ObamaCare: Unable to Keep Private Insurance

O'S BROKEN PROMISES

By BETSY MCCAUGHEY


July 17, 2009 --

PRESIDENT Obama promises that "if you like your health plan, you can keep it," even after he reforms our health-care system. That's untrue. The bills now before Congress would force you to switch to a managed-care plan with limits on your access to specialists and tests.

Two main bills are being rushed through Congress with the goal of combining them into a finished product by August. Under either, a new government bureaucracy will select health plans that it considers in your best interest, and you will have to enroll in one of these "qualified plans." If you now get your plan through work, your employer has a five-year "grace period" to switch you into a qualified plan. If you buy your own insurance, you'll have less time.

And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).

When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).

It's one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone's consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.

Nowhere does the legislation say how much health plans will cost, but a family of four is eligible for some government assistance until their household income reaches $88,000 (House bill, p. 137). If you earn more than that, you'll have to pay the cost no matter how high it goes.

The price tag for this legislation is a whopping $1.04 trillion to $1.6 trillion (Congressional Budget Office estimates). Half of the tab comes from tax increases on individuals earning $280,000 or more, and these new taxes will double in 2012 unless savings exceed predicted costs (House bill, p. 199). The rest of the cost is paid for by cutting seniors' health benefits under Medicare.

There's plenty of waste in Medicare, but the Congressional Budget Office estimates only 1 percent of the savings under the legislation will be from curbing waste, fraud and abuse. That means the rest will likely come from reducing what patients get.

One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."

This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?

Shockingly, only a portion of the money accumulated from slashing senior benefits and raising taxes goes to pay for covering the uninsured. The Senate bill allocates huge sums to "community transformation grants," home visits for expectant families, services for migrant workers -- and the creation of dozens of new government councils, programs and advisory boards slipped into the last 500 pages.

The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.

They have good reason to be. If you're diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients' needs, including providing timely treatments and a choice of doctors.

Congress should pursue less radical ways to cover the uninsured. We have too much to lose with this legislation.

Betsy McCaughey is founder of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York. betsy@hospitalinfection.org

Fattening the Beast - Fred Hiatt

Fattening the Beast

Obama’s Twist on a GOP Budget Strategy

Since the Reagan era, some conservatives have hoped to shrink government by “starving the beast.” Refuse to raise taxes, they figured, and eventually spending would have to fall.

It’s beginning to look as though the new team may have a similar strategy, in reverse: Increase spending, and eventually taxes will have to be raised.

No official has articulated that to me as a strategy. But look at the evidence.

George Bush bequeathed to President Obama a nation heading slowly but surely toward fiscal disaster. Because of an aging population and rising health-care costs, spending — primarily on Medicare, Medicaid and Social Security — will steadily rise in coming years, as the nonpartisan and authoritative Congressional Budget Office explained in a report last month. Revenue is not projected to rise nearly as quickly. The result, if the government does not alter course: crushing debt that could lead to hyperinflation, prolonged depression, or both. Poor people would suffer most, and there would be many more of them.

“The systematic widening of budget shortfalls projected under CBO’s longterm scenarios has never been observed in U.S. history,” the CBO pointed out in its usual dry style. And: “All in all, the U.S. economy could contract sharply for a long period.”

Obama’s response has been to acknowledge the seriousness of the problem — and make it worse. I’m not talking about his record-breaking stimulus plan, which was essential (if not ideally shaped) given the recession he also inherited. Rather, it is Obama’s long-term budget that would more than double the projected deficit over the next 10 years, to $9 trillion, by extending most of the Bush tax cuts and limiting the alternative minimum tax while creating new programs and entitlements (to college tuition scholarships, for example) and refusing to cut back on existing ones.

And that’s not to mention his top priority, universal access to health care. Obama has said that reform must be paid for, and he hopes it will lead to a slowing in the growth of health-care costs. That would hugely improve the long-term budget outlook.

But the prospects of cost control are tenuous, experimental, distant and politically fraught; by comparison, creating an expensive new entitlement is easy. Obama has proposed to pay for part of universal access by collecting more income tax from the wealthy, which would make the existing deficit that much harder to close. The cost of the entitlement could rise more quickly than the revenue paying for it. There is a good chance, in other words, that whatever emerges from Congress this summer will worsen the budget prognosis.

The bottom line is this: You cannot run a progressive government of the kind Obama favors by collecting only 18 percent of the gross domestic product in taxes, which has been the norm over the past 40 years. Nor can you increase the tax take to 24.5 percent of GDP — which is what Obama proposes to be spending in 2019 — simply by making the rich pay more.

But rather than level with the American people about this, or lay out a plan to raise the needed taxes, the Obama administration and the Democratic Congress are putting the spending pieces of progressive government in place and apparently counting on the tax piece to fall into place later.

Just to be clear: I support universal access to health care, and I don’t think there’s any natural law that says the U.S. economy couldn’t function with higher taxes — say, 22 percent of GDP. But you can’t get there without wrenching changes — abolishing the mortgage and charitable deductions, for example, or instituting a nationwide consumption tax. And unless you raise taxes so high that you risk choking economic growth, you also will have to trim Medicare and Social Security benefits.

It would be foolishly counterproductive to begin closing the gap in the midst of recession. But you could be setting long-term changes in motion — adjusting rules for people who will retire five or 10 years from now, for example.

Obama and his economic team understand all this, and maybe they have a plan to get from here to there. Maybe they’ll do the popular stuff first, and then next year, or next term — as global investors become alarmed at the U.S. fiscal outlook and begin driving our interest rates higher — persuade Congress to take its medicine and get the fiscal house in order.

But let’s not forget how that starving-the-beast thing worked out. Conservatives were happy to cut taxes, but cutting spending didn’t appeal all that much, and deficits soared. By postponing all the “hard choices” he warns of, Obama may be scripting a sequel.