Michael Gerson

WASHINGTON -- It is symbolic of the Senate's health care bill that the section titled "No lifetime or annual limits" would allow insurance companies to impose annual dollar limits on medical care -- meaning that patients in need of expensive cancer treatment, for example, could still be bankrupted.

Democratic health reform legislation promises everything to everyone -- while imposing a series of hidden burdens to make a massive new entitlement affordable, at least on paper. So its authors are in a game of beat the clock -- pass the legislation before those burdens are fully disclosed to the public.

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The case of annual dollar limits -- now being renegotiated after they were finally noticed -- is instructive. In the "reformed" insurance system, every plan would be a high-end plan, requiring insurance companies to cover people who are already sick and limiting the ability to charge higher premiums for those at higher risk. To avoid going out of business or dramatically increasing insurance premiums across the board, insurance companies want the ability to cap yearly benefits. The Senate bill included this limit, because higher insurance premiums would require greater government subsidies to help people afford them. Cutting off cancer patients helps Congress meet its budget target.

The entire Democratic health reform effort is now foundering, as its deep bow enters the shallow channel of fiscal reality. And that splash you hear is various groups thrown from the ship to lighten the load. Instead of beginning with affordable, realistic objectives, President Obama and the Democratic Congress set the goal of guaranteed, comprehensive coverage for everyone. This requires a lot more money in the system, which must come from somewhere. Actually, from someone.

One source is the young and healthy who currently take the risk of living without insurance. They would be legally mandated to pay premiums each month. According to the polls, it doesn't bother young people much that they would be forced to subsidize the insurance costs of middle-aged Americans with pre-existing health conditions. We are grateful for young people's indifference.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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