Nasty surprises are always nasty. We can expect to see a lot of them as the details of Barack Obama's Big Bopper Bailout unfold over the next several months. Joe Biden reckons the chances of the bailout working, despite the hype and hysteria, to be no better than 30 percent "even if we do everything right, if we do it with absolute certainty."
We've already had a few nasty surprises, enlivening the front pages from the moment President Obama took the oath. Sen. Judd Gregg's deciding that he doesn't have the stomach to be the secretary of Commerce is only the latest of the misfires. But the nastiest surprises are not likely to be the failure of the bailout legislation to work, but the way some of it will work only too well. The surprises won't be the Bridges to Nowhere, but the bridges to places no one wants to go.
Nastiest of all will be the health care catastrophe hidden in the thousands of pages of this legislation, the work of Tom Daschle, who was almost secretary of Health and Human Services before he was sent back to K Street to work on his tax returns.
The health rules set out in the bailout legislation will, as the bill boasts, affect "every individual in the United States." There will be no escaping the consequences of turning life-and-death health care decisions over to officious bureaucrats. (Members of Congress will get their usual special privileges.) If you think dealing with insurances companies is as awful as it can get, you'll be surprised.
A vast bureaucracy called the National Coordinator for Health Information Technology, soon to be vaster, will carefully monitor what your doctor prescribes for you, not to protect and restore your health, but to make sure your doctor does what the government deems "appropriate" and "cost-effective."
These provisions are identical to the prescriptions set out by Mr. Daschle last year in his book about what to do about "the health care crisis." Doctors, he wrote, have to forgo their own judgment and "learn to operate less like solo practitioners." Deference will not be required to, say, distinguished professors from the Harvard Medical School, but to narrow-minded little men armed not with learning but with a lot of attitude, trained not in the medical arts and sciences but in government paperwork.
"Hospitals and doctors that are not 'meaningful users' of the new system will face penalties," Betsy McCaughey, a former lieutenant governor New York who is an analyst of health care issues at Hudson Institute, writes for Bloomberg News. " 'Meaningful' user isn't defined in the bill. That will be left to the HHS secretary, who will be empowered to impose 'more stringent measures of meaningful use over time.' "
How doctors will be penalized for putting the health of their parents above all else is not specifically set out in the bailout bill. But Mr. Daschle offers a hint or two in his book, language borrowed by the authors of the bailout bill's health care passages. The goal is to slow up the development of new medications and treatments that are driving up costs. He praises Europeans - whose health care is rarely praised for its quality or efficiency - as being more willing to accept "hopeless diagnoses."
Americans expect miracles; Europeans are resigned to mediocrity. (Does anybody go to London or Paris for advanced surgery?) The government bureaucrats would work from a formula dividing the cost of the treatment by the number of years a codger could expect to live. The elderly are expected to understand they're supposed to get sick when they get old, and hear something like: "Here, take this aspirin and if you don't feel better tomorrow don't call me, call the undertaker."
He cites as an example of what to expect from the decree of a British health board, which told elderly patients with macular degeneration that they must wait until they go blind in one eye before they could get expensive drugs to prevent losing sight in the other. Only after years of angry protests was the grotesque regulation rescinded.
But where are the angry protests here from Congress, or from the American Association of Retired Persons (AARP), which worked to elect Barack Obama. Where is the coverage from our robust mainstream media? Where is the follow-up to Miss McCaughey's revealing account in Bloomberg?
President Obama and his partisan allies in Congress are determined to get this bailout legislation to his desk for a signature before all its gory details are discovered. He calls it "inexcusable and irresponsible" to delay. Why the rush? He remembers what happened to Hillary Rodham Clinton's health care plan, and he's determined that this one gets no scrutiny, or, as Mr. Daschle warns, is "stalled by Senate protocol."
The nasty surprise is saved for later.