The "Government Option": "Single Payer" By Another Name

Hugh Hewitt
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Posted: May 18, 2009 12:00 AM

Ask any employer that provides their workers with health insurance what they will do if the government offers every American a "government option" for their health care. Whether the employees want it or not, if the feds offer every American the option of buying a health insurance policy from the federal government, employers will be immediately begin sending out notices that health care is no longer a company-provided benefit and directing their workers to the 1-800 number for the new federal plan. The boss may even include a slight pay hike with the notice as a nod to the enormous savings he or she will be achieving by off-loading the cost of employee health care, but that bump --if it comes at all-- will be a short term analgesic that will mask the onset of long-term pain. The "government option" will quickly become the single payer nightmare that is Canadian health care, and Americans will look back at the summer of 2009 and wonder when this became the American way of medicine.

This is the great head-fake of the health "reform" debate taking place behind closed doors in D.C. Veterans of the 1993 Hillarycare debate know that "single payer" scares most Americans and with good reason. The vast majority of Americans are used to picking their doctors and getting great care in relatively rapid fashion. We don't like the idea of waiting months or even years for "elective" surgeries, and we abhor the idea of having only a handful of doctors available from which to chose our provider.

If the "government option" emerges from the high-stakes negotiations under way right now, it will be the "reform" that swallows the entire system. It is no secret that large companies want to dump the responsibility for providing health insurance to their employees. The costs are high and going higher because American workers want the best health care available. Unions demand it in negotiations, and businesses competing for top drawer talent must offer health plans that appeal to the cream of the workforce, plans which are then available to all levels of the employee network.

But if the mirage of a government-backed plan suddenly appears (complete with a vast new bureaucracy to enforce the rules and calculate the discounts for those at or near the poverty line) embattled employers will see the opportunity to escape en masse from their expensive obligations to their workforce. The big insurance companies may survive a while, but competing against the government dooms most of them to an obviously uncompetitive position vis-a-vis any federal plan.

The rhetoric of "competition" that single payer fans are using to spruce up the "government option" is deeply deceptive. Many if not most private sector plans will face extinction as they are pushed into a ruinous race to the bottom of the benefits pool by employers studying the bottom line advantage of shifting health care costs to the government. Think about "competing" with Amtrak for passenger rail service and you get the picture of the future of the health care system.

Doctors will quickly have to decide whether to refuse the government plan's rate and rules. Some will, but those with the sunk costs of education and equipment purchased under the old rules will have to try the option of going off the government grid, forcing an immediate fracturing of American medicine into two systems, one for the wealthy and one for everyone else. Right now most of the waiting rooms of America's health care professionals are as diverse as the workforce that is covered by employer-provided health care. Within months of the adoption of a government option, expect many of your doctors to greet your next request for an appointment with the news that he or she isn't accepting the government option.

Beyond that immediate series of dislocations, look for a sharp decrease in the number of talented young people heading towards medical school. Of course many thousands of young doctors will pursue their dreams of being healers regardless of the economics of the out-years of their practices, but only fools will deny that thousands of other would-be doctors will simply refuse to go to work for the government, which is what the government option means for health care providers.

I have written before and repeat again: The country is on the verge of an enormous, culture-changing shift when it comes to the most basic of its expectations with regards to medicine, and yet this potential radical shift is almost wholly unreported on in the MSM in the sort of detail that would allow for an informed debate. Thus is the old media working hand-in-hand with the Congressional left to completely rewrite the rules of healthcare.

Democrats in the House are surely going to face retribution for their breach of faith with their constituents once they experience the reality of single-payer, but that payback is 18 months away. The "government option," by contrast, is on the fast track for passage by early autumn. The GOP has to take up the cause of patient choice and genuine reform, and it has to do so soon.