Conservative Principles Now

Today’s Washington Post editorial page takes a critical look at Majority Leader Harry Reid’s (D-NV) latest “compromise” health care bill, which it describes as 11th-hour “legislative sausage” that was “made on the fly” and includes ideas dating “at least to the Clinton administration.”

Most significantly, though, the Washington Post sees Sen. Reid’s bill as a “dramatic step” toward a single-payer health care system, even if the public option is not on the table:

[T]he last-minute introduction of this idea within the broader context of health reform raises numerous questions — not least of which is whether this proposal is a far more dramatic step toward a single-payer system than lawmakers on either side realize.

In a nutshell, Sen. Reid’s latest compromise allows uninsured individuals over 55 to buy into Medicare. As we wrote on The Foundry today, that policy brings with it numerous problems, the core of which are higher costs to taxpayers, squeezing individuals out of their private coverage (including retiree coverage from a former employer), and adding costs to an already-unsustainable Medicare system.

Why would costs skyrocket? As The Washington Post notes, sicker seniors “might flock to Medicare,” thinking that the government will be more likely to approve their treatments, which “would raise premium costs and, correspondingly, the pressure to dip into federal funds for extra help.” In other words, sicker seniors would move into the public pool, costs would go up, and so too would taxpayers’ bills.

There are more questions than answers, as The Washington Post points out, regarding reduced reimbursements to health care providers and further expansions of Medicare:

Presumably, the expanded Medicare program would pay Medicare rates to providers, raising the question of the spillover effects on a health-care system already stressed by a dramatic expansion of Medicaid. Will providers cut costs — or will they shift them to private insurers, driving up premiums? Will they stop taking Medicare patients or go to Congress demanding higher rates? Once 55-year-olds are in, they are not likely to be kicked out, and the pressure will be on to expand the program to make more people eligible.

There are other serious concerns, too, as detailed elsewhere on The Foundry, including even more unintended consequences of Sen. Reid’s bill. The Washington’s Post final analysis is on point:

The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market.

This marks not the end of the public option, but the beginning of single-payer health care.

The “public option,” or government-run health insurance plan, in the just-released House health care bill was previewed in the news media as a diluted form of hard-core liberal versions that the Left have pushed for months. While that may be the case, calling the public option “more conservative” isn’t appropriate for any form.

To be fair, the intent probably was to distinguish this new public plan as a “government-lite” option because it’s supposed to let doctors and hospitals negotiate rates with the government over payments for health care services. Earlier public plans used Medicare rates (which are really price controls) to compensate doctors and hospitals — far less than what the private market pays.

As we scour through this 1,990-page monster of a bill (topping the 1,502-page health bill from the Senate Finance Committee), it will be important to determine how the feds and health care providers will come to these negotiated rates. Plus, other questions crop up, like will the government-run plan be subject to the same rules and market regulations that private insurers face? If we see the same language in the new House bill that was in H.R. 3200, then government will operate on an unlevel playing field where it has a clear advantage in the marketplace.

The bottom line is that any version of the public plan — whether it’s in the form of a trigger, an opt-out option for states or a bureaucratic cartel moonlighting as a co-op — is not conservative. Conservative health reform puts health care decisions in the hands of individuals and families through reforms on the tax treatment for health benefits and insurance market changes that put the consumer in charge.

This government-run health plan will be a wholly owned subsidiary of Congress. It will progressively displace existing private coverage and give Washington more direct control and decision-making power over the health care of ordinary Americans. If it is financed like most big public health programs, it will accumulate Medicare-style debt, while, as numerous reports from the public and private sectors show, canceling private health insurance for millions of Americans.