The Magazine

Dare to Defeat ObamaCare

The American public is right. ObamaCare is wrong. It should and can be defeated.

Jun 22, 2009, Vol. 14, No. 38 • By WILLIAM KRISTOL and YUVAL LEVIN
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As long as the health care reform plan envisioned by the Obama administration and congressional Democrats was just a series of slogans, it was easy for the left to build support for it and difficult for the right to imagine how it could be stopped. It is hard, after all, to object to vague promises to cut health care costs and cover the uninsured and improve health outcomes. The brute fact of Democratic domination of Washington gave key health industry players an incentive to look as if they wanted to cooperate with the Obama administration. The whole affair began to assume an air of inevitability.

But as general slogans give way to particular plans, reality is setting in. Outlines and drafts of the key House and Senate bills began to emerge last week, and the grim reality of what the Democrats in fact have in mind has started to exercise an undeniable effect upon the politics of health care.

The fact is, the Democrats' proposals are a liberal wish list of expansions of the role of government in health care, combining an array of taxes, regulations, incentives, and mandates aimed over time to create a massive and unfunded new entitlement that would limit patient choices, ration care, and bankrupt the Treasury. The Democrats' plan would force everyone into the system through an individual mandate and lead employers to drop their health coverage; their new public insurance plan would then price private insurers out of the game and attract the refugees from private coverage into the public system. All of this would put us well on the road to government-run health care.

At the core of this scheme, and of the growing political restlessness about it, is the proposed government insurance "option"--essentially a new insurance company run by the federal government. Its defenders argue it would have no inherent advantage over private insurers and would simply spur them to improve their offerings through healthy competition. As President Obama put it last week, "One of the options in the exchange should be a public insurance option  .  .  .  [because] if the private insurance companies have to compete with a public option, it will keep them honest and help keep prices down."

It's an interesting statement. We had thought the role of government was to set rules for honest private competition, which does keep prices down and improve products. And there are reforms that could improve the important rule-setting role government should play, and could increase private competition and transparency. But Obama wants government to be one of the competitors--in the alleged interest of honesty and price reduction. When has a government alternative produced those results? Clearly the point is to use the power of the government to impose price controls and override state rules in order to undersell private insurers. The public plan is a gradual path to single payer health care, aimed at moving American health care in a European or Canadian direction.

This has made the Obama plan increasingly controversial, if not imperiled. Essentially every Republican in Washington has expressed firm opposition to a government plan, and a growing number of Democrats are doing the same. Nebraska senator Ben Nelson has called it a deal-breaker. Louisiana's Mary Landrieu said last week she would not vote for it. Many other Democrats in the Senate and the House are wary, to say the least.

Meanwhile, those industry groups who joined President Obama at the White House for a photo-op last month are now worried. One of them, the American Medical Association, announced last week it would oppose outright any plan with a government insurance option. "The introduction of a new public plan threatens to restrict patient choice by driving out private insurers," the AMA said, and the requirements of such a plan would severely burden doctors and "would likely lead to an explosion of costs that would need to be absorbed by taxpayers." The American Hospital Association sent a letter to its members in late May clarifying that "The A.H.A. did not commit to support the 'Obama health plan' or budget." AHIP, the association of insurance providers, is preparing to mount a campaign against the public plan.