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Promise-Driven Healthcare By: Andrew Cline
FrontPageMagazine.com | Thursday, July 02, 2009

“Don’t ever promise more than you can deliver,” legendary college coach Lou Holtz said in 1993, in the midst of, though not in reference to, Hillary Clinton’s plan to take control of health care in America. Alas, politicians ignore the sage advice of football coaches. President Obama, being a politician, has followed Hillary rather than Holtz, and is promising vastly more on health care than he or anyone else can plausibly deliver.


Obama’s push for health-care reform is based on two conflicting promises. The first is that he will change everything by providing comprehensive reform that will entirely transform America’s health care system. Thus, when Obama announced his health care plan on May 29, 2007, he said, “If you already have health insurance, the only thing that will change for you under this plan is that the amount of money you will spend on premiums will be less.”


The second promise is that nothing will change under Obama’s reform, and that Americans who like their current insurance can keep it. At his June 23 press conference, he said, “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan.”


The motivation for making the second promise is obvious. Somewhere between 70 and 80 percent of Americans say they are satisfied with their current health-care plans, a point Obama acknowledged at his press conference. The politically savvy Obama realized early on that fear of the unknown would be a major hurdle for the type of health care changes he wanted to offer. HillaryCare collapsed in 1994 because Americans were rightly worried that it would force them to give up coverage and health care providers they liked. Learning from that blunder, Obama asserted from the beginning that his plan would change nothing for the millions of Americans who are satisfied with their current plans.


The trouble with that promise is that – considering Obama’s transformative plans for the nation’s health care – it is impossible to keep. If 80 percent of Americans like their health care plans, then Obama must keep health care unchanged for 243 million people. That leaves just 20 percent of the health care sector available for reform. If he’s reforming only 20 percent, then the comprehensive reform he promised is impossible.


But of course Obama is not talking about reforming just 20 percent of the system. He wants to change the way health care is provided and funded across the board. As he explained at his June 23 press conference:


“So if we start from the premise that the status quo is unacceptable, then that means we're going to have to bring about some serious changes. What I've said is, our top priority has to be to control costs. And that means not just tinkering around the edges. It doesn't mean just lopping off reimbursements for doctors in any given year because we're trying to fix our budget. It means that we look at the kinds of incentives that exist, what our delivery system is like. . . and figuring out how can we make sure that everybody is benefiting from lower costs and better quality by improving practices.”


The president wants “serious changes” that affect “everybody.” There can be no equivocating, then: people who like their current coverage would see it changed, and in unforeseen ways. In other words, Obama’s promise to leave parts of the system unchanged is a lie.


The Congressional Budget Office estimated last month that under one of the leading health care proposals, the plan sponsored by Ted Kennedy, the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent). Coverage from other sources would fall by about 8 million. That’s 23 million Americans who would lose their coverage.


Ten million Americans would lose their coverage because of subsidies offered through health insurance “exchanges” the plan would set up, the CBO calculated. The Kennedy plan includes no “public plan,” which Obama wants. If the Kennedy plan’s subsidies alone would result in 10 million Americans being shifted from their current plan to a different one, surely a public plan would have at least as large an impact, if not much larger.


Now that he has finally been asked some hard questions about his promises, Obama has already retreated from his claims that no American who likes his health care plan would lose it. He now says the government wouldn’t take away your health care plan directly, but he acknowledges that because of government action your employer might change your plan. But observers may reasonably suspect that this is a distinction without difference. For Obama’s own proposals would force changes that would lead to lost coverage for millions of Americans.


First, Obama’s public plan would have numerous structural advantages that would allow it to offer the same services for less money than a private plan. With state subsidies, the ability to negotiate cheaper prices from providers and suppliers, and no need to return a profit, it would undercut its private competitors. That would cause employers to drop coverage since there is now a “free” plan available to their employees. All of this would likely put some, or most, private insurers out of business.


Second, Obama’s plan calls for forcing every employer to either offer the benefits Washington demands or pay a tax to fund the public plan. If your employer adopts the Washington-demanded plan, your plan will change. If your employer opts for the tax, your plan might still change, as your employer will have to cut costs somewhere else to pay the tax.


Third, Obama would regulate what types of coverage private plans could offer, dictate reimbursement rates, and establish a government body to decide what procedures, devices and medications could be offered. Every one of those changes would dramatically alter existing health care plans, and would put an end to many.


Fourth, Obama has now conceded that he is open to a plan by Congressional Democrats to tax employer-provided health insurance. If he agrees to tax “Cadillac” health care plans, that would prompt employers to drop lavish coverage and offer scaled-down plans, or to drop plans altogether. Either way, millions of Americans would lose the coverage they now have.


There is no way around it. The “reforms” Obama wants will force millions of Americans who like their current health care coverage to lose it and to switch to something else. Whatever one makes of this change, it is increasingly clear that Obama has sold his plan by reassuring Americans that he would not do precisely what he is doing now.

Andrew Cline is editorial page editor of the New Hampshire Union Leader.

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