October 19, 2009
By Robert A. Book, Ph.D.
The debate over health-care reform has sparked all sorts of
controversy over costs, regulations and choices. But one 'feature'
seems to have escaped notice: the built-in lack of accountability
of our elected leaders for what health care will be like after the
plan is implemented.
Proponents claim we need reform now to solve an immediate health
care "crisis." "If we don't act, 14,000 Americans will continue to
lose their health insurance every single day," President Obama
claimed on July 22.
Yet the bills he urges us to support will not actually provide
any health care until 2013 -- by which time, if the president's
claim is correct, an additional 17 million Americans will have lost
Why the delay? The best way the people have to hold their
elected leaders accountable for results is by threatening to
withhold their votes. But this bill seems expressly designed to
eliminate that source of accountability. By the time Americans
experience the effects of this health care bill (except for the tax
increases), not only will President Obama have run for re-election,
but so will two-thirds of the senators -- and every House member
will have been up for re-election twice. Their votes on health care
reform will be old news. If it goes very badly, it will be too late
to vote those responsible out of office.
Furthermore, the House bill leaves all the knotty details and
controversial issues to the newly created "Health Choices
These and other issues will be left to an appointed
official. Elected leaders will never have to face the voters and
defend these crucial decisions that affect the life and health of
every American, since the decisions will be made by an unelected
Any representative or senator confronted by an angry constituent
could respond, in effect, "I didn't say grandma couldn't have a
pacemaker. I didn't deny you that expensive cancer drug. It was the
independent, nonpartisan Health Choices Commissioner. Congress --
let alone any individual member -- can't micromanage every decision
the commissioner makes."
By pushing the tough decisions onto a bureaucrat -- so they
don't have to go on the record by voting -- they effectively enact
a system that allows them to dodge accountability.
The same official would also have the authority -- even the duty
-- to audit the private plans that compete with the public option
(or "co-op"), both employer-sponsored plans and plans sold by
insurance companies. The official could audit plans randomly or "in
response to complaints" -- and according to the House bill, demand
"reimbursement" for the cost of the audits. In effect, a competitor
or disgruntled former employee could run any employer or insurance
company out of business by filing repeated complaints to force the
targeted company to pay the cost of repeated audits to verify their
And if the commissioner determines that any violations have
occurred? Then according to the House bill, he or she is authorized
to impose civil money penalties, suspend further enrollment in the
plan, withhold premium payments made through the federal "exchange"
and "work with State insurance regulators to terminate plans" (p.
These penalties are entirely up to the commissioner. No
particular evidentiary standard is required, and no appeals process
is specified or mentioned, let alone any decision by a judge or
jury. The commissioner, who will administer the "public option" or
"co-op" plan, is totally unaccountable to anyone for penalties
imposed on competing private health plans. And does anyone expect
him or her to impose penalties on the "public option" or "co-op"?
Is this the promised "level playing field"? The one designed to
"keep insurance companies honest"?
The real question is, with such broad and unaccountable
authority, who will keep the Health Choices Commissioner and the
secretary of Health and Human Services honest? And more important,
with none of this taking effect until after the next two elections,
who will keep the politicians honest?
Book, Ph.D., is Senior Research Fellow in Health Economics in
the Center for Data Analysis at The Heritage Foundation.
First appeared in St. Paul Pioneer Press
The debate over health-care reform has sparked all sorts of controversy over costs, regulations and choices. But one 'feature' seems to have escaped notice: the built-in lack of accountability of our elected leaders for what health care will be like after the plan is implemented.
Robert A. Book, Ph.D.
Senior Research Fellow in Health Economics
Read More >>
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