Increasingly in Washington over the last few weeks, we have heard this assessment of the president’s health care upheaval prospects: Something will pass, because the president and his party have such large majorities (nearly 60 percent) in both chambers of Congress that it is inconceivable that they could not bludgeon their way to the necessary majorities. But victory will be the product of power, not debate – and it will cost them control of the House in the next election.
The problem for the president is that he has lost the health care debate. No one in either party or in the media has dared speak this fact as of now, but it is inescapable.
Let’s review the bidding:
- Cost: The president said the upheaval would cost nothing. The Congressional Budget Office put a trillion-dollar-plus price tag on it. Others have since confirmed their assessment.
- Taxes: The president said only those making more than $250,000 per year would pay more. As details have emerged, virtually every American will be paying additional taxes to fund this new federal health care behemoth.
- Death Panels (really policies to cut the cost of that famously expensive “last year of life”): The president and his team have called the death panel charge a lie. They have pointed to Britain’s National Health Service as a counter example. But about two weeks ago, an article by British policy expert Rupert Darwall appeared in the Wall Street Journal (http://tinyurl.com/nqr3au) showing that, well, actually policies in the British service are tilted toward cutting off care to the aged. As Darwall wrote:
“[Recently] a group of senior doctors and health-care experts wrote to a national newspaper expressing their concern about the Liverpool Care Pathway, a palliative program being rolled out across the NHS involving the withdrawal of fluids and nourishment for patients thought to be dying. Noting that in 2007-08, 16.5% of deaths in the U.K. came after “terminal sedation,” their letter concluded with the chilling observation that experienced doctors know that sometimes “when all but essential drugs are stopped, ‘dying’ patients get better” if they are allowed to.”
Darwall was pointing out what everyone except the president’s policy experts seems to understand: None of us knows which year is our last year of life until we actually die. The rationing policies at the heart of the president’s money saving plan will inevitably lead to government panels setting standards for the entire population. But not everyone – actually, not most of us – will fit those standards. With genetics driving medicine towards highly individualized care at all levels, the president’s upheaval plans will drive the nation to care by the averages, or, as one former senior Food and Drug Administration official called it in a talk with me recently, a lurching back to the Middle Ages of treatment.
- Keep our own plans: The president has said that no one will be forced to give up his or her current health plan. But increasingly it is clear that his program will drive current health plans from the market. As someone put it, “No, you won’t be forced to give up your current plan. It’s just that your current plan will cease to exist.”
- More: I could go on. But undoubtedly the best rundown of the misconceptions at the heart of the president’s plan and of why he has lost the debate is a book (available here — http://tinyurl.com/6rzagq — for free in pdf form) titled The Top Ten Myths of American Health Care: A Citizen’s Guide. It is by Sally Pipes, president of San Francisco’s Pacific Research Institute (of which I am chairman). “[F]or health care policy makers, it should be required reading,” says Steve Forbes in its introduction — not that the president’s people can be expected to heed Forbes’ advice.
On point after point, the president has been on the short end of the health care argument. Facts have got in his way so often as to raise doubts about whether the White House even has a fact checking staff.
Meanwhile, he and his allies have tried to ignore the increasingly loud and much better informed voices for modest reforms that might actually lower costs while improving access and quality. A recent and brilliant brief for this consumer-driven model appeared (http://tinyurl.com/lquswk) in the September issue of The Atlantic. By businessman and Democrat David Goldhill, it was just one dozens of recent appeals along the same lines: that if Washington’s Golden Rule is “he who has the gold makes the rules”, in health care each of us individually should have the gold: not the government, not our employer, us.
Over the weekend, the Rasmussen organization released polling numbers that found the percentage of likely voters strongly disapproving of the president’s handling of his job ten points higher than strong approving. Public opposition to his health care proposals was as large a week following his recent address to Congress as it was the week before. This debate is over – even if the power politics are not.
An old political rule says, if you find yourself in a hole, stop digging. The more Mr. Obama demands passage of his unsaleable program, the higher his disapproval ratings go. The question now is, will he will he have the sense to stop digging?