Charles Krauthammer

WASHINGTON -- Obamacare Version 1.0 is dead. The 1,000-page monstrosity that emerged in various editions from Congress was done in by widespread national revulsion not just at its expense and intrusiveness but at the mendacity with which it is being sold. You don't need a Ph.D. to see that the promise to expand coverage and reduce costs is a crude deception, or that cutting $500 billion from Medicare without affecting care is a fiction.

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But there is an exit strategy. And a politically clever one, if the Democrats are smart enough to seize it.

(1) Forget the public option. Whatever the merits, and they are few, it is political poison. It dies by the Liasson Logic, the unassailable observation by NPR's Mara Liasson that there are no liberal Democrats who will lose their seats if the public option is left out, while there are many moderate Democrats who could lose their seats if the public option is included.

(2) Jettison any reference to end-of-life counseling. People see (correctly) such Medicare-paid advice as subtle encouragement to voluntarily refuse treatment. People don't want government involvement in a process they consider the private province of patient, family and doctor. The Senate is already dropping it. The House must follow.

(3) Soft-pedal the idea of government committees determining "best practices." President Obama's Federal Coordinating Council for Comparative Effectiveness Research was sold as simply government helping doctors choose the best treatments. But there are dozens of medical journal review articles that do just that. The real purpose of FCCCERs is ultimately to establish official criteria for denying reimbursement to less favored (because presumably less effective) treatments -- precisely the triage done by the NICE committee in Britain, the Orwellian body that once blocked access to a certain expensive anti-blindness drug until you went blind in one eye.

(4) More generally, abandon the whole idea of Obamacare as cost-cutting. True, it was Obama's original rationale for creating a whole new entitlement at a time of a sinking economy and a bankrupt Treasury. But, as many universal-health care liberals complain, selling pain is poor salesmanship.


Charles Krauthammer

Charles Krauthammer is a 1987 Pulitzer Prize winner, 1984 National Magazine Award winner, and a columnist for The Washington Post since 1985.

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