The Senate vote on government-run health care will also be close. In fact, it is likely that liberals will need some kind of stealth plan in order to gain the 60 votes they need. They are working on so-called compromises right now that will essentially give us a government-run health care system without it looking like it. Two plans are being floated that could very possibly garner the last couple of votes Senate liberals need to pass their own version of a massive government takeover of health care.
The first plan is known as an opt-out plan. Under this proposal, each state would get to decide whether or not it wanted to allow a government-run plan to be offered within its borders. While it sounds like a nice nod to states' rights principles, the truth of the matter is that it is highly unlikely that any states would opt-out of the plan.
For one thing, opting out is simply a political non-starter. There are several reasons. First, the government-run plan will promise lower health insurance premiums. Citizens will not tolerate the prospect of paying higher premiums for the same coverage available in other states that offer the government-run plan. Second, health insurance subsidies for low income people will likely be tied to the government-run plan rate. So, the subsidies may not cover as much of the gap between the cost of health insurance and what people can afford in opt-out states. This will not be received well by the citizens of those states. It is even possible that subsidies will not even be available to states that opt-out. Third, uninsured/underinsured citizens and businesses in opt-out states will be forced to pay taxes and penalties that will be used to help pay for the government-run plan for people in other states, with no benefit for themselves. They will certainly resent this inequity.
The other problem in opting out is purely economic. The states are looking at serious financial shortfalls as soon as the stimulus funds run out. They call this event ominously "the funding cliff." If the states think they can close their impending gaping budget holes by moving their employees into what they are told is a cheaper government-run plan, they will likely feel compelled to grab any rope thrown their way, and then, so much for states opting out. Of course, all of the currently proposed government-run plans will lead to increased rates for everyone, but this will not be evident until the government-run plan is introduced in the states. Then the states' health insurance dilemmas will be even more perilous. But it will be too late.
The second plan being floated in the Senate is called a trigger option. In this scenario, the government-run health plan would be included in the bill, but would only be activated if insurance companies fail to achieve certain benchmarks set by the health care reform legislation. If this option passes, one thing seems quite certain -- the trigger will be pulled. It is easy enough to imagine that liberals, who are determined to create a government-run plan, could simply create a set of goals that are nearly impossible to meet. For example, they could require that health insurance premiums decline by a certain percentage -- which is certainly a reasonable gauge -- but fail to do anything to help drive down costs.
The stage for higher health care premiums has already been set. Consider these facts. The bills liberals have put forward do not allow for interstate competition among private health insurers, without which it will be hard to drive down costs. The bills require free preventive care, which people will appreciate, but which will make health care costs go up. Everyone knows this. The reform proposals prevent insurance companies from denying coverage based on pre-existing conditions. Again, this is an important reform measure, but it will not make insurance premiums decline. It will cause them to go up. There is no tort reform in any of these bills, which means that doctors will be forced to continue to engage in defensive medicine to protect themselves from lawsuits, once again, driving up the cost of health care and consequently driving up premiums. So, when the lower premium benchmark is not reached, the government-run plan will be triggered.
Barrett Duke is vice president for public policy and research at the Southern Baptist Ethics & Religious Liberty Commission.
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