The Medical State of the Union
By Richard E. Ralston
September 10, 2009
President Obama is an intelligent and eloquent speaker. He understands the advantages of making an argument on a complicated and unpopular subject to a room that will provide a standing ovation once every minute.
But Americans do not need to listen to extended periods of adoring applause. On an important issue like health care reform, they need to listen to the substance of what was said—and take note of what was not said—as President Obama's message to Congress on September 9 reaffirms a commitment that will so intimately intrude on our rights and daily lives.
The red herring that everyone who currently has insurance will be allowed to keep it omits the detail that a government-managed "public option" would provide an overwhelming financial incentive to every employer in the country to drop insurance for their employees in favor of throwing them into the public plan.
The President and many in Congress have indeed made it clear that they prefer a completely government-controlled, single-payer insurance system. The public option, as supporters like Rep. Barney Frank (D-Mass) have stated, is the best and surest path to a single-payer system and would accomplish that end by demonstrating "the strength of its power," as he puts it—an accurate, if ominous, turn of phrase. The public option would be enacted with that intent and would be administered with that objective.
Further to that end, a "trigger" to impose a public option if insurance companies fail to reduce costs—after all of the government-imposed costs are in place—would inevitably be implemented by those anxious to pull the trigger.
Most deceptive about the President's stubborn defense of the public option is the assertion that only government can provide competition to private insurance, when it is only the government that now prevents private insurers from competing with each other. Current federal legislation that prohibits the selling of insurance across state lines could be repealed along with the massive coverage mandates now required in most states.
But requiring everyone to buy current policies will only serve as a powerful magnet to special interests who will pile on further coverage requirements, which will further reduce competition and drive up insurance costs.
When insurance companies are forced to sell policies to those with preexisting conditions whose care will cost far more than the premiums they pay, what will happen to other policyholders' premiums? What will happen if insurance companies can place no limit on annual or lifetime payments and must pay millions of dollars for experimental treatments? And if they must reduce co-pays and other out-of-pocket expenses? And if they must pay all the costs of expensive diagnostic tests? If insurance companies must pay new taxes and fees on high-level insurance coverage that they provide, who will pay for that?
The President explained that eliminating inefficiency and waste in Medicare would pay for his proposals, but not why massive new government programs are a necessary precondition for such savings. Nor why, if the wonder of competition from government insurance will do so much to improve private insurance, the few paltry examples of competition in Medicare Advantage must be eliminated in order to pay for it.
Most ludicrous in the speech was the President's notion that Congress can do anything about costs, with such measures as creating 53 new government boards and agencies. When has Congress controlled spending on anything?
Most evasive was the rhetorical gesture in the direction of medical malpractice reform. The President conspicuously did not propose any reforms in Congress but promised to set up a few "demonstration areas"—as if no one knows what has to be done.
The tragedy is that President Obama and his supporters have not proposed the things government could do—or stop doing—to promote more affordable health care. That would take a stand for real reform, not standing ovations for more government powers.
Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine.
Copyright © 2009 Americans for Free Choice in Medicine. All rights reserved.
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