Premium ObamaCare (2009 Aug)

by Barry A. Liebling

President Obama pledged that he would bring change to America during his election campaign, and he has made Health Care Reform a priority for his first year in office. The president’s website ( promises that his program will “Reduce costs, guarantee choice, including a public option, and ensure quality care for all.” The big claim is that the President’s Health Care Reform will be a vast improvement compared to the present system.

The editors of The Wall Street Journal ( /SB124692973435303415.html) do not expect the President’s reform to be benign. They anticipate that Americans will see something similar to what is in the UK – where the National Institute for Health and Clinical Excellence (NICE) contains health care costs by mandating which treatments will be permitted (only the most effective) and who will be treated (only those most likely to benefit). The Wall Street Journal reports that NICE-managed health care leads to horrendous consequences. For example, to conserve government funds older people suffering from macular degeneration, a cause of blindness, can only be treated in one eye. Similarly, women under 25 cannot obtain cervical cancer screening because it is rare in that age group.

The Wall Street Journal writers are worried that if ObamaCare comes to pass the default quality of health care will go down for most people, and they are probably right. In a government-run system there will always be limited resources, and some form of rationing is inevitable. But that does not mean that premium health care will be completely extinguished. Instead, the game will change, and the key to getting the best service will shift from having access to money to being politically connected.

In a private health care system money is the key to getting excellent services. If you have substantial financial assets or an insurance policy with generous benefits you can get the best that modern medicine has to offer. If there were a free market in health care – which there is not – insurance companies would be able to sell policies anywhere in the country (instead of having to deal with each state one at a time) and genuine competition would drive premiums down. Health plans would reflect consumer preferences (instead of government requirements about what is covered whether the providers or consumers want it or not), and innovation would flourish as health care providers and consumers negotiate mutually advantageous arrangements.

The details of ObamaCare have not been worked out, and probably will not be fully understood until after the legislation is passed. However, the guiding principle that animates ObamaCare is obvious – transfer decisions away from private individuals and put them under the supervision of public servants. More than ever before the government will control the world of health care.

And control is the prize that the statist is really after. While they acknowledge that excellent health care and innovation are good things, statists are willing to sacrifice quality for the power to decide who gets what. In a free market there is no telling who will accumulate money – it is often people who government officials despise. There is no way to determine how money will be spent – perhaps on health care services that bureaucrats do not approve of. With the government hand on the steering wheel “social justice” can be achieved – people can be nudged into producing and consuming health care services according to the preferences of experts.

But there are always loopholes. Some citizens are more equal than others. In countries where the state is the main supplier of health care there is a better tier of service available to those who are deemed to be “important to society.” You can be sure that if America has a dominant “government option” high ranking public officials will go to the front of the line, obtain premium services, and never have to choose whether their left eye or right eye is treated.

In the new world of ObamaCare what can you do to get the best health care if you are not a government big shot? You might still get excellent private treatment if you have enough money, but you may have to visit clinics abroad.

Within the new system the surest way to get the positive attention of the health care gate keeper will be to demonstrate that you are contributing to “the social good.” Never mind about working to better yourself in business; that is the old fashioned way.

The modern path will be volunteering for public service. You will have to pretend to be unselfish and community-oriented, or worse – actually embrace collectivism. You can demonstrate your fealty to the new order by participating in the Corporation for National and Community Service – which was started under President Clinton. It oversees AmericaCorps (the federal program where adults volunteer to work on programs important to the state), ServeAmerica (where students get involved in community-based organizations), and Senior Corps (volunteers over 55 are assigned to help those who need them the most). You should expect these programs to expand and the danger of not serving in them to increase.

President Obama has promised to bring change to the health care system. How will you respond?

*** See other entries at in “Monthly Columns.” ***

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