If you think government is too big and too costly, wait until Obamacare kicks in. The Congressional Budget Office put the price tag of the House Democrats' health care takeover plans at $1.5 trillion over 10 years. But the CBO's fine print included a telltale caveat:
"We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal's likely effects on spending for other federal programs."
You don't need an accounting degree or clairvoyant powers. The administrative costs and spillover spending effects will be astronomical. Look at existing federal programs. In 1966, the Office of Management and Budget put the total taxpayer costs for Medicare at $64 million. In 2011, Medicare costs are expected to balloon to nearly $500 billion. Medicaid cost $770 million in 1966. By 2011, that program will cost taxpayers an estimated $264 billion. The Virginia-based Council for Affordable Health Insurance estimated that the administrative expenses of both programs last decade were 66 percent higher than those of private sector health insurance companies.
And we ain't seen nothing yet. House Republicans on the Joint Economic Committee sifted through their opponents' 1,018-page health care bill and released a dizzying flow chart detailing the Byzantine bureaucracy Obamacare would create. Washington would become the home of at least 31 new federal programs, agencies and commissions to oversee the government-run health insurance regime.
Because 32 "czars" isn't enough, the Democratic plan would add another overlord to the Obama administration. The new "Health Choices Commissioner" would helm the new "Health Choices Administration" (section 141 of the bill) -- separate from the already existing Department of Health and Human Services, Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Veterans Health Administration and the Indian Health Service.
Because the government has done such a boffo job managing the near-bankrupt Social Security and Medicare Trust Funds, the Democrats have proposed creating a "Public Health Investment Fund" and a "Health Insurance Exchange Trust Fund." The latter would create a "transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers."
No matter that state insurance departments already operate such systems. Health care must be "fixed." The federal cure is redundancy.
The Obamacare bill also creates a new "Bureau of Health Information" (not to be confused with the already existing National Center for Health Statistics) within the department of Health and Human Services. A new "Assistant Secretary for Health Information" will lead the BHI. The new assistant secretary will coordinate with the recently created "National Coordinator for Health Information Technology" -- who is responsible for monitoring the $19.5 billion in the stimulus law to implement "a nationwide interoperable, privacy-protected health information technology infrastructure."
New bureaucracies always have old special interests to appease. The Bureau of Health Information will house its own "Office of Civil Rights" and "Office of Minority Health." The information czar will be required to collect health statistics in the "primary language" of ethnic minorities -- and, thus, the need for a new "language demonstration program" to showcase their efforts. Obamacare will also ensure "cultural and linguistics competence training" and establish "a youth public health program to expose and recruit high-school students into public health careers." The government health care juggernaut must be fed and staffed, after all.
Providing more stimulus for taxpayer-funded jobs, the Democrats' bill would add a new "Senior Advisor for Health Care Fraud" and require the Attorney General to appoint a "Senior Counsel for Health Care Fraud Enforcement." There's already a national Health Care Fraud and Abuse Control Program, but who's counting?
To coordinate all the new bureaucrats, Obamacare would create a new "Health Care Program Integrity Coordinating Council" to "to coordinate strategic planning among federal agencies involved in health care integrity and oversight."
To make sure all the existing local and state environmental public health agencies don't feel lonely, the Democrats' plan creates a new "Coordinated Environmental Public Health Network" to "build upon and coordinate among existing environmental and health data collection systems and create state environmental public health networks."
A new "National Health Care Workforce Commission" will be "tasked with reviewing health care workforce and projected workforce needs." New funding will be available for a "demonstration program to improve immunization coverage" that would enable government busybodies to send reminders or recalls for patients or providers, or make home visits.
Who'll be looking out for you? The House bill creates a "public plan ombudsman" and a "special health insurance exchange inspector general" to police spending and guard against waste, fraud and abuse. Given the sad fate of aggressive watchdogs in the age of Obama, however, these positions will end up like every other new agency, commission, task force and office created to serve the federal health care beast: black holes.