Obama's Health Care Whopper is Bigger

Obama's Health Care Whopper is Bigger

By Robert Robb - August 22, 2009

Health care reform supporters claim they are losing public support because of lies and distortions told by opponents designed to scare people.

There's some of that going on. But the most consequential misrepresentation in the health care debate is actually being told by President Barack Obama and other supporters.

The lie supporters most resent, and with good reason, is that the health care reform bills have death panels or provisions to encourage euthanasia for the old and infirmed. Instead, there was a provision to provide end-of-life counseling services.

There's reason to doubt that government should be paying for or involved in such services, but the country needs to continue to have a grown-up discussion about end-of-life issues. The hospice movement is one of the most blessed developments of our time, allowing people to die with dignity in their own homes rather than in an impersonal, and expensive, hospital bed.

The old and infirmed have reason for worry about health care reform, however. One of the premises of the effort is that the amount of overall health care expenditures in this country is a concern for the federal government. Virtually all the countries that are supposedly our betters in containing health care costs limit access to some medical procedures on the basis of age and infirmity.

There are not explicit provisions for such rationing in the current health care reform bills. But there are the mechanisms put in place - government panels to determine benefit packages and medical cost-effectiveness - for such. Moreover, the bills don't fundamentally change the economic incentives driving costs - third-party payers for even routine expenses - so rationing is the only practical way cost-containment will happen.

The alleged distortion that most concerns supporters is that the Obama reform constitutes "government-run" health care. Obama protests that's not true. He has a point, but not much of one.

The heart of the Obama reform, supported by virtually all congressional Democrats, is to treat health insurance companies as national public utilities. The federal government would determine the benefit packages they could offer. Pricing decisions would be strictly limited and profits capped.

An essential element of the reform is also a mandate that people purchase health insurance. If the federal government is requiring people to purchase health insurance, you can bet that politicians and bureaucrats will increasingly treat health insurance companies as federal subsidiaries, feeling free, even obligated, to meddle in every aspect of what they do.

And then there is the public option, which would be government-run health care. The notion that such an entity can exist without the government showing such favoritism that private competitors eventually die out defies logic and history.

So, the accurate way to frame the opposition point is that the Democrats are proposing extensive government control of health care, which may lead to government-run health care.

The most consequential misrepresentation in the health care debate is when Obama and other supporters claim that if people like their doctor and their insurance plan, they will get to keep them. The reason for the heavy stress on that reassurance is the belief that health care reform that jeopardizes what people currently have isn't going anywhere.

The promise is false, however, even by the terms of the committee bills. Existing plans are grandfathered in, but only for five years. After that, they have to meet the new federal mandates, whatever they turn out to be. In the interim, they can accept no new enrollees.

More fundamentally, the Obama reforms completely scramble the health care market. There will be new governmental mandates, huge new individual subsidies and different tax treatments. What employers will offer after everything is scrambled up and resettles is entirely unknowable.

Simply put, the health care coverage people currently have would be subject to considerable change. An honest health care debate would acknowledge that.

Robert Robb is a columnist for the Arizona Republic and a RealClearPolitics contributor. Reach him at

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