The fractious, divided nature of the Democrats' majority in Congress continues to extend the health care debate - and excite the press, who are enthralled by every "11th hour" compromise. Still, Democrats’ internal squabble over the public option will cause them to miss their fourth (or is it fifth?) artificial deadline this year. It also provides a convenient distraction from the real story: poll after poll shows that, in the court of public opinion, Democrats have lost the debate – and lost badly.
True, 63 percent of the public still believes that the health care system needs major changes or a complete overhaul according to George Washington University’s Battleground poll. But 64 percent think that Obamacare does not address their priorities, the largest of which is the cost of health care.
It’s no surprise that no one outside the Beltway is drinking the health care Kool-Aid. Democrats’ bills are riddled with contradictions and fiscal gimmicks – and the more the public learns about the legislation, the less they like it.
Nowhere is this more apparent than in the legislation’s Medicare provisions. For weeks, it has become increasingly clear that if Democrats actually follow through on their plans to cut $400 billion from health care support for the elderly, seniors will see sharp cuts in their benefits and reduced access to doctors and hospitals.
This is unlikely. But if Democrats cave to the pressures to keep up entitlement spending and simply further raise taxes to pay for subsidies for the uninsured, they’ll rob future generations of their dollars, economic vitality and hope for a more prosperous future.
The "doc fix" is a real-time example. Under both the House and Senate legislation, Medicare physician reimbursements are slated for a hit of over 20 percent starting in 2011. But House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have both advanced over $200 billion in new spending to rescind the cuts, blowing a hole in the budget along the way.
Democrats seem to believe nobody will notice. But the key constituency – those 55 and older – is watching closely. According to a survey released Friday by Resurgent Republic, fully 81 percent oppose the cuts to Medicare in the health legislation, which is the heart of the supposed funding mechanism. And 68 percent expect health care reform to increase the bloated deficit.
The public knows cynical bait-and-switch politics when it sees it. While embracing the program as a “sacred trust” between generations, Democrats are using across-the-board Medicare cuts to fund a new health care entitlement for the middle-class uninsured. While claiming deficit reductions, the reality is just the opposite: The Congressional Budget Office estimates that the coverage provisions – subsidies, Medicaid expansions, and tax credits – in the Senate bill would rise at about 8 percent annually, bending the cost curve up. While raiding one broken entitlement to fund the start-up of another, Democrats are luring new beneficiaries into the train wreck.
It is a $2.5 trillion house of cards, with Medicare at the center, poised to collapse and bring the economy down with it.
Democrats want to argue that even if their reforms are costly, we’ll end up with a better health care system. Will it really be better? Fifteen million Americans would be thrust into Medicaid, further crowding out private coverage. Their providers and hospitals would receive just a fraction of the costs of the care they provide for millions of new patients. The CEO of Johns Hopkins Medicine says the expansion could have “catastrophic effects” on the safety net care for low-income Americans.
Dozens of new committees, commissions, and panels would drown health care providers in yet more red tape, adding to the administrative headaches that plague providers now.
Using the metrics the public cares most about, the Democrats would worsen, not improve, the status quo. True, they do cover millions of uninsured – but in the most expensive, bureaucratic way possible.
It’s not too late for responsible policymakers to choose a different course. Entitlement and delivery system reforms could genuinely bend down the cost curve and make existing insurance less of a burden. As savings are generated, they can gradually be used to expand coverage through high quality private health insurance.
A separate track should focus on insurance system reforms and the creation of high-risk pools that can offer coverage to the uninsured with the highest needs. The approach would cost a fraction of the legislation in Congress and responsibly expand the nation’s safety net programs. This two-tiered approach is more honest, avoids playing shell games with Medicare funding, and meets the real health care concerns of Americans.
While the press obsesses over Senator Reid’s arm-twisting route to 60 votes, voters recognize that the Democrats' partisan legislation will lock the country into an unsustainable spiral of debt or taxes. On Main Street, Democrats have lost the real debate – and that’s why it looks increasingly like their efforts will fail.
Douglas Holtz-Eakin is former director of the Congressional Budget Office and a fellow at the Manhattan Institute