Revolutionary. There's no other word that more aptly describes the health reform that was just enacted. It will affect everyone. Every employee. Everyone on Medicare. Everyone on Medicaid. It will even affect those who choose to remain uninsured. It will give the federal government enormous control over a sector that spends one out of every six dollars in our economy. Once fully phased in, the ten-year costs will approach $2.5 trillion - and maybe more.
Given all that, does anyone find the way the president talks about health care these days a bit strange? As I said in my post at National Review and at the National Journal Health Blog, the president and most Democrats in Congress are focused on the minutia. Consider these fairly routine stump speech phrases:
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"Insurers will not be able to drop your coverage after you get sick." True enough. But this practice has been illegal for the last decade-and-a-half under a federal law called HIPAA. It's as though the White House went back through the books, found a law it liked, and chose to pass it again!
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"There will be no more lifetime caps on health insurance benefits." Good news, no doubt, for the 1/100th of 1% of the population who bumps up against them.
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"If you have a 26-year-old dependent child who can't get health insurance elsewhere, you will be able to cover him on your own health plan." Well, okay. But how many 26-year-olds have this problem? NCPA employees can buy insurance for their children more cheaply in the individual market than we can in the group market.
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"If you have a child or adopt a child, your insurer will not be able to exclude him because of a pre-existing condition." Don't most states already require this? And isn't it standard insurance practice anyway?
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"In four years, no insurer will be able to discriminate against anyone because of a pre-existing condition." True enough. But more than 90% of everyone in the United States with health insurance is already in a plan that can't exclude people because of pre-existing conditions. And for the other 10%, only a small fraction faces serious problems.
I could go on, but I think you get the picture. For the people who have the problems just described, the problems are real and sometimes tragic. But they represent a minute fraction of the overall set of problems ObamaCare is designed to address.
Anything You Want, You Got It
The rhetoric the president is using these days is radically different from the rhetoric he used only a few months back in making the case for reform. Does anyone remember the president saying that 47 million people have inadequate access to care? Or, that for 300 million Americans, costs are too high? Or that quality is too low? What happened to all those problems?
I have a theory. Although the president says he doesn't pay attention to public opinion polls or focus groups, I think that is all he is paying attention to these days. I imagine the focus groups went something like this:
"Okay, we know you all don't like this big bill, but is there any part of it you do like?....Even a small sliver?....What about 26-year-olds?....Could we see a show of hands on that provision?.....Okay!.....We have a winner!.....Tell the speech writers to put that up near the top, Joe."
Also, I don't think there is anything new about this strategy. Barack Obama's approach to health care has always been poll-driven. During the Democratic Party's presidential primary, Obama (along with every other serious candidate) repeated the "universal coverage" mantra over and over again. Presumably, this is what the party's base wanted to hear.
But after his primary victory, we never heard the words "universal coverage" again - at least not that I recall. Instead, "cost" and "quality" became the reasons for reform that appealed to general voters.
Today, however, the polls are clear. People do not believe that ObamaCare will solve the problems of rising costs and inadequate quality. In fact, they believe it will make those problems worse.
Although people do believe that ObamaCare will insure a large number of the uninsured, the president faces a huge credibility problem on this score as well. Where are the 32 million newly-insured people going to get additional health care? The very reform that will spend several hundred billion dollars a year on health insurance spends not one dime to train new doctors and nurses or build even a single new hospital!
So, Obama is talking about "insurance reform" issues, because this is the only area where he has any credibility left. He is playing trivial pursuit, because those are the only cards he has left to play.
John C. Goodman is president and CEO of the National Center for Policy Analysis. The Wall Street Journal and the National Journal, among other publications, have called him the "Father of Health Savings Accounts," and the Media Research Center credits him, along with former Sen. Phil Gramm and columnist Bill Kristol with playing the pivotal role in the defeat of the Clinton Administration's plan to overhaul the U.S. health care system. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system.
Dr. Goodman's health policy blog is the only right-of-center health care blog on the Internet. It is the only place where pro-free enterprise, private sector solutions to health care problems are routinely examined and debated by top health policy experts throughout the country-conservative, moderate and liberal
