The Senate Gang of Six may make some marginal improvements to health-care legislation, such as the elimination of a government-run “public plan” and of the tax increase on high-earners. The downside of these changes is that they may help Obamacare to pass with bipartisan applause for the supposed reasonableness of the Senate negotiators. Conservatives should not be fooled and should not stand down. Even without the public option and the surtax, Obamacare would cause a huge, hard-to-reverse reduction in the quality and affordability of health care — and would represent a setback to free markets and conservatism, as well.
The public option is certainly a weakness of the current House Democrats’ bill, one that could destroy the private-insurance market over time. But the rest of the bill takes the same federal-government-knows-best approach. It uses mandates on employers and individuals to force tens of millions of Americans to buy the level of insurance coverage the federal government demands. For those who cannot afford this level, it offers subsidies in the form of a new entitlement. And it increases the federal role in telling doctors and hospitals what constitutes appropriate medical practice.
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The mandates — effectively, they are taxes — will reduce wages, limit new hires, and increase prices. The subsidies, enormously expensive from the outset, can be expected to grow with time to cover a larger and larger share of the population, just as Medicaid has done, and for the same political reasons. And having the government dictate medical practice worsens care and will inevitably lead to rationing.
Even without the public option, liberal health legislation fails the basic tests laid out by President Obama himself. He has called for universal coverage and reduced costs. But requiring people to purchase health insurance, even with subsidies, does not mean that all people will have health insurance, as Massachusetts residents have recently learned. The Congressional Budget Office reports that even the government-run option would leave us with 17 million uninsured. Meanwhile, it is getting harder and harder to find anyone who can repeat the administration’s lines about “bending the cost curve” with a straight face.
If Obamacare is enacted without a new surtax, its immense costs will lead to tax increases soon enough. If it is enacted without a public plan, the federal government will nonetheless be paying a bigger and bigger share of a larger and larger number of people’s health-insurance bills. What we have here, in other words, are amendments that change the speed rather than the direction of the legislation.
And it is premature to celebrate even a modest victory. The public option may yet resurface in a new guise. Senate majority leader Harry Reid, in his usual bumbling way, has previewed the subterfuge: “We’re going to have some type of public option, call it ‘co-op,’ call it what you want.” Changing the name on the government-run option will not make it any less government-run. Conservative arguments have made great headway in making the Democrats defensive about a public plan. But removing a single objectionable feature from Obamacare does not make the overall package any less intrusive or ineffective. It's still a pig, even if the Democrats have started taking out their lipstick.
