Catastrophe - Dick Morris [47]
Obama has already extended coverage to more children under the SCHIP program and to unemployed adults under the COBRA program. The feds pay two-thirds of the cost of insurance for anyone who is unemployed for nine months.
But how will Obama extend coverage beyond its current limits? Though he hasn’t specified the details of his program, its broad outlines are visible. To cover those without insurance, Obama will require all employers either to pay for insurance or to give money to a federal program to buy it for them. He will also launch a new federal government insurance program offering benefits comparable to those given members of Congress. Consumers or employers could switch from their current plans, if they wished, to enroll in the new federal program.
That’s the good news.
The bad news is that adequate medical care for the additional 47 million people is going to mean worse care for the rest of us.
The issue isn’t money. Obama estimates the cost of his health care program at about $600 billion over ten years. That’s surely a lowball estimate; cost calculations on medical care always are. But he can and will raise the extra money.
How? Despite pledging not to tax employer-paid health benefits during the campaign—and attacking McCain for proposing it—he might reverse field and institute such a tax. As of this writing, he is promising to fund at least half of his program by curtailing tax deductions for state and local taxes, charitable donations, or mortgages for those making more than $200,000 per year. But the charities are kicking up a fuss, and he may have to backtrack.
One way or another, he’ll probably come up with the money. Democrats are good at that.
But it isn’t money that is the problem—it’s the supply of doctors and nurses. You can’t just buy good medical care. It takes years to train doctors and nurses to deliver it. Even if Obama were to start now, massively recruiting future doctors and nurses, it would take at least five to ten years to build the workforce he needs.
The New York Times reports that Massachusetts has adopted a variant of the plan Obama is likely to propose—and impose—is facing just such a shortage of medical personnel:
The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.
“Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.
The ratio of primary care doctors to population is higher in Massachusetts than in other states.
You can spend more money on health care, but that won’t buy you an instant enlargement in the number of doctors to provide it.157
And Obama’s cuts in the cost of health care will inevitably involve limiting compensation, at least for doctors and perhaps for nurses too. The tighter the limits, the lower the cost—but the fewer people who will enter the professions. So cost limitations are likely to worsen the supply shortage.
The answer, then, has to be rationing—government control over who gets what service. Since the problem isn’t how to pay for the service but how to find the medical personnel to deliver it, Americans won’t be able to opt out and pay for the services themselves. Rationing means being told what tests, procedures, operations, treatments, medicines, therapy, and so forth you’re able to get and which ones you’re not. These decisions, of course, will be made not by your doctor or nurse but by bureaucrats—people who’ve never met you but who will literally determine whether you live or die.
If you read between the lines of Obama’s happy pronouncements on health care, you can see that he is leading toward rationing.
Mindful of the mistakes Bill and Hillary Clinton made in 1993, Obama always goes out of his way to say that if you’re happy with your insurance, you can keep it and not be affected