The Democrats’ health care legislation, as is or in very similar form, cannot be passed. Every choice point they encounter from this stage on leads to an internal contradiction or a dead end. To use a mathematical metaphor, their situation is overdetermined: there are too many conflicting restrictions; there is no solution to their dilemma. (To use a liberal metaphor: It’s a slam dunk!)
Democratic proponents of health care reform have the following major goals:
(1) Create a federal public health insurance option to “compete with” private insurers, or
(2) Set up state cooperatives to “compete with” private insurers on a state-by-state basis;
(3) Prevent discrimination by insurance companies based on preexisting condition—i.e., forbid insurance companies from “providing insurance”;
(4) Limit the ratio of high-to-low insurance premiums by age group.
Whether pursuing any of these goals is the government’s business—and it isn’t—Democrats need to enact some combination of these proposals in order to fulfill their aim of turning us into Canada; the Congressional Budget Office estimates that this will cost about $1 trillion.
Democrats have proposed numerous bad ideas for paying for their legislation, all of which lead to intractable circumstances that they cannot tolerate politically with the general electorate, even if they were able to figure out a way to cobble together, rush through, or force the votes in Congress to pass them, including:
(1) Increase the deficit: This would violate Obama’s promise that health care reform will be “dime”-neutral.
(2) Make taxpayers subsidize the public option: This would keep the government plan from having to cut costs or be efficient to attract and retain customers, as any private insurance company must. It would therefore eventually force those who are satisfied with their current plans to pay higher premiums or get less for their money.
(3) Cut $500 billion in Medicare: This would upset seniors, and anyone who plans to be a senior at some point in his life, who fear rationing of care.
(4) Tax high-cost plans at a 40% rate: This would anger emergency workers and union members, and huge numbers of people who will hit the non-insurance-adjusted premium threshold for this level of taxation in the next 10 years.
(5) Impose fees on insurance and pharmaceutical companies: These costs would simply be passed on to doctors, who would in turn dump them on to patients.
(6) Cap deductions for health savings accounts: This would increase out-of-pocket medical expenses.
(7) Force everyone to buy government-approved health insurance by charging a penalty for not having coverage: If the penalty were low, in order to avoid making it burdensome, then people would wait to get coverage until they became sick, then drop coverage after they recovered, which means the penalty would be useless. If the penalty were high, in order to make it effective, then the public would be infuriated over the imposition of a costly penalty for not buying something that should be optional.
(8) Cover fewer uninsured people: This would involve turning the nation’s health care system upside down while failing to fulfill the basic aim of the plan.
In case Democrats are interested, there are provisions to which they could agree, all previously proposed in legislation by House Republicans, which would actually pay for the proposed plan. These steps should be taken anyway, and should be pursued instead of the Democrats’ aims, but just for the record, they include:
(1) Medical liability tort reform: This would reduce settlement amounts and lower doctors’ malpractice insurance premiums.
(2) Tax deductions for health insurance premiums, medical expenses, and prescriptions: This would allow people to decide how to allocate their earnings toward medical expenses, which they can do more efficiently than Kathleen “Jolly Roger” Sebelius.
(3) Vouchers for opting out of Medicare: This would allow people to decide how to spend their money on medical care in old age.
(4) Interstate provision of private insurance: This would allow for greater competition and cost-cutting.
Despite conservatives’ nail-biting uncertainty over their ability to defeat HR 3200, they have one advantage: the truth. All the arguments conservatives have advanced against liberals’ bad ideas are informed by it, whereas liberals must disguise it, distort it, downplay it, or lie about it to persuade anyone that their impossible legislative feat and fevered social engineering fantasy can be achieved. There are plenty of voters and legislators who are content to ignore the truth and stumble down dead ends, but enough may turn out to be smart and honest enough to see through these efforts and find their way out of the labyrinth.