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Does anyone remember the TV show "Supermarket Sweep"? Contestants would
compete with one another by careening through a supermarket and grabbing
as many products as they could toss into a basket. The winner was the
shopper whose cart carried the biggest price tag when the bell sounded.
It's a fitting image for the way Nancy Pelosi and Harry Reid have
handled the most important domestic issue of the decade. They've raced
down the health policy aisles, sweeping items off the shelves and into
their legislative carts, heedless of nutritional value, taste, or cost.
As items dropped out on the hairpin turns, others were shoved into the
spaces. Harry Reid inserted the Medicare "buy-in" at the 11th hour and
just as quickly withdrew it under pressure. No organizing principle has
governed the contents of their baskets (Pelosi added and jettisoned
abortion coverage), just an urgent imperative to pass something. And
now, as the clock winds down, they are declaring, as a journalistic
cheerleader at the Washington Post put it, "a legislative feat of epic
proportions."
Actually, it was the sloppiest and most slapdash legislative process
ever to accompany a major bill. The 383-page manager's amendment, making
changes to the Senate bill, was released on the morning of the cloture
vote. Secrecy marked Reid's handling of the bill throughout. Not only
Republicans, but Democrats, too, were kept from studying the
legislation. Payoffs to wavering Sens. Lieberman, Landrieu, and Nelson,
on the other hand, were blatant.
The Democratic leaders of the House and Senate, in concert with the
White House, have bullied, bribed, and rushed their members to vote on
this legislation so that the deed could be done before constituents —
who oppose it forcefully — could confront their representatives
face-to-face over the Christmas break.
The Democrats have endured bruising internecine conflicts and risked the
loss of between 20 and 40 seats in 2010 (Pelosi's estimate) for this.
And what have they achieved? Their goal — a single-payer system or a
glide path to one — remains as distant as ever. Instead, they have
produced (or will, after the conference committee) an enormous new $2.5
trillion octopus of federal regulation that will increase premiums,
contribute to medical cost inflation, reduce quality and choice of care,
and deeply politicize an aspect of life that most Americans regard as
sacrosanct. Additionally, and most alarmingly, it will aggravate the
already crushing debt we are accumulating.
President Obama has betrayed every ringing promise he made about this
reform. People will not be able to keep their
health plans if they are happy with them. The federal government will
determine which plans pass muster. As for not adding one dime to the
federal deficit? Risible. The "savings" in the Senate bill consist of
cuts to Medicare, not increased competition or more efficient delivery
of services. And while CBO has scored the bill as reducing the deficit,
CBO must abide by the assumptions Congress presents. It cannot say what
we know from history to be the truth: Congress will not make cuts in
Medicare. Besides, every entitlement ever enacted has wound up costing
orders of magnitude more than the estimates at passage. That's why the
Medicare and Social Security unfunded liability is currently $107
trillion, according to a 2009 trustees' report. The Reid bill will add
at least 15 million new beneficiaries to Medicaid, accelerating that
program's budget-busting momentum.
The president also promised that no one earning less than $250,000 would
pay higher taxes. But under both the Senate and House bills, people who
do not purchase health insurance will be slapped with an excise tax (2.5
percent of adjusted gross income under Pelosicare, and $750 or 2 percent
of income, whichever is larger, under Reidcare).
The Democrats have not achieved their goal of completely lassoing
one-sixth of the economy, but their mammoth legislation (the House and
Senate bills both top 2,000 pages) will apply heavy-handed regulation
that will further gum up a system already choking on bureaucracy.
Americans will be forced to buy health insurance. Insurance companies
will be forbidden to price their services according to actuarial tables.
And no aspect of medical care will be free of political interference.
(One section of the Senate bill reinstates coverage for DXA scans
because two senators insisted upon it. Another requires breastfeeding
breaks in the workplace.)
The Democrats will create, among others, the following new bureaus: The
Grant Program for Health Insurance Cooperatives, the Telehealth Advisory
Committee, the Community Based Medical Home Pilot Program, the Center
for Comparative Effectiveness Research, and the Qualified Health
Benefits Plan Ombudsman. In short, Democrats have done the maximum
amount of damage to our system that they could manage under the
circumstances.
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