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Jewish World Review
April 8, 2009
/ 14 Nissan 5769
Health Care in the Offing
Of all President Barack Obama's transformative domestic policy
proposals, none is more far-reaching and less transparent than health
care. What most Washington policy people mean when they talk about his
health care proposal was described in the first two paragraphs of Robert
Pear's meticulous article in The New York Times on April 1:
"Efforts to overhaul the health care system have moved ahead rapidly,
with the insurance industry making several major concessions and the
chairmen of five Congressional committees reaching a consensus on the
main ingredients of legislation. The chairmen, all Democrats, agree that
everyone must carry insurance and that employers should be required to
help pay for it. They also agree that the government should offer a
public health insurance plan as an alternative to private insurance."
Also, President Obama wants to digitalize and collect all patient health
care data initially because such data could assist in assessing best
This is, for certain, a controversial and vastly expensive universal
coverage proposal; it would cost between about $1.5 trillion and $2
trillion over 10 years. But the full scope of the president's health
care policy ambitions cannot be understood without accounting for his
claim that he needs to do health care this year as part of his long-term
plans to reduce the deficit.
While some emergency-room and related cost savings would be realized if
everyone had health insurance, no one seriously suggests that such
savings would even put a dent in the $1.5-2 trillion that this proposal
would cost in tax increases and debt issuance in the first 10 years.
The president's claim only would make sense if this huge proposed
undertaking were to be merely the first step in a series of timed policy
changes on a path toward nearly comprehensive federal government
regulation and management of health care.
What follows is my surmise of what the administration hopes the path to
America's future health care system will look like. Currently, a little
less than one-fifth of the American economy is devoted to health care.
Of that, about 68 percent of it is in the private sector, with 32
percent run by the government (Medicare, Medicaid, Veterans Affairs,
Defense Department health services, etc.).
This year, the Democrats hope to pass the above described universal
coverage law, which would include creating a public insurance option,
that is, the federal government would offer health insurance plans to
compete with the private-sector health insurance that most of us
purchase through our employers. In the face of government's undercutting
the cost of private-sector health insurance, more and more Americans
would choose to come under the federal health system.
At some point, the age eligibility for Medicare may be lowered (perhaps
to 50 or 55), and the income ceiling for Medicaid may be raised, thus
further increasing the percentage of the public covered by government
rather than by private-sector health insurance.
According to Tom Daschle (Obama's first choice to design and implement
his health care policy), in order to manage federal cost by prescribing
permissible treatment procedures and medical technological use (and
proscribing diagnostic and treatment methods deemed not cost-effective),
a regulatory board to establish standards for public health care
delivery in the United States would be created modeled on how the
Federal Reserve Board and Securities and Exchange Commission oversee
banks and corporations. Technically, it only would oversee the public
health systems. But in his book last year on how to redesign health
care, Daschle suggested: "Congress could opt to go further with the
Board's recommendations. It could, for example, link the tax exclusion
for health insurance to insurance that complies with the Board's
After first squeezing the private insurance policies by undercutting
their offerings with a subsidized federal government health insurance,
the government then could undercut the private insurance further by
denying the insurers tax deductibility unless they complied with federal
health service regulations. As only the wealthiest could afford to buy
private health insurance if the cost were not deductible, private health
insurance companies would be compelled to follow federal benefits and
At that point, almost all Americans would get their health care pursuant
to federally regulated systems. Then the president would be able to
begin to deliver on his twin pledges to reduce the cost of entitlements
and make health care overall contribute to lower deficits.
The federal regulators could do merely what the British regulators do
Constantly reduce the compensation of doctors and all other skilled
health care providers. (As domestically trained American doctors became
scarcer, more not-as-well-trained foreign doctors would be needed.)
Limit the availability of medical technology. (In Canada, patients
have to wait for months for MRIs, so those who can come to America for
immediate diagnostic services.)
Ration available treatment to fit the federal budget requirements. The
universal digitalized health data could be used to justify non-treatment
on a cost-benefit basis. For example, hip replacement for older people
may be denied because they are not likely to live long enough to justify
At that point, Americans would (too late) understand more fully what
happens when health care is a right rather than a service purchased by a
sturdy, free people in an unfettered free market.
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Tony Blankley is executive vice president of Edelman public relations in Washington. Comment by clicking here.
© 2009, Creators Syndicate