Does anyone remember the TV show "Supermarket Sweep"? Contestants would compete with one another by careening through a supermarket and grabbing as many products as they could toss into a basket. The winner was the shopper whose cart carried the biggest price tag when the bell sounded.
It's a fitting image for the way Nancy Pelosi and Harry Reid have handled the most important domestic issue of the decade. They've raced down the health policy aisles, sweeping items off the shelves and into their legislative carts, heedless of nutritional value, taste, or cost. As items dropped out on the hairpin turns, others were shoved into the spaces. Harry Reid inserted the Medicare "buy-in" at the 11th hour and just as quickly withdrew it under pressure. No organizing principle has governed the contents of their baskets (Pelosi added and jettisoned abortion coverage), just an urgent imperative to pass something. And now, as the clock winds down, they are declaring, as a journalistic cheerleader at the Washington Post put it, "a legislative feat of epic proportions."
Actually, it was the sloppiest and most slapdash legislative process ever to accompany a major bill. The 383-page manager's amendment, making changes to the Senate bill, was released on the morning of the cloture vote. Secrecy marked Reid's handling of the bill throughout. Not only Republicans, but Democrats, too, were kept from studying the legislation. Payoffs to wavering Sens. Lieberman, Landrieu, and Nelson, on the other hand, were blatant.
The Democratic leaders of the House and Senate, in concert with the White House, have bullied, bribed, and rushed their members to vote on this legislation so that the deed could be done before constituents -- who oppose it forcefully -- could confront their representatives face-to-face over the Christmas break.
The Democrats have endured bruising internecine conflicts and risked the loss of between 20 and 40 seats in 2010 (Pelosi's estimate) for this. And what have they achieved? Their goal -- a single-payer system or a glide path to one -- remains as distant as ever. Instead, they have produced (or will, after the conference committee) an enormous new $2.5 trillion octopus of federal regulation that will increase premiums, contribute to medical cost inflation, reduce quality and choice of care, and deeply politicize an aspect of life that most Americans regard as sacrosanct. Additionally, and most alarmingly, it will aggravate the already crushing debt we are accumulating.
President Obama has betrayed every ringing promise he made about this reform. People will not be able to keep their health plans if they are happy with them. The federal government will determine which plans pass muster. As for not adding one dime to the federal deficit? Risible. The "savings" in the Senate bill consist of cuts to Medicare, not increased competition or more efficient delivery of services. And while CBO has scored the bill as reducing the deficit, CBO must abide by the assumptions Congress presents. It cannot say what we know from history to be the truth: Congress will not make cuts in Medicare. Besides, every entitlement ever enacted has wound up costing orders of magnitude more than the estimates at passage. That's why the Medicare and Social Security unfunded liability is currently $107 trillion, according to a 2009 trustees' report. The Reid bill will add at least 15 million new beneficiaries to Medicaid, accelerating that program's budget-busting momentum.
The president also promised that no one earning less than $250,000 would pay higher taxes. But under both the Senate and House bills, people who do not purchase health insurance will be slapped with an excise tax (2.5 percent of adjusted gross income under Pelosicare, and $750 or 2 percent of income, whichever is larger, under Reidcare).
The Democrats have not achieved their goal of completely lassoing one-sixth of the economy, but their mammoth legislation (the House and Senate bills both top 2,000 pages) will apply heavy-handed regulation that will further gum up a system already choking on bureaucracy. Americans will be forced to buy health insurance. Insurance companies will be forbidden to price their services according to actuarial tables. And no aspect of medical care will be free of political interference. (One section of the Senate bill reinstates coverage for DXA scans because two senators insisted upon it. Another requires breastfeeding breaks in the workplace.)
The Democrats will create, among others, the following new bureaus: The Grant Program for Health Insurance Cooperatives, the Telehealth Advisory Committee, the Community Based Medical Home Pilot Program, the Center for Comparative Effectiveness Research, and the Qualified Health Benefits Plan Ombudsman. In short, Democrats have done the maximum amount of damage to our system that they could manage under the circumstances.