National Health Insurance Reform Done

The passage of a bill that will supposedly “reform” private health insurance, while radically altering the manner by which medical services are delivered to American citizens, was achieved with much drama, less prudence, and no judgment as Congress voted 219-212 in favor of a measure widely seen as seriously if not fatally flawed — even by many of its proponents.


Fittingly, it was in the last few hours of debate that the dishonesty of reform supporters reached its zenith. A toothless executive order piously reiterating the language of the Hyde Amendment banning federal funds for abortion was signed by the president, thus supplying a fig leaf for “pro-life” Democrats, allowing them to vote in favor of the bill and giving Speaker Nancy Pelosi the margin she needed for victory.

But as Jennifer Rubin points out, “If ObamaCare says, ‘We will subsidize abortion,’ no executive order can effectively say, ‘but not really.'”

On such trivialities was the partisan coalition of Democrats cobbled together to pass the bill.

Indeed, in a striking and ironic twist to the entire debate over nationalized health insurance, the president’s call for a bipartisan effort was met not by proponents of the bill, but by its enemies. The 34 Democrats who opposed the measure made the bill the president’s first success in creating a bipartisan coalition, although the fact that it almost derailed the effort to realize his dream of massive federal regulation of the insurance industry probably gives him little cheer.

What hath Congress wrought? The difference between what the president and congressional Democrats say the bill will do, and the likely effect the legislation will have on the lives of American citizens, is a chasm whose depth and girth is unknowable. What we know is that more people will have health insurance, and that those who currently have no insurance due to a pre-existing condition will be able to purchase policies. Beyond that, Democratic claims such as insurance that offers more benefits while costing less and no change in most citizens’ insurance plans are viewed with a jaundiced eye by serious analysts. If we didn’t know any better, we would accuse the Democrats of lying about this, except they wouldn’t lie about something as critically important as health insurance, would they?


It is written that doctors and hospitals will receive less in payments from the government for treating Medicare patients, but nobody believes that. It is written that the government will dutifully find hundreds of billions of dollars in Medicare fraud, but no one believes they will find as much as they are saying they will. It is written that state Medicaid programs will be just fine with the sudden influx of 30 million new subscribers, although the balance between federal and state contributions to the program will not change and nobody believes the burden on states won’t skyrocket.

In short, despite the fact that no one believes some of the basic actuarial and fiscal assumptions that under-gird this legislation — no one who isn’t besotted with partisan fervor — it was rammed down the throats of the American people with as much cynicism, trickery, deliberate obfuscation, and budgetary tomfoolery as has ever been seen for a major piece of legislation in the history of the republic.

The idea that “the perfect is the enemy of the good” in this case is nonsense, made even more idiotic by the notion that this is the best Congress could have done. Subsidizing couples who make $88,000 a year so that they can purchase health insurance is not perfect, not good, not prudent, and titanically unfair. The same goes for singles who earn less than $44,000. Since it is extraordinarily unlikely that the cost of insurance will stop increasing, the prospect of rising subsidies that would make the program even more expensive than Democrats were trying to hide from the public becomes a virtual certainty.


This brings us to the cost of this monstrosity. Others have debunked the $940 billion price tag over 10 years for this bill, pointing out the seminal fact that the cost of the legislation was arrived at by not counting the first four years of the next decade when the costliest provisions in the legislation will not be operative. The real cost of the bill in the first decade of its operation — 2014-2023 — is more than $3 trillion. Similar legerdemain was achieved in “savings” that would be realized, and for the same reason.

At bottom, it isn’t the fact that the numbers have been fudged, smudged, and mutilated to massage them into a PR pablum that would help the bill go down easier with the American people. It’s the breathtaking irresponsibility inherent in the notion that we are creating this out-of-control entitlement at a time when the federal budget will be running deficits of more than a trillion dollars a year almost as far as the eye can see.

What madness has gripped Democrats in Congress who have already shown an enormous reluctance to deal with our current deficit and a willingness to add untold billions of dollars to it that has the real potential to bankrupt us? The depth of this delusion is matched by a towering myopia akin to the captain of the Titanic blindfolding his lookouts in order to ensure a collision with the fatal iceberg.

Thus, the president’s pledge to have the most transparent administration in history has been met. It’s too bad that he didn’t tell us that he would lead the most transparently hypocritical administration in history. The fact that the Democrats aren’t even bothering to hide their cynicism about the disconnect between their rhetoric and what the bill will accomplish has few parallels in the history of Congress.


There will be constitutional challenges to several aspects of the bill, but the chance of the courts finding the entire program illegal are slim. Hopes that a Republican majority that might be elected in 2010-2012 could repeal the bill is also based on a chimerical notion: no entitlement once granted by Congress has ever been repealed. And if history is to be a guide, it is also true that any estimates about the cost of this program are laughably inaccurate. No health entitlement has ever obeyed the importunings of its creators and stayed within budgetary bounds.

Others may wish to exaggerate and claim that this is the “death of freedom” or that the bill places us on the road to a Marxist dictatorship. Instead, I agree with Matthew Yglesias, who proudly states that health care reform is the completion of the American welfare state:

If reform passes and is signed into law, then immediately Barack Obama’s position in history is secured. When people look back from 2060 on the creation of the American welfare state, they’ll say that FDR, LBJ, and BHO were its main architects, with Roosevelt enshrining the principle of universal social insurance into law and Obama completing the initial promise of the New Deal.

To paraphrase Benjamin Franklin, you’ve got your welfare state — if you can keep it.


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