In his hour long speech on health care, he failed to spend even a moment rebutting the central critique of his program: His inability to provide quality medical care for 30 million new patients without any additional doctors or nurses.

The shortage of medical personnel which will inevitably accompany the expansion of the patient population will leave some element - and perhaps all -- without adequate care. Like the man who sleeps with a blanket that is too small, either his neck or his feet will get cold unless he gets a bigger blanket.

Click here to get your FREE Obama crisis kit! The result of expanding the demand for medical services without augmenting the supply of doctors or nurses must be the rationing of medical care. And rationing will inevitably take its greatest toll among the elderly, forcing them to forgo elective surgery or, if their remaining quality years are likely to be limited, to do without vital life-prolonging treatment. Inevitably, we will all have to wait many more days, weeks, months or years for care we now receive on demand.

Obama will cut Medicare and that portion of Medicaid which serves the elderly in nursing homes (75 percent) in two ways:

(a) As he said in his speech, he will cut "hundreds of millions in waste and fraud and unwarranted subsidies in Medicare." To identify this "waste and fraud" he proposes to establish a commission within the Executive Branch to investigate the program and initiate cuts. Congress will have only sharply limited power to override these reductions or else they will automatically take effect.

Obama admits that these cuts will largely take the form of reducing reimbursement rates for hospitals and doctors. Paid less per office visit, doctors will spend less time on each patient. Reimbursed less for MRIs or CT Scans, they will order fewer of them. And getting less income, more doctors will retire and fewer will enter the profession aggravating the scarcity.

The president also plans to eliminate the Medicare Advantage program, an approach to managed care which permits the elderly a coherence and a coordination in their treatment that about one-third of them find valuable enough to sign up for.

(b) His newly established panel to cut Medicare will also "encourage the adoption of...common sense best practices by doctors and medical professionals...reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan."

These are code words for the rationing the imbalance in supply and demand will cause. The panel will "encourage" doctors to adopt the "best practices" the panel recommends by limiting reimbursement rates or even banning alternatives. Likely guidelines will govern who can get elective surgery like hip replacements or new knees based on the number of QARYs "quality adjusted remaining years" the patient has. Continued...