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.
The government insurance "option" is clearly shaping up to be the first key vulnerability of ObamaCare. It is crucial to the logic of the Democrats' approach, as it would offer convenient cover both for the move toward government financing of coverage and for the rationing of care such a move would require. The president, congressional leaders, and key liberal interest groups have insisted it be part of any reform effort. But as outside opposition grows, it is far from clear that the government option will have the votes to pass. If it were voted down or pulled out of the Democrats' bills, the logic and the inevitability of the remainder of their reform effort would be called into question, and Republicans would face a real opportunity to make the case for their own brand of reform, and to stop the ObamaCare train in its tracks.
It is crucial that they seize the opportunity. The public plan is not the only important question in the health care debate. There are many other strong reasons for stopping a plan that would cost at least $1.5 trillion, create a huge and growing new entitlement without paying for it, impose great financial burdens on employers and individuals, displace millions of families who are happy with their existing health care arrangements, lead to increasing rationing of care, and do very little else to control health care costs. If they lose the government plan the Democrats will still pursue its ends by other means--including onerous new mandates and the federalization of insurance regulation envisioned in their bills. So conservatives need to defeat the government insurance "option"--and then move on to finish the job by exposing the other massive problems with ObamaCare, so as to bring the whole edifice of bad and dangerous "reform" crashing down.
The good news is that opinion polls suggest the vast majority of Americans do not want their health coverage forcibly changed by the federal government. Indeed, Americans today are less persuaded of the need for radical reform than they were the last time the Democrats tried to enact one, in 1993. As Michael Barone points out, "An April tracking poll conducted for the Kaiser Family Foundation shows that voters rank changing health care below strengthening the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit on a list of eight possible priorities. . . . The blunt fact is that most Americans are satisfied with their health insurance and don't believe major legislation will improve things for them."
The American public is right. ObamaCare is wrong. It should and can be defeated. It is moderates and Democrats who ultimately will defeat it late this year or next--but they will do so only if Republicans stand firm now and conservatives make the arguments now. If we do, and this fight goes well, the struggle to save the country from ObamaCare could mark the beginning of a new center-right coalition to restrain the grossly excessive ambitions of the administration and congressional Democrats, with regard not only to health care but to spending and borrowing, and to the role and reach of government more broadly.
--Yuval Levin and William Kristol