The so-called Obamacare package now before the U.S. House of Representatives is neither socialism nor – by itself – a solution for what’s wrong with health care in America. We’d prefer to order a different bill, but this is the only one on the menu.
The claim that President Obama and Congress are enacting something like socialized medicine isn’t serious. Britain has socialized medicine: The system is owned by the state, and doctors are government employees.
Canada’s semi-socialized “single-payer” is a hybrid: The government is the insurer, but many doctors remain in private practice. Most liberal Democrats probably wanted something like Canada’s system, but they didn’t get it and they didn’t get even the consolation prize of a government-run “public option.”
The new “reconciliation” bill the House will vote on shortly would leave America’s private insurance industry in place, but with new regulations designed to cover the nation’s uninsured and help the insured keep their coverage. It’s not a conservative, market-oriented plan, but the American health care system has been a creature of heavy regulation for many decades.
The bill isn’t a line drive to far left field. If one accepts the premise that a wealthy, civilized country shouldn’t leave so many of its working citizens without insurance, the measure is a defensible effort to protect them.
Defensible, but very far from ideal. The bill creates a vast new entitlement without enough safeguards to keep its costs in line.
House Speaker Nancy Pelosi and other supporters are celebrating a new estimate from the respected, nonpartisan Congressional Budget Office, which concluded that the plan would not increase the federal deficit over the next 10 years. But the CBO’s ground rules require it to assume that future lawmakers will honor the intentions embodied in the present bill.
Don’t bank on it. For that CBO estimate to work – and keep on working after 10 years – Congress will have to resist constituent pressure to kill cost-saving provisions (in Medicare, for example) and fatten benefits. Even this Congress showed how quickly lawmakers cave in the face of such pressure when the Democratic leadership gutted a measure that would have discouraged cost-escalating “Cadillac” insurance plans.
In health care, cost-control isn’t just for Scrooges. If the new regime merely perpetuates a Medicare-style money pit, the system will go bust. It’s a matter of sustainability. Reform won’t be complete until Congress ensures that Americans will still be able to afford it 15 and 20 years out.
We’re hoping that the sheer weight of the national debt – and the threat of having all other national priorities swallowed by health costs – will constrain spending in the long run.
The question now is whether to adopt an imperfect package or wait who knows how many years before another imperfect package again gets this close to passage.
The answer depends on whether Americans ought to have ready access to affordable medical coverage – wealthy or not, healthy or not. We think they do.
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