There is an air of absurdity to what is mistakenly called "health-care reform." Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. Recovering slowly from a devastating recession, it's widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending, and curb massive future deficits. The president and his top economic advisers all say this. (Click here to follow Robert J. Samuelson ).
So, what do they do? Just the opposite. Their sweeping overhaul of the health-care system—which Congress is halfway toward enacting—would almost certainly make matters worse. It would create new, open-ended medical entitlements that would probably expand deficits and do little to suppress surging health costs. The disconnect between what Obama says and what he's doing is so glaring that most people could not abide it. The president and his allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.
The campaign to pass Obama's health-care plan has assumed a false, though understandable, cloak of moral superiority. It's understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise in the public good.
It is false for two reasons. First, the country has other goals—including preventing future financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans—that "health-care reform" would jeopardize. And second, the benefits of "reform" are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today's uninsured would be modest. They already receive substantial medical care; insurance would help some individuals enormously, but studies find that, on average, gains are moderate.
The pretense of moral superiority dissolves before all the expedient deceptions used to sell the health-care agenda. Obama says he won't sign legislation that adds to the deficit. One way to do this is to put costs outside the legislation. So: doctors have long complained that their Medicare reimbursements are too low; the fix for replacing the present formula would cost $210 billion over a decade, says the Congressional Budget Office. That cost was originally in the legislation. Now it's been moved to another bill, but because there are no means to pay for it, deficits would increase.
Another way to disguise the costs is to count savings that, though they exist on paper, would probably never be realized in practice. The House bill claims reductions in Medicare reimbursements of $228 billion over a decade for hospitals and other providers. But Congress has often prescribed reimbursement cuts that, under pressure from providers, it's later rescinded. Claims of "fiscal responsibility" for the health-care proposals reflect "assumptions that are totally unrealistic based on past history," says David Walker, former U.S. comptroller general and now head of the Peter G. Peterson Foundation.
Equally misleading, Obama's advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with no legislation. The studies estimate the extra spending, over the next decade, at $750 billion, $525 billion, and $114 billion, respectively. The reasoning: greater use of the health-care system by the newly insured would overwhelm cost-saving measures ("bundled payments," "comparative effectiveness research," tort reform), which are weak or experimental.
Though these estimates could prove wrong, they are more plausible than the administration's self-serving claims. Its health-care plan is not "comprehensive" because it slights cost control; and if its spending commitments worsened some future budget crisis, it wouldn't qualify as "reform." It would be a self-inflicted wound.