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Rationing and Taxes — Who Could Resist?

ObamaCare is now caught in a bind of its supporters’ own making. They want universal care and they want government-run care. But they are also insistent on keeping the measure cost-neutral. The only way to manage all this is to ration health care. And now the administration and its allies are stumbling, trying to explain how they are going to do this without scaring the dickens out of voters and lawmakers. So far, they aren’t doing a very good job of concealing their designs.

Bill Kristol, analyzing Ted Kennedy’s column in Newsweek, gets to what lies at the heart of liberal health care:

The government is going to decide — ahead of time, obviously, since deciding after the fact wouldn’t save any money; and based on certain general criteria, since the government isn’t going to review each individual case — what kinds of hospital readmissions for the elderly are “unnecessary” and what kinds aren’t. And it’s going to set up a system “to reward hospitals and doctors for preventing” the unnecessary ones. That is, the government will reward hospitals and doctors for denying care they now provide, care the government will now deem “unnecessary.”

And Peter Orszag, in one of his least coherent outings, got caught on exactly the same point in this exchange on Fox New Sunday with Chris Wallace:

WALLACE: The president says no rationing of health care costs, but you’ve mentioned a couple of times he wants this commission of doctors and medical experts to oversee medical practices.

In the end, aren’t they going to be telling private and public insurers what treatments are allowed and what treatments aren’t?

ORSZAG: This is the biggest canard that is floating throughout this debate. The fact of the matter is right now politicians and insurance companies are making decisions. We’re saying we want doctors to be making decisions. And I think that will lead to a higher-quality, lower-cost system over time.

WALLACE: But when you say they’re making decisions, they would be saying, “You can have this treatment. You can’t have this treatment.”

ORSZAG: Do you think that politicians are currently rationing care? Are insurance companies currently rationing care? There is no set of decisions that this commission would have that is not currently resting with either members of Congress or insurance companies.

WALLACE: So they would be rationing care.

ORSZAG: No, I — because I don’t think we’re rationing care today. And similarly, they would not be in the future.

What they would be doing is setting reimbursement rates and moving towards a higher quality system.

Got that? On one hand, he says that “right now politicians and insurance companies are making decisions.” But then he insists: “I — because I don’t think we’re rationing care today. And similarly, they would not be in the future.” This is doublespeak, of course.

When Orszag acknowledges that the current bill isn’t cost neutral because it is not slashing Medicare payments (i.e., not restricting care) and the way to achieve cost neutrality would be through setting up “an independent commission to help bring down costs over the long haul,” he is talking about limiting care. We know how this works whenever government-run health care is forced to wring costs out of a system.

There is an irony to this. HMOs — impersonal bureaucracies that squeeze care and hold down costs — used to be the bane of liberals. These were the “bad guys” who denied care, thought up excuses not to spend money, and stood between patients and doctors. Now liberals want to turn the entire health-care system into one big HMO.

As Americans become aware of the scheme, this will seem less and less attractive. If we are going to hike marginal tax rates above 50% and whack small business in the middle of a recession, shouldn’t we get something better than what Kennedy, Orszag, and Obama are peddling? It seems the “perfect” plan to simultaneously hobble our economy and our health care. And, really, who is in favor of that?



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