Michael Gerson

Another target is older people on Medicare. Health reform that doesn't "add a dime to the deficit" assumes large reductions in government payments to doctors and other health care providers. Last week, the Centers for Medicare and Medicaid Services issued a devastating report, saying these cuts "may be unrealistic" because they would threaten the fiscal stability of the Medicare system. One in five hospitals, nursing homes and home health providers could be pushed into the red. Many would stop participating in Medicare, restricting access for seniors.

It is an extraordinary political development that Democrats are willing to put Medicare -- a program that already faces serious fiscal challenges -- at further risk to pay for a new health entitlement. Or maybe they know the risk is minimal, because Congress will eventually abandon this pretense, restore the Medicare cuts and fund health reform with deficit spending.

Whatever the outcome, promises of greater efficiency in delivering health care seem empty. "In 10 years' time," says James Capretta of the conservative Ethics and Public Policy Center, "even if all of these ideas are fully implemented, the Medicare program would look and operate largely as it does today, which is to say as a fee-for-service insurance model that rewards volume and fragmentation, not integration."

The final source of funding is taxpayers. In an assault on the wrinkly, the Senate bill includes a 5 percent tax on cosmetic surgery. A larger revenue source is a tax on high-end "Cadillac health plans." It is a problem, however, that many Cadillac plans are owned by people who build Chevys and Fords. Over the years, unions have often taken generous benefits packages in lieu of salary increases. If the Senate approach becomes law, that will have been a poor calculation.

How long before the young and the old, union workers and the millions in desperate need of Botox realize that the health care free lunch is to be provided at their expense? This may already be happening, with some polls now showing opposition to reform more than 20 points higher than support.

But perhaps the largest reason for this decline is the impression that all these deceptive burdens, risky moves, budget tricks, tax increases and new bureaucracies have been thrown together to meet a political deadline, with little clear idea of how they would affect the health of the nation. Sometimes brain surgery is necessary, but this one is being conducted by moonlight with pruning sheers and chicken wire.

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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