By Jane Orient View all 4 articles by Jane Orient Published 09/28/09 
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As Obama has noted, health care reform has been an emergency for at least half a century, yet many previous presidents have failed to ram through a national health system. So why is it an even bigger emergency now, requiring that we "get it done" before the end of the year? Most of it, of course, will not even take effect for several years -- until after the next presidential election. Nobody really believes that a radical restructuring of one-sixth of the nation's economy -- by adding requirements, demands, mandates, and other costs -- is going to pull us out of a recession. Or that adding a trillion dollars to the national debt will make us solvent. Part of the urgency is that the public is awakening to what the radical change will mean to them, in terms of cost, quality, and access to care. Congress is beginning to feel a lot of heat from the opposition. Waiting another few months might mean more Democrats defecting from the Speaker's and the President's agenda. But there's something else: Medicare. Now immensely popular, our single-payer system for the elderly can still be pointed to as a model. But the leading edge of the Baby Boomer generation is on the verge of retirement, and the reality of the Madoff scheme cannot be concealed much longer. The original architects of Medicare are long dead and beyond the reach of the prison system. But putting Madoff and his government imitators in prison doesn't bring back the money. Boomers have paid into the system their entire working lives. And they have simply been robbed. Their money was spent as soon as it was collected. To kick the can down the road a little longer, the government desperately needs huge new sources of revenue. Increasing taxes on the non-rich is running into resistance, and the "rich" are running out of money, so a functional equivalent of a tax is needed: mandatory "insurance premiums." "Community rated" premiums mean that younger, healthier, low-risk individuals subsidize older, sicker, high-risk individuals. That's not really insurance, but we have mostly abolished true sickness insurance anyway. Today's "health plans" look a lot more like social welfare schemes than casualty insurance, which indemnifies (reimburses) the subscriber (not the provider) in the event of a covered catastrophe. At the same time that we increase revenue, we need a mechanism for pruning liabilities. No, none of the proposed legislation contains the words "death panels." But it does have "require" and its derivatives 427 times, "limit" 167 times, and "penalty" 156 times, as John Goodman has pointed out. It sets up the infrastructure for tracking every encounter, and the incentives and disincentives (punishments) for adherence to or "deviations" from "guidelines" or "best practices." It establishes the principle that some lives are more worthy of public funding than others. It constantly harps on "prevention" and "wellness" -- to be funded at the expense of the sick, the injured, the old, and the disabled. It criticizes doctors for providing billions of dollars of "unnecessary" care or "futile" care, especially in what turns out to be the last 6 months of life. It advocates "end-of-life care," which is too easily translated into "ending life" or "non-care." The plan is structured so that a liability for the government also becomes a liability for the doctor. Provide unapproved, costly care and see your paycheck slashed. Or worse, face draconian civil monetary penalties ($50,000 per item) or even prosecution for "waste, fraud, and abuse." The doctor is working for the payer anyway, not the patient: The payer is the one who writes the check. Reform will cement the fundamental change in the patient-physician relationship that is already occurring. Physicians will no longer be healers, who serve their patients, but technicians, who help the state achieve its objectives. And they serve the state in another way too: since they are the ones who actually write the orders, they are the scapegoats for the system's failure. The proposed reforms will make many more patients dependent on a bankrupt for their only source of medical insurance -- and most doctors dependent on a bankrupt for their livelihood. Ultimately, the tens of trillions of dollars (estimates vary) of unfunded Medicare liabilities simply cannot be paid. The government will default one way or another. The younger generation will pay in an impoverished standard of living and lost opportunities. The old and the sick will be paying with their lives. The cost of the day of reckoning could be mitigated, but only if we admit to the problem and start remedying the government policies that created this situation. The longer we delay, the more dreadful the cost. "Health care reform" is a desperate delaying tactic. Those who are pushing for it will be responsible for unprecedented hardship and loss of life -- even if, as is likely, they project the blame onto someone else. Copyright © 2009 Campaign for Liberty |
Also by Jane Orient:
Health Care: Missing the Forest for the Trees 11/21/09
Town Halls: If Congress Really Cared What You Think. . . 09/22/09
Why Not a Public Option for Automobile Insurance? 07/30/09
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