Commentary Magazine


Topic: health care

The Move to Single-Payer Health Care

Do voters exist? In the United States, that is–do we still have voters? All available evidence points to yes, we have millions upon millions of them who vote in national elections. But maybe I’m getting too caught up in the numbers. Recent anecdotal evidence challenges my theory. I’m referring, of course, to the obvious consequences if the Supreme Court strikes down Obamacare. The result, everyone says, will be single-payer, government-run health care for all.

The problem, though, is that this was suggested and polled repeatedly during the health care debates in 2009-10. As the debates dragged on, a single-payer health care program repeatedly polled as the least popular path to universal coverage, and its poll numbers dropped over time. So I’ll pose a simple question: If the entire Obamacare law is struck down, will President Obama campaign on a single-payer system? No, he won’t. And the reason is because it will hurt him with voters, who in the end really do exist. Ezra Klein has, however, proposed a feasible way for the Democrats to move toward a default single-payer system:

I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children’s Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans — and particularly a majority of Americans who have significant health risks — are covered by the government.

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Do voters exist? In the United States, that is–do we still have voters? All available evidence points to yes, we have millions upon millions of them who vote in national elections. But maybe I’m getting too caught up in the numbers. Recent anecdotal evidence challenges my theory. I’m referring, of course, to the obvious consequences if the Supreme Court strikes down Obamacare. The result, everyone says, will be single-payer, government-run health care for all.

The problem, though, is that this was suggested and polled repeatedly during the health care debates in 2009-10. As the debates dragged on, a single-payer health care program repeatedly polled as the least popular path to universal coverage, and its poll numbers dropped over time. So I’ll pose a simple question: If the entire Obamacare law is struck down, will President Obama campaign on a single-payer system? No, he won’t. And the reason is because it will hurt him with voters, who in the end really do exist. Ezra Klein has, however, proposed a feasible way for the Democrats to move toward a default single-payer system:

I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children’s Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans — and particularly a majority of Americans who have significant health risks — are covered by the government.

It certainly could happen. Klein isn’t in love with the idea, to say the least. But yes, it’s a possibility. But the part I take issue with is the first sentence, in which Klein says everybody walks away from the health insurance issue for a decade. I don’t think Obama would do that, and I don’t think the election could pass by without health care thrust right back in the debate, only this time centered on the question of how to replace Obamacare.

So in that case, politically, what does Obama do? Like I said, I don’t think he runs as an advocate for single-payer. Klein’s suggestion is probably workable in the long run, but Obama can’t run on it. He cannot stage a re-election campaign on the idea that he’ll give up the reform game and that it’s now up to Harry Reid to slowly and quietly bring us to the cusp of single-payer while everyone else is distracted watching “Mad Men” and arguing over Tim Tebow.

Again, I don’t doubt the feasibility of this incremental Medicare-for-all approach. But elections include voters, and voters will want to know what the candidates are going to do about health care if Obamacare disappears entirely. The president cannot say “nothing.” He cannot say “trust us, we’ll take care of it in a way that requires no public discussion and no voter input.” And he cannot say: “We’ll do what Canada and Britain have done.” So what will he say?

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Opposition to ObamaCare High Among Women, Youth

During the past year, opinion polls have consistently shown widespread public disapproval of President Obama’s health care reform law. The Hill has a new survey out reaffirming this, as the Supreme Court prepares to hear arguments on the constitutionality of the law later today.

The most interesting takeaway from the poll is that the disapproval for ObamaCare is spread across most voting demographics, including two key groups that Democrats have argued benefit most from the law: young people and women. From The Hill:

By a 52-percent-to-39-percent margin women are more opposed to it than men, who oppose it 48 percent to 45 percent, a difference that matches the poll’s 3-point margin of error. …

While even the youngest voters oppose the law (47 percent to 42 percent among those aged 18-39), opposition grows to 53 percent among voters aged 65 and older.

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During the past year, opinion polls have consistently shown widespread public disapproval of President Obama’s health care reform law. The Hill has a new survey out reaffirming this, as the Supreme Court prepares to hear arguments on the constitutionality of the law later today.

The most interesting takeaway from the poll is that the disapproval for ObamaCare is spread across most voting demographics, including two key groups that Democrats have argued benefit most from the law: young people and women. From The Hill:

By a 52-percent-to-39-percent margin women are more opposed to it than men, who oppose it 48 percent to 45 percent, a difference that matches the poll’s 3-point margin of error. …

While even the youngest voters oppose the law (47 percent to 42 percent among those aged 18-39), opposition grows to 53 percent among voters aged 65 and older.

While President Obama didn’t personally commemorate the two-year anniversary of his health care law last week, his campaign has been emphasizing the supposedly positive impact the law will have on women and young Americans. Obviously, the numbers in The Hill poll complicate that message. The fact that women are more likely to oppose the law than men is particularly interesting, and gives the GOP an opening to try to frame this as a women’s issue.

But the poll also bolsters one of the main arguments we may hear from Democrats if the Supreme Court does end up overturning the law or portions of it. While voters want to see the law repealed, they also believe the justices’ eventual decisions may be politically motivated:

Although voters want the Court to strike the law, they don’t necessarily trust the justices’ motivations. Fifty-six percent of likely voters believe the justices are swayed by their own political beliefs, while just 27 percent believe they “make impartial decisions based on their reading of the Constitution.”

Skepticism about the justices relying on their political beliefs ran consistently among age, racial and philosophical categories, with a majority of whites (54 percent), blacks (59 percent), Republicans (56 percent), Democrats (59 percent), conservatives (54 percent), centrists (56 percent) and liberals (59 percent) expressing the same viewpoint.

When people decry “judicial activism,” often they’re really using it as a euphemism for a decision they don’t like or don’t agree with. If the law is struck down, the health care issue will likely become an election-year motivator for Democratic voters, and the blame will no doubt be pinned on conservative activist judges.

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ObamaCare Gross Cost Expected to Double

ObamaCare’s gross cost during the next ten years is expected to nearly double the $940 billion price tag projected in 2009. Phil Klein reports on the Democratic Party’s sketchy math that resulted in the discrepancy:

Democrats employed many accounting tricks when they were pushing through the national health care legislation, the most egregious of which was to delay full implementation of the law until 2014, so it would appear cheaper under the CBO’s standard ten-year budget window and, at least on paper, meet Obama’s pledge that the legislation would cost “around $900 billion over 10 years.” When the final CBO score came out before passage, critics noted that the true 10-year cost would be far higher than advertised once projections accounted for full implementation.

Today, the CBO released new projections from 2013 extending through 2022, and the results are as critics expected: the ten-year cost of the law’s core provisions to expand health insurance coverage has now ballooned to $1.76 trillion.

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ObamaCare’s gross cost during the next ten years is expected to nearly double the $940 billion price tag projected in 2009. Phil Klein reports on the Democratic Party’s sketchy math that resulted in the discrepancy:

Democrats employed many accounting tricks when they were pushing through the national health care legislation, the most egregious of which was to delay full implementation of the law until 2014, so it would appear cheaper under the CBO’s standard ten-year budget window and, at least on paper, meet Obama’s pledge that the legislation would cost “around $900 billion over 10 years.” When the final CBO score came out before passage, critics noted that the true 10-year cost would be far higher than advertised once projections accounted for full implementation.

Today, the CBO released new projections from 2013 extending through 2022, and the results are as critics expected: the ten-year cost of the law’s core provisions to expand health insurance coverage has now ballooned to $1.76 trillion.

However, the projected net cost of ObamaCare is actually down, though not for a particularly encouraging reason. The CBO estimates that many more Americans will lose private insurance coverage under ObamaCare than previously thought, which means the federal government will rake in more revenue from fining uninsured individuals and businesses that don’t provide coverage. IBD reports:

The projected rise in revenue is ironically largely due to the increase in the uninsured and the decline in employer-based coverage.

The government will fine individuals $45 billion — up from $34 billion — for failing to have insurance. Businesses are expected to pay $96 billion for not providing coverage, an increase of $15 billion.

Another $81 billion in higher net revenues comes largely from employees no longer getting tax-exempt health insurance but instead being paid more in taxable wages.

So ObamaCare will cost more than thought, but make up for it by increasing the number of Americans who are uninsured, and thus fineable. And remember, this is all happening because the Obama administration wanted to lower insurance costs and provide more coverage for the uninsured.

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Obama Supporting the Troops?

Could the Obama administration make it any clearer that it has little regard or respect for the men and women who make the world safe so that the president can indulge so happily in the rich man’s game, and his wife and family can gallivant so luxuriously around the globe?

Bill Gertz at the Washington Free Beacon reported yesterday on some strong opposition from the VFW, the Military Officers Association of America, and House Armed Services Committee Chairman Howard “Buck” McKeon to the Pentagon’s plan to lay some of its budget cutting squarely on the backs of military personnel by raising their healthcare fees.

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Could the Obama administration make it any clearer that it has little regard or respect for the men and women who make the world safe so that the president can indulge so happily in the rich man’s game, and his wife and family can gallivant so luxuriously around the globe?

Bill Gertz at the Washington Free Beacon reported yesterday on some strong opposition from the VFW, the Military Officers Association of America, and House Armed Services Committee Chairman Howard “Buck” McKeon to the Pentagon’s plan to lay some of its budget cutting squarely on the backs of military personnel by raising their healthcare fees.

Specifically, if President Obama and Defense Secretary Panetta have their way, active duty servicemen and women will have to pay higher co-payments for prescriptions and will no longer get incentives for buying generic drugs.  And military retirees will see 30 percent to 78 percent increases in their annual healthcare premiums for the first year, and after that, five-year increases from 94 percent to 345 percent.

Meanwhile, guess who gets off scot-free in the budget-cutting scheme? Surprise! It’s civilian workers – in the Department of Defense and other agencies – who happen to belong to that last bastion of labor movement power, government employee unions. And just to hedge the president’s bets on another four cushy years in the White House, the increases aren’t scheduled to begin until after the election.

Oh, and, for anyone who still buys Obama’s promise that we’ll be able to keep our current plans if we like them, apparently his administration expects that one of the side benefits of the planned increases will be to push American soldiers, sailors and flyboys (and girls) away from their military healthcare plans and into the waiting arms of the Patient Protection and Affordable Care Act program.

Hot air about supporting our troops from Mrs. Obama and Dr. (Jill) Biden notwithstanding, it’s pretty obvious where the sympathies of this White House lie.

 

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Obamacare’s Stepchildren: The Food Police

The debate about Obamacare and the way the government is using it to mandate that institutions pay for services they oppose such as contraception has brought the whole question of intrusive federal regulation back into the public eye. But those who believe this is something that will be limited to health care are probably deceiving themselves. The impulse to tell people how they should live and what they should do is implicit in the ideology that gave birth to Obamacare. If some influential people have their way, Washington’s power to impose its will may be extended into other spheres that were heretofore considered so far out of the government’s purview as to have been considered laughable. But as New York Times Magazine food columnist Mark Bittman wrote yesterday, the day may be fast approaching when government bureaucrats will be telling some, if not all citizens, what foods they may or may not eat.

Bittman picks up on the attempt by a conservative Republican in the Florida legislature to pass a bill that would prevent recipients of food stamps from spending their chits on junk food like candy, chips or soda. The willingness of a right-winger to join the food police encourages Bittman to think the time will not be long before sugar is regulated the way the production and marketing of alcohol and tobacco are controlled by the government. While Bittman’s nutritional advice about the dangers of over-consumption of products drenched in sugar and corn syrup is well taken, the notion that such choices will be taken out of the hands of consumers ought to frighten anyone who values individual freedom and understands the perils of a nanny state. Some may scoff at this possibility, but the Obamacare precedent and the power the president’s signature program will give the government may change everything in the future. Bittman’s argument that the costs of health care will make such government micro-managing of our lives inevitable may prove prophetic if Obamacare is not repealed next year.

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The debate about Obamacare and the way the government is using it to mandate that institutions pay for services they oppose such as contraception has brought the whole question of intrusive federal regulation back into the public eye. But those who believe this is something that will be limited to health care are probably deceiving themselves. The impulse to tell people how they should live and what they should do is implicit in the ideology that gave birth to Obamacare. If some influential people have their way, Washington’s power to impose its will may be extended into other spheres that were heretofore considered so far out of the government’s purview as to have been considered laughable. But as New York Times Magazine food columnist Mark Bittman wrote yesterday, the day may be fast approaching when government bureaucrats will be telling some, if not all citizens, what foods they may or may not eat.

Bittman picks up on the attempt by a conservative Republican in the Florida legislature to pass a bill that would prevent recipients of food stamps from spending their chits on junk food like candy, chips or soda. The willingness of a right-winger to join the food police encourages Bittman to think the time will not be long before sugar is regulated the way the production and marketing of alcohol and tobacco are controlled by the government. While Bittman’s nutritional advice about the dangers of over-consumption of products drenched in sugar and corn syrup is well taken, the notion that such choices will be taken out of the hands of consumers ought to frighten anyone who values individual freedom and understands the perils of a nanny state. Some may scoff at this possibility, but the Obamacare precedent and the power the president’s signature program will give the government may change everything in the future. Bittman’s argument that the costs of health care will make such government micro-managing of our lives inevitable may prove prophetic if Obamacare is not repealed next year.

Bittman is right to say obesity has become a major national health problem. Nor would I dispute his arguments that American nutritional habits are doing us and the country no good. But the notion that this is reason enough to give the government the power to prevent people from buying the food they wish to eat is a fundamental assault on individual liberty.

Food stamp recipients are vulnerable to such regulation because their poverty and dependence renders them helpless against such intrusions. If they are taking our money, some people reason, then we should be able to tell them what to do, especially if it is obviously for their own good. But this sort of utilitarian argument has no limits. If the national exchequer is burdened by the costs of caring for those who suffer from obesity, then we can just as easily be told that sugar or any other substance selected by the food police (Bittman prefers the term “vigilantes”) can be regulated or banned for everyone, not just those who rely on government handouts.

The ideological underpinning of this thinking can be found in Bittman’s assertion that it is the government’s job to take care of itself. If, as he believes, the government is failing to sufficiently protect us from ourselves, then it is time for enlightened souls to step in and force it to take control. However well-intentioned Bittman’s prescription for the national diet may be, government involvement on the scale that he is discussing is the epitome of the political trend that Jonah Goldberg aptly styled Liberal Fascism.

One might assume the food industry will fight this expansion of government control tooth and nail. But the example of Obamacare demonstrates all too well how businesses can be co-opted into acquiescing to a takeover by the federal leviathan. Unless Obamacare is stopped next year by a new president and Congress, we may well eventually find out just how far the reach of an empowered government can go.

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