August 7, 2009

August 7, 2009 | Commentary on Health Care

Phase II for Obamacare: The New Strategy

House Democratic leaders sent their rank-and-file members home for the August recess armed with a stunningly disingenuous memo that sets forth the Democrats' new strategy for health-care reform. "Our message is simple," the memo began. "It is in sync with the White House. And it counters the Republican 'government takeover' message."

Yes, all that "government takeover" rhetoric that has contributed to the recent round of negative polls does need to be addressed. After all, a plurality of Americans now believe that Obama-style health-care reform will increase the cost of health care not only for the nation as a whole but, most ominously, for them personally. A plurality also believe Obamacare will limit their access to care and lower the quality of health care in the United States. And then there are all those nettlesome town-hall meetings . . .

Thanks to the new talking points, town-hall participants in Democratic districts won't be bored with last month's tired old rhetoric. Gone is all that happy talk about keeping the health plan you like, or continuing to see your family doctor whenever you want. Gone is the claim that reform will "bend the cost curve" and lower overall medical costs. And don't expect to hear that the reform will, all things considered, reduce your personal health-care costs by $2,500 per year.

Pelosi and Co. have hit the rhetorical reset button.

Last month's ineffective talking points have been thrown under the bus, supplanted by attacks on the "villains" who run the nation's insurance industry. The strategy memo continues:

Hold the insurance companies accountable. Remove them from between you and your doctor. No discrimination for pre-existing conditions. No dropping your coverage because you get sick. No more job or life decisions made based on loss of coverage. No need to change doctors or plans. No co-pays for preventive care. No excessive out-of-pocket expenses, deductibles, or co-pays. No yearly or lifetime cost caps on what insurance companies cover.

In their totality, these mandates would effectively socialize the market for health insurance and transform health insurers into de facto public utilities. No word yet on how much they would increase the cost of a basic, government-approved health plan. Nor do we have the details on the extent to which this socializing effect would subsidize some (e.g., older, less healthy workers) at the expense of others (e.g., the young and the healthy). But never mind. Health and Human Services Secretary Kathleen Sebelius assures us that these reforms will deliver "peace of mind" to Americans worried about their health coverage.

The radically altered sales pitch reflects a radically altered state of play for ObamaCare. Its advocates find themselves on the short end of public opinion, and lobbying powerhouses are starting to jump off the bandwagon.

Consider the pharmaceutical industry. It had offered tens of billions in concessions on drug pricing to get a seat at the negotiating table. Now, however, it is opposing the so-called Tri-Committee Bill in the House. In a very direct letter to House leaders, Big Pharma's industry association, the Pharmaceutical Research and Manufacturers of America, explained:

[T]he House Tri-Committee Bill . . . would effectively act as a tax increase by raising premiums for seniors in the popular Medicare prescription drug program, severely restrict patient access and choice and hurt an innovative sector that currently employs hundreds of thousands of workers. The result could mean significant job losses in the middle of a recession . . .

Under the House bill, we're concerned that the federal government will wind up rationing health care and dictating what medicines doctors can prescribe to their patients. This may well prevent patients from gaining access to the critically important medicines they need to fight diseases such as cancer, diabetes and heart disease.

What's more, even the Congressional Budget Office has said that government negotiation of Medicare Part D prices would save little, if any, money.

Wow. Other than that, Mrs. Lincoln . . .

Finally, the Chamber of Commerce, the National Federation of Independent Business, and hundreds of small-business owners signed a sobering letter to House leaders. The government plan, they argue, will "significantly increase costs for every American who purchases private insurance." The proposed mandate that employers "either provide health insurance or pay huge fines or payroll taxes" will "kill many jobs." Consequently, employers "will not be able to continue offering their current plans, which cover more than 170 million Americans."

The employers' bottom line: "Market forces and employer autonomy should determine what benefits employers provide, rather than Congress."

Add in a growing rump group of influential physicians and state medical societies furious with the American Medical Association for its inexplicable endorsement of the House legislation, and the contours of the next phase of the debate are now in focus.

Expect to see it portrayed by the Left as a good, old-fashioned populist street fight - the little guy vs.big special interests; David vs. Goliath.

Specifically, the president and his allies in Congress will jettison all these large interest groups they sought to co-opt through back-room negotiations and turn elsewhere for support. They'll join hands with an entirely different collection of interest groups: think MoveOn.org, Families USA, the unions, the liberal blogosphere, and the Democratic National Committee, and you get the picture. Collectively they will don the robes and carry the slingshot of the young David and sanctimoniously seek to slay Goliath - i.e., those special-interest defenders of the status quo.

You can see the dramatic possibilities. However, this strategy poses a host of problems for the president. For one, handing over this priority issue to the tender mercies of the single-payer crowd, a cast of characters not exactly known for its volume control or subtle political judgment, will inevitably bring on a leftward shift in policy. A leftward lurch, in turn, will make it well nigh impossible for Senate Finance Committee Chairman Max Baucus (D., Mont.) to cobble together a truly bipartisan proposal. Moreover, the 52 House Blue Dogs are already having palpitations at the new approach and would almost surely oppose en masse the resulting legislation. That would make passage in the House all but impossible.

If this scenario sounds irrational, consider the leftist mindset. A government takeover of our health-care system has been the stuff of liberal dreams since the Truman administration. But, for one reason or another, that dream has never materialized. Now, our leftist friends believe the stars have aligned for "robust" reform. Why compromise your principles on your most treasured issue if, like Elvis, the Republicans, Blue Dogs, and moderate Senate Democrats have left the building?

Tragically, the prospects for legislation that would inject much-needed market principles and consumer control into health-care financing and delivery would vanish in a vitriolic debate. And that would only aggravate the undeniable problems in our current health-care system.

The rosiest possible scenario? The leftist gambit fails; congressional leaders, acknowledging that they overreached, embark on Phase III of the reform effort; ultimately, they agree on a more modest set of reforms that even conservatives can embrace.

Unfortunately, rosy is not likely.

Mike Franc is Vice President for Government Relations at The Heritage Foundation.

About the Author

Michael Franc Distinguished Fellow
Government Studies

Related Issues: Health Care

First Appeared in National Review Online