ObamaCare: The sum of all fears

Today, we welcome a guest post from Mary Katharine Ham of the Weekly Standard and Townhall’s political editor Guy Benson, bringing us up to date on the status of promises made in connection with ObamaCare.

Two years ago, Ed Morrissey and Allahpundit were kind enough to allow us to write here on “The Comprehensive Case Against Barack Obama” —a lengthy analysis pitting candidate Obama’s rhetoric against his actual record, past statements and long-time associations. We felt certain at the time, and still do, that his campaign was at its core a savvy marketing machine designed, in part, to deliberately mislead voters about the candidate’s true beliefs and experience. Revisiting our presentation two years later, we take no joy in saying that the administration has largely vindicated our concerns.

One of those concerns is health care reform. On March 21, after more than a year of contentious debate, Congressional Democrats finally passed their health care reform bill without a single Republican vote in either house. The president has challenged Republicans to run against his unpopular health care law—implying that they don’t have the political courage to do so. He may be right on that point; he may not—but the facts show that (a) many of the highest-profile selling points employed by the Left to drag Obamacare across the finish line were either incorrect or intentional distortions, (b) the consequences of not repealing this law are dire, and (c) the public’s enduring hostility toward Obamacare demonstrates a political appetite for repeal.

Recent polls reflect America’s zeal for repeal, as does an August ballot referendum in Missouri rebuking the individual mandate, which succeeded by a margin of 71-29. Throughout the lengthy public debate, President Obama and his surrogates consistently ridiculed and denounced critics of the bill as bad-faith, fear-mongering propaganda merchants.

The facts now prove there was plenty to fear in good faith.

Promise #1: If you are satisfied with your existing health care arrangement, you can keep it.

Over and over again, the president and his ideological allies assured Americans satisfied with their current plan/doctor/coverage that nothing would change if the bill became law:

He told the AMA: “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”

Critics of the bill predicted this pledge would expire almost immediately. They were right. As government mandates for plans— “important consumer protections” as Obama called them— pile up, premiums will rise and the composition of even allegedly “grandfathered” plans will change.

A former Medicare/Medicaid official wrote that insurers and doctors are already shifting business models in anticipation of dramatic changes. CBS News featured a small business in Pennsylvania to demonstrate how provisions within Obamacare incentivize employers to drop their employee’s health coverage, and how other elements of the law discourage hiring—thus undermining the nation’s employment recovery. Companies with 25-49 workers are relatively unscathed by the new law, whereas businesses with 50 or more employees face stringent new mandates. Under this system, employers with, say 48 workers, would have compelling reasons to avoid hiring any more full-time workers.

Even more devastating, draft regulation guidelines issued by the federal government itself predict that between half and two-thirds of Americans’ current private plans will lose grandfathered (i.e., “protected”) status by 2013. As the Daily Caller reports, “for plans that do not fall under the grandfathered status, employers would have to find a plan that complies with the health care bill.” More than one million part-time and lower-wage workers are already feeling the squeeze, as popular “mini-med” affordable limited-benefit plans will be banned by the feds starting this fall.

And, if none of this worries you, keep in mind that the same Congress assuring you that no matter how much changes, your personal health care will remain the same may have accidentally stripped themselves of their own health care.

Bottom line: Despite what the president told us repeatedly, it’s quite possible you will not be permitted to keep your health care plan– no matter how much you may like it. Supporters of health care reform argue that government mandates for certain kinds of coverage will only change health care plans for the better, making them more comprehensive, so no one will be negatively impacted. This argument ignores the loss of both choice and money inflicted by government mandates, but even if it were true, that wasn’t the promise, was it?

Promise #2:Reform will lower America’s health care spending.

Remember all that talk about “bending the cost curve down”? Obamacare supporters often spoke about the urgent need to lower the country’s out-of-control spending on health care. They often cited statistics suggesting that the U.S. spent exorbitant amounts of money on care; far more than other industrialized nations. Obamacare, they told us, would finally bring spiraling costs under control.

On March 4, 2010, President Obama committed to the premise that, “My proposal will bring down the cost of health care for millions: Families, businesses, and the federal government.” Conservatives weren’t so sure. Hadn’t Congressional Budget Director Doug Elmendorf warned Congress that, if anything, the legislation would actually bend the cost curve up?

Approximately a month after the vote went through, a damning report prepared by the government’s very own Medicare Actuary exposed the truth: Obamacare will actually increase the nation’s health care tab. In the first ten years of the program, spending will increase about 1 percent or roughly $310 billion.

Bottom line: Obamacare supporters were wrong when they told the country the legislation would lower the nation’s health care costs. Ten years after its passage, health care will represent a larger percentage of GDP than the current projection.

Obamacare proponents like Jonathan Cohn of The New Republic argued that the uptick in spending over 10 years didn’t matter because the long-term trend does bend the curve down. But the Actuary’s report says the savings liberals are counting on in part to cause this long-term bend “may be unrealistic.”

Promise #3: Reform will lower Americans’ health care premiums.

People on all sides of the debate seemed to agree on one thing: Higher premiums were a major bummer. So, President Obama announced his plan would reduce them. The new health care market “will lower rates,” he said, “it’s estimated by up to 14 to 20 percent over what you’re currently getting.” During a stump speech in Cleveland, he went even further, claiming that premiums could fall by as much as 3,000 percent (a spokesman later clarified he meant $3,000). Gaffes aside, the message was rates would head south under Obamacare. But CBS, the Washington Post, and the CBO argued in 2009 that kind of reduction was unlikely.

Even early on in the public debate, opponents of the plan harbored serious doubts about this claim. Could the government really force insurance companies to lower premiums without risking a collapse of the private market? Federally mandated bargain-basement premium rates would inevitably lead to insurance companies cutting costs through layoffs, offering lower quality care, going bankrupt, or all the above. President Obama insisted that the demise of private insurance was no longer his or the Left’s long-term goal, going so far as to claim that his bill would actually strengthen the private market by opening it up to millions of new consumers. But the question remained: How would the government add patients, add mandates to health plans, and not raise costs to average Americans?

Were Congressional Democrats convinced by their own party’s talking point? Nope. Less than a month after their March triumph, Senate Democrats were so concerned over the prospect of dramatic premium hikes, they began scrambling to regulate premium rates. (Video of Harkin’s committee hearing is unavailable on CSPAN or YouTube, but it can be seen here, on the committee’s website.)

Democrats’ price-control bluster has only intensified as reality sets in. The original bill did not use explicit price-control mechanisms because, of course, premiums were supposed to fall because of the original bill. But the CBO and media fact-checkers agreed that higher premiums were likely on their way.

Obama himself conceded people might be paying more for health insurance before his bill passed, during a Blair House exchange with Sen. Lamar Alexander, but that it was only because they’d be getting better insurance. Politifact awarded the president a generous “Half-True” in this exchange, but added, “Bottom line, people won’t be paying more for the same thing. They’ll be paying more for better plans.” One can argue that paying more for more product is something worth doing, but one can’t argue it satisfies Obama’s promise.

In their defense, if only some real-life scenario had been available to Democrats to help them envision how top-down health insurance price controls would play out, may have made more responsible decisions. Oh, wait. If only there had been some trusted, liberal source who could have delivered the message— like an Edwards and Clinton speechwriter who can’t afford health care in a state with allegedly “universal” health care.

Bottom Line: Contrary to the president’s commitments, your premiums could increase under Obamacare. Why? Just count the reasons. Or ask Dick Durbin.

Promise #4: Obamacare will not lead to a doctor shortage, or escalate the primary-care physician shortfall.

Implicit in the president’s if-you-like-your-doctor-you-can-keep-him schitck was the assumption that his plan certainly wouldn’t negatively impact Americans’ access to doctors. The administration dismissed admonitions of the impending doctor shortage their bill would exacerbate. No worries, they cooed, primary care physicans would come out of the woodwork once all of the bill’s wonderful elements were implemented. After all, Obama had secured the backing of the AMA for his endeavor, right? What could go wrong? Quite a lot, actually.

As a result of the new law, the Associated Press advises Americans to “beat the crowd and find a doctor” because the “landmark health care overhaul…promises extra strain” on the already-dwindling ranks of primary care physicians. Inauspiciously, the Association of American Medical Colleges’ Center for Workforce Studies estimates a shortage of 160,000 doctors within 15 years. America’s medical schools “can’t keep up,” the Wall Street Journal reports. “A nurse may soon be your doctor” because of the shortage, explains USA Today.

Obamacare proponent Ezra Klein conceded this point in a post arguing against fears of a doctor shortage. He euphemized such a possibility as a “hiccup” in a growing system and predicted, “Increased need for basic care could lead to more use of nurse practitioners, physician’s assistants, and things like Minute Clinics.”

There’s also considerable evidence that Obamacare will overwhelm cramped emergency rooms and slammed hospitals. How might this deepening shortage affect Americans? Just ask a Canadian.

Bottom Line: Thanks to Obamacare, America’s doctor shortfall will accelerate and it will become more difficult to get quality, timely care from a doctor.

Promise #5: There will be no government rationing of medical care.

Democrats’ most furious pushback against anti-Obamacare arguments resulted from predictions of government-mandated rationing. The White House website’s “reality check” feature devotes two full pages to “debunking” so-called right-wing smears about rationing. The president himself assailed his opponents on this point.

Speaking in New Hampshire, he dismissed concerns over rationing, “that somehow some government bureaucrat out there will be saying, well, you can’t have this test or you can’t have this procedure because some bean-counter decides that this is not a good way to use our health care dollars. Those fears, he said, were unfounded. So I just want to be very clear about this. I recognize there is an underlying fear here that people somehow won’t get the care they need. You will have not only the care you need, but also the care that right now is being denied to you.”

What worried many skeptics was the equal clarity expressed by liberal Democrat and former cabinet secretary Robert Reich, who in 2007 candidly laid out the underlying need for government rationing within any government-run health care framework:

Does Secretary Reich fall under into the category of smear merchant? What about Obama’s own Director of the Office of Management and Budget, Peter Orszag? After his boss’ plan was signed into law, Orzag publicly marveled at the government’s new powers to hit “aggressive” health care cost-cutting goals—largely without the inconvenience of Congressional oversight. His unedited remarks belie the president’s words in New Hampshire:

In addition to Orszag’s remarks, consider President Obama’s appointment to head the Centers for Medicare and Medicare Services, arguably one of the most influential health care posts in the entire new federal bureaucracy. The president has selected Harvard professor Donald Berwick, who the American Spectator’s Philip Klein nicknamed “Obama’s rationing man.” Berwick is an unapologetic fan of Britain’s National Health Services, notorious for cutting effective (but expensive) medical treatments, and subjecting patients to sub-standard care and neglect.

“I am a romantic about the [British system]; I love it,” Berwick told a British audience in 2008. He also co-authored an academic paper urging “rational collective action overriding some individual self-interest” to “reduce per capita costs.”

The Obama administration gave Berwick a recess appointment in July, which means he will get no public hearing. The disingenuous rationale for this appointment was that Republicans were holding the nomination up, but as ABC News reported at the time, “Republicans were not delaying or stalling Berwick’s nomination. Indeed, they were eager for his hearing, hoping to assail Berwick’s past statements about health care rationing and his praise for the British health care system.”

It is precisely because the administration no longer wants to address what Obama once called a “legitimate concern” that Berwick will not have to face the Senate.

There was also that whole Guide to Death pamphlet issued by the VA— a joint venture of sorts with the Hemlock Society—which might have led to “legitimate concern” about bean-counters meddling in personal medical decisions.

Bottom Line: Whether dressed up as “comparative effectiveness research” or described bluntly by Mr. Reich or Berwick, government rationing is a frightening and unavoidable byproduct of government-administered and –regulated health care.

Promise #6: “The firm pledge”Ninety-five percent of Americans will not see any form of tax increase because of Obamacare (or anything else).

It doesn’t get any less ambiguous than this Obama promise: “I can make a firm pledge,” he said in Dover, N.H., on Sept. 12, 2009. “Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

Candidate Obama repeated this vow so often on the campaign trail, anyone who even loosely followed the 2008 presidential campaign could likely repeat it in his sleep. Once a behemoth new entitlement was on the table, some dishonest, rumor-peddling cynics began to wonder if the president would be forced to abandon his central campaign pledge to pay for it. Such an admission, naturally, might have caused some angst among voters and fomented more opposition to the bill. “But of course we’ll honor our tax pledge!” the White House insisted.

Appearing on CBS’ Face the Nation, the president was adamant: “I can still keep [the $250,000 tax] promise because as I’ve said, about two-thirds of what we’ve proposed would be from money that’s already in the health care system but just being spent badly. And as I said before, this is not me making wild assertions.”

He was even more frank speaking with ABC’s George Stephanopoulos.

Now the federal government itself is arguing in court challenges to its constitutionality that the individual mandate is a tax after all, to which all Americans will be subject. The New York Times:

When Congress required most Americans to obtain health insurance or pay a penalty, Democrats denied that they were creating a new tax. But in court, the Obama administration and its allies now defend the requirement as an exercise of the government’s “power to lay and collect taxes.”

We also now know that in its current and future attempts to pay for Obamacare, the federal government will raise taxes on millions of Americans, violate “the firm pledge” repeatedly, and force the American public to become even more intimately acquainted with the Internal Revenue Service.

There are at least 18 new taxes embedded into the new law, many of which don’t detonate until after the president’s 2012 re-election campaign. All of those taxes must just target the rich, right? Wrong. The non-partisan Joint Committee on Taxation breaks the bad news: Millions of middle class families will get “socked” with a $3.9 billion tax hike in the years ahead thanks to Obamacare.

There are also some “costly” new IRS mandates. The head of the IRS has warned taxpayers failure to comply with the government’s new universal mandate to purchase approved coverage may result in the confiscation of tax refunds. If that sounds like a lot of bureaucratic work, you’re right: The feds are contemplating hiring thousands of new IRS agents to track and enforce compliance on a national scale.

The federal government’s own National Taxpayer Advocate Service argued in July that Obamacare has it doing work it’s not remotely trained, qualified, or funded for and that the health care law “may impose significant burdens on businesses, charities, and government agencies.”

So, how’s that ‘firm pledge’ holding up, Mr. Outgoing White House budget director? It’s been downgraded to a presidential “preference,” eh? It was fun while it lasted.

Bottom Line: Hold on to your wallets.

Promise #7: Health care reform won’t add “a single dime” to the deficit—and will actually cut it.

Remember that unambiguous, crystal-clear presidential promise from item number six? Here’s another one, delivered to a joint session of Congress and a nationally televised audience: “I will not sign a plan that adds one dime to our deficits — either now or in the future.  (Applause.) I will not sign it if it adds one dime to the deficit, now or in the future, period.” 

Right-wing paranoiacs really didn’t believe this one, but the Democrats had an ace in the hole. Leading up the vote—voila!—Pelosi & Co engineered a final CBO score that magically validated the president’s famous words. Go crazy, America! Your massive new entitlement program will reduce the deficit by $130 Billion over ten years!

A number of Debbie Downers made valiant attempts to expose the folly. Former CBO director Douglas Holtz-Eakin crunched the un-manipulated numbers for the New York Times and found that the “real arithmetic” was nowhere near deficit-reducing or –neutral. The truth: Obamacare would bloat the deficit by $563 Billion. The advertised ten-year price tag of $900+ Billion was risible. In reality it sat much closer to $2.5 Trillion, as the Democratic Chairman of the Senate Financial Services Committee inadvertently admitted.

So how did Democrats manage to gerry-rig the CBO’s scoring system to produce superficially solvent math? Rep. Paul Ryan meticulously decimated their “smoke and mirrors” gimmickry at the Blair House summit, thoroughly explaining to the president’s face precisely how his administration and party were misleading the country. The clip is worth your time, and informative to the last drop:

In fairness, here’s Obamacare proponent Ezra Klein’s rebuttal to Ryan, which is worth a read for a pretty frank but ultimately unconvincing defense of tricky government accounting. But even in rebutting Ryan, Klein concedes, “The 10-year cost of the bill is really only counting six years of operation. This was a deceptive effort to keep the bill’s price tag under $1 trillion, even as the bill’s price tag was really quite a bit more.”

In short, the Democrats’ bogus score relied on:

(a) Double-counting unrealistic, never-gonna-happen Medicare cuts to the tune of $500 Billion.

(b) Pretending the $200B+ “Doc Fix” was a separate, unrelated issue—it has since passed the Senate. For those who think treating “doc fix” as an unrelated issue was fair, they may want to ponder why the expensive measure was included in an early version of the House bill until Democrats needed a better CBO score, at which point it was removed.

(c) Shoehorning 10 years’ of tax revenues into just six years of “benefits.”

(d) Double-counting social security tax revenue.

(e) Totally ignoring billions in requisite “discretionary” spending for Obamacare’s implementation.

On the eve of the health care vote, a CBO letter to Rep. Paul Ryan confirmed that, without such gimmickry, the health care bill would add $260 billion over 10 years to instead of reducing it by $138. Both the CMS and the CBO have objected to the double-counting of Medicare savings as paying for Obamacare and shoring up Medicare, but the administration continues to use the misleading metric, even this week.

Passage of the “Doc Fix” alone, coupled with this little wrinkle, has already driven Obamacare into the red. Finally, the current director of CBO has decisively torpedoed the entire “cost savings” charade. Revisiting a previous devastating critique that nearly derailed the process in 2009, Elmendorf has concluded that Obamacare will not “bend the cost curve” of health care spending down.

Putting the federal budget on a sustainable path would almost certainly require a significant reduction in the growth of federal health spending relative to current law (including this year’s health legislation).

Too little, too late. It’s now the law of the land.

Bottom Line: The president’s bill won’t add a single dime to the deficit. It will pile trillions upon trillions of dimes atop an already mountainous debt.

Promise #8: Health care reform will help businesses—employers and employees, alike.

The conservative think tank The Heritage Foundation offers a good list of concerns conservatives had about the effect the health care reform bill might have on businesses. Here’s the story of just one, wholesome Midwestern company rethinking its employer-provided health insurance in the wake of Obamacare. White Castle, maker of the nation’s beloved fast-food sliders, provides employees with health care coverage that covers 70-89 percent of their costs. This would seem to make the company one of the good actors, according to the administration’s standards. But health care reform is discouraging this good behavior instead of encouraging it. They will consider dropping their health care and leaving employees to government exchanges.

They’re not the only ones. That’s why the International Franchise Association opposed the law, saying it will “impose tremendous burdens on America’s restaurants and hurt our industry’s ability to create and sustain jobs.”

Small business owners and the self-employed get hit again with a new, onerous tax burden meant to close a tax reporting “loophole” to pay for the health care that’s allegedly going to do nothing but help them. The federal government’s IRS ombudsman took issue with a new requirement that every business and non-profit file a 1099 form for anyone from whom they buy $600 or more in goods or services annually. This would require that each business owner keep a tally of goods he bought from Staples to make sure his ink cartridges don’t hit $600, and would affect up to 40 million businesses, many of them sole proprietorships.

Some House Democrats have since realized the folly of this anti-business imposition, and have offered a bill to repeal this part of Obamacare, but are balking at the loss of revenue. They say realizing you have a problem is the first step to recovery. Let’s hope they’re right, as even Democrats begin to relinquish the farce that this bill can be all things to all people and all paid for, all at the same time.

Promise #9: Obamacare will not allow for funding of abortions with taxpayer money.

At his address to the joint session of Congress in September 2009, President Obama attempted to “clear up” what he called a “misunderstanding.”

“Under our plan,” he said. “No federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

Pro-life activists were accused of lying for pointing out that a “segregation of funds” would not prevent funding of abortions through federally subsidized plans because money is fungible. Pro-life Democrats balked at the idea of the federal government funding abortions on Indian reservations and in community health centers, endangering the passage of the bill. A last-minute Executive Order allegedly preventing federal funding of abortion only affirmed the inadequate language in the original bill, but garnered enough pro-life Democrats to win bill passage.

In July 2010, the Congressional Research Service found that Obamacare did indeed allow federal funding for abortions through high-risk pools created and entirely funded by the federal government. The Executive Order doesn’t prevent abortion funding through high-risk pools.

When New Mexico’s high-risk pool made it possible to get an abortion on demand, the public outcry caused the federal government to set stricter guidelines, allowing abortions only in the case of rape, incest, or to save the life of the mother. The rules in Pennsylvania also seem to allow for federally funded abortions, though the administration and the state claim the problematic language is just a “placeholder.” Pro-life activists also have concerns about Maryland.

Bottom Line: Were it not for watchful pro-life activists and the wide unpopularity of federally funding abortions, the bill would already be paying for them in at least one state.

Promise #10: Obamacare will not only satisfy each of the promises above, but satisfy all of them at the same time with virtually no downsides.

In defense of the administration, it did start lowering expectations shortly after passage. On Obama’s post-passage p.r. push, he gave a speech in Iowa that included this decidedly un-lofty section:

“Now, it’s going to take about four years to implement this entire plan — because we’ve got to do it responsibly and we need to do it right. So I just want to be clear: that means that health care costs won’t go down overnight; not all the changes are going to be in place; there are still going to be aspects of the health care system that are very frustrating over the next several years.”

With all due respect to the president, we weren’t pitched “This’ll take four years of frustration but it won’t be as bad as Republicans say it is” for $2.5 trillion. We were pitched perfection. Every substantive criticism was met with charges of “fear-mongering.” We were pitched a bill that expanded coverage and increased subsidies without increasing the deficit, mandated new levels of coverage without taxing citizens, that changed everything unless you didn’t want anything to change, that cut costs without rationing, and that enacted 2,500 pages of law without any unintended negative consequences.

Instead we have a bill that’s already been uncertain on whether it covers Congress, is missing deadlines and confusing doctors and patients, is threatening to throw the sickest off its high-risk rolls to save money, raises questions about covering children with and without preexisting conditions, and may take decades for the federal government to figure out. No wonder proponents got a little testy, right after passage, about actually providing verifiable results of all they’d promised.

At the risk of using the “overheated rhetoric” and “fear-mongering” I know the president hates, it’d be fitting if Americans exercised their Berwickian right to comparative research and subjected Obamacare to its own death panel. All Obama’s promises have expiration dates. Why not his policies?

Thanks to Ed and Allah for letting us hang out with Hot Air readers once again, and special thanks to Phil Klein of the American Spectator, whose extensive health care reporting and knowledge (cited throughout) added so much to this effort.

: Fixed some faulty code in C-SPAN videos.