Roger’s Rules

Mitt's Mea Culpa & Obama's Waterloo

Mitt Romney has promised that one of his first acts as president would be to dismantle ObamaCare. (“Repeal and Replace ObamaCare” is the operative slogan.) I like to think that his imperative attention to ObamaCare is something more than a deliberate policy program. In part, I suspect, it is an act of expiation, for ObamaCare is to a large extent RomneyCare — the health care reform act that Romney oversaw as governor of Massachusetts — writ large (writ very, very large).

And since RomneyCare has been around a few years longer than ObamaCare (it came online in 2006), it provides an excellent laboratory for seeing what happens to health care when the government takes over. What is happening in the great Commonwealth of Massachusetts today is what will be happening in the U.S. of A. the day after tomorrow unless something is done about this legislative monstrosity eftsoons and right speedily.

This morning, a cardiologist friend of mine sent me a note that contained a link to an excellent article in the Wall Street Journal about RomneyCare as a guide to ObamaCare. By “cardiologist” I mean “former cardiologist,” for like many doctors I know, he has left the practice of medicine in disgust — disgust over the government’s steady encroachment on his income in part, but also disgust over the way government was intruding on the doctor/patient relationship and bureaucratizing the practice of medicine, transforming doctors into wards of the state and patients into abstract consumers of scarce medical “resources” that the government was set to ration. (Why do you think that new government guidelines suggest that regular prostate tests and other screenings are unnecessary? It’s not because those tests don’t pick up pathologies: it’s because they cost money and the government wants to limit its expenditures.)

As I say, he is only one of many doctors I know who have left or are considering leaving the practice of medicine because of ObamaCare. Indeed, a recent study by the Doctor Patient Medical Association reports that 83 percent of doctors have considered quitting because of ObamaCare. But you don’t need me to tell you this: you probably know plenty of doctors who have left or shortly will leave their practices. And the flight of doctors is only one problem: “Even if doctors do not quit their jobs over the ruling,” a precis of the DPMA report notes, “America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.”

While you’re pondering what that is going to mean for your dotage and the health care provided for your children, have a seat and prepare to get outside some of the facts purveyed by that Wall Street Journal story on “RomneyCare 2.0” from a couple weeks ago. (The full story may be available only to subscribers. What follows are highlights.)

The bottom line? “Surging costs, price controls, physican shortages” — all that and “so much else.”

The idea of RomneyCare, as with the “Affordable Care Act” (a.k.a. ObamaCare), is that it if insurance coverage were forced on everyone, costs would go down. More people, bigger pool, lower costs, right? Nope. Only lower quality of care, longer waits, more bureaucracy, and more abuse of the system.

Some stats:

— In Massachusetts, 79% of the newly insured are on public programs.

— Health costs — Medicaid, RomneyCare’s subsidies, public-employee compensation — will consume some 54% of the state budget in 2012, up from about 24% in 2001.

Let’s pause over that terrifying statistic: more than half of the state’s budget will be consumed by health care costs.

There’s more:

— Over the same period state health spending in real terms has jumped by 59%, while education has fallen 15%, police and firemen by 11% and roads and bridges by 23%.

There’s only so much dough to go around. As government-controlled medicine gobbles up more of the available resources, there is less to go around for other important services.

Yet more bad news:

— Massachusetts spends more per capita on health care than any other state and therefore more than anywhere else in the industrialized world.

Why? Because of the horrendous inefficiencies built into socialized medicine.

All this is bad for patients, i.e., you and me. But it is also bad, very bad, for doctors. Consider:

— Under the plan, all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure — that is, permission to practice. They’ll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

Were you thinking of setting out a shingle in Massachusetts as a GP, cardiologist, obstetrician, gastroenterologist, etc.? Bet you’ll think twice about that.

The Journal appropriately invokes Jeremy Bentham’s totalitarian idea of the all-seeing panopticon here:

— Massachusetts takes 360-degree surveillance and converts it into a panopticon prison. An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017, and 0.5 percentage points lower thereafter.

Got that? Your doctor is actively discouraged from spending too much on you lest that extra test that might save your life adds too much red ink to the bottom line.

RomneyCare is a disaster unfolding before our eyes. I’ll leave it to others to apportion the appropriate quantum of blame to its eponymous architect or sponsor or whatever role Mitt Romney played in the creation of the misbegotten piece of legislation. We all make mistakes. The important thing is that Mitt Romney has recognized his mistake and has credibly outlined a plan to make amends by repealing and replacing ObamaCare. Meanwhile, team Obama continues to tout the most unpopular piece of legislation since Prohibition. And people wonder why I predict Romney/Ryan will win by a landslide.