STAFF NEWS & ANALYSIS
There's an Exit Strategy in Obamacare Ticket?
By Staff News & Analysis - August 31, 2009

Obamacare Version 1.0 is dead. The 1,000 page monstrosity that emerged in various editions from Congress was done in by widespread national revulsion not just at its expense and intrusiveness but at the mendacity with which it is being sold. You don't need a Ph.D to see that the promise to expand coverage and reduce costs is a crude deception, or that cutting $500 billion from Medicare without affecting care is a fiction. – Washington Post Writers Group

Dominant Social Theme: But where is it?

Free-Market Analysis: Are the compromisers becoming more evident. This article indicates that there are ways to move the American health-care bill forward by removing the public option and emphasizing insurer-led cost control. The article is actually written tongue-in-cheek (see below), but let us – to begin with – deal with it seriously. US health care does not need cost-cutting or various kinds of panels to determine what procedures are effective and what are not. What health care in the US and elsewhere in the Western world needs is a good dose of free-market competition.

We've pointed out in previous articles that the private sector is extraordinarily inventive when it comes to solutions that benefit those in need of them. One only needs to look at the 1800s to bear witness to numerous religious and private charitable groups that provided social services to those who needed them. This is not unusual or surprising. Human beings are extraordinarily social beings and the urge to provide for others, locally, amounts to a genetic compulsion.

It has apparently been shown by archeologists and psychologists that humans have the ability to recognize up to 90 individuals within a familial setting. This makes a great deal of sense as older humanity apparently moved in fairly small tribes with family bonds to keep them together. But within a larger context what the state represents is a recognition of a kind of shared responsibility. Caring for others is hard-wired into the human psyche. Left alone, communities will create safety nets that have nothing to do with government mandates.

It is a sad fact that government programs often intrude on the delicate web of related charity provisions that provide the realest kind of aid to the impoverished and helpless. But such programs are inevitably bureaucratic in nature, which means that the impetus of the service providers is to retain their own employment primarily. Privatized public charity, administered by private means on behalf of mandated public services, is likely even worse. In these instances, as we have pointed out, cost-containment is likely a priority.

Only private charity, privately administered, can truly serve the community at large. It does so in small doses on a one-to-one level in many cases. It partakes of larger private solutions and uses care-givers employed in the private sector to provide what is necessary. This means the same level of care is available to all.

There is nothing mysterious about private charitable provisions. The argument against them is that they are not comprehensive enough and are likely to miss needy cases. But the alternative, public charity, or privatized public charity is no better and over time likely worse. Public charity suffers from rigidity and its inclusiveness may mean only that all are exposed to insufficiency. Privatized services are often adversarial to those they are supposed to serve.

As we indicated above, the writer of the article, conservative columnist Charles Krauthammer, is not in this article suggesting a private option so much as indicating that any tinkering with what has been proposed by the Obama administration is bound to end with a public option sooner or later – and rationing as well. Here is how he presents his argument further down in the article:

But there is an exit strategy. And a politically clever one, if the Democrats are smart enough to seize it.

(1) Forget the public option. Whatever the merits, and they are few, it is political poison. It dies by the Liasson Logic, the unassailable observation by NPR's Mara Liasson that there are no liberal Democrats who will lose their seats if the public option is left out, while there are many moderate Democrats who could lose their seats if the public option is included.

(2) Jettison any reference to end-of-life counseling. People see such Medicare-paid advice as subtle encouragement to voluntarily refuse treatment. People don't want government involvement in a process they consider the private province of patient, family and doctor. The Senate is already dropping it. The House must follow.

(3) Soft-pedal the idea of government committees determining "best practices." President Obama's Federal Coordinating Council for Comparative Effectiveness Research was sold as simply government helping doctors choose the best treatments. But there are dozens of medical journal review articles that do just that. The real purpose of FCCCERs is ultimately to establish official criteria for denying reimbursement to less-favored (because presumably less-effective) treatments – precisely the triage done by the NICE committee in Britain, the Orwellian body that once blocked access to a certain expensive anti-blindness drug until you went blind in one eye.

(4) More generally, abandon the whole idea of Obamacare as cost-cutting. True, it was Obama's original rationale for creating a whole new entitlement at a time of a sinking economy and a bankrupt Treasury. But, as many universal-health care liberals complain, selling pain is poor salesmanship.

(5) Promise nothing but pleasure – for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one – Obamacare 2.0 – promulgating draconian health-insurance regulation that prohibits (a) denying coverage for pre-existing conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement.

Having explained in a tongue-in-cheek way what the administration could do to extricate itself, Krauthammer then shows that his solution will still likely end up with socialized health care:

Here's what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage – but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop and how much they can limit their own liability, they will live off government largesse — subsidized premiums from the poor; forced premiums from the young and healthy.

It's the perfect finesse: Government health care by proxy. And because it's proxy, and because it will guarantee access to (supposedly) private health insurance – something that enjoys considerable Republican support – it will pass with wide bipartisan backing and give Obama a resounding political victory. Isn't there a catch? Of course, there is. This scheme is the ultimate bait-and-switch. The pleasure comes now, the pain later. Government-subsidized universal and virtually unlimited coverage will vastly compound already out-of-control government spending on health care.

The financial and budgetary consequences will be catastrophic. However, they will not appear immediately. And when they do, the only solution will be rationing. That's when the liberals will give the FCCCER regulatory power and give you end-of-life counseling. But by then, resistance will be feeble. Why? Because at that point the only remaining option will be to give up the benefits we will have become accustomed to. Once granted, guaranteed universal health care is not relinquished.

We think Krauthammer's real point is that almost ANY such legislation will merely further diminish the private sector in American health care. And we believe the current problems all have to do with the creeping socialism of the system, starting with corporate offerings of health back in the 1940s, to Lyndon Johnson's Great Society programs in the 1960s, to George Bush's government drug benefits in the 2000s. Each government give away drags the system further into the public domain and further complicates simple transactions.

After Thoughts

The health care debate throughout the West has been distorted by a false impression of the options available. It is not the private sector that should be questioned but the public. In fact, it probably cannot be mentioned too many times that public options are usually unsupportable as they tend to expand to the limits of whatever income is available without providing commensurate service. The end result of universal health care services is the right to every available health care option and the utilization of very few, if any.

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