble. Why? Because at that point the only
remaining option will be to give up the benefits we will have become
accustomed to. Once granted, guaranteed universal health care is not
relinquished. Look at Canada. Look at Britain. They got hooked; now they
ration. So will we.