ObamaCare Goes Off Track – by Jacob Laksin

Can the Senate's defectors derail the government takeover of health care?


It’s a sign of how desperate the Democratic base is to see some version of ObamaCare enacted before the end of year that one of the chief hurdles in their path, Senator Joe Lieberman, is being castigated as a mass murderer for his failure to toe the Left’s line.

Liberal pundit Ezra Klein, writing this Monday at the Washington Post, charged that Lieberman “seems willing to cause the deaths of hundreds of thousands of people” because of his failure to support a Senate version of the health care bill that would expand Medicare for those between the age of 55 and 64. Knives were also out for the senator at the Daily Kos, which called for the “creaking-voiced monster” to be stripped of his committee chairmanship, and at the Huffington Post, which pressed Democrats to treat their former colleague as a “persona non grata.” Connecticut Rep. Rosa DeLauro, giving voice to the more disgruntled bloggers, even suggested that Lieberman should be recalled for his opposition to the health care bill. Plainly, the senator has touched a nerve.

Yet Lieberman’s opposition to allowing the non-elderly to “buy-in” to Medicare is well-founded. In substance, the proposal to expand the country’s largest government program seems like little more than a stealth attempt to pass a government-run public insurance option that the liberal base wants and that Democrats have failed to pass.

It also suffers from the usual flaws of massive government programs. The well-respected Mayo Clinic has opposed the buy-in plan on the grounds that it would be “unsustainable,” expanding the price controls of the Medicare program without reducing the long-term costs that afflict it. “Expanding this system to persons 55 to 64 years old would ultimately hurt patients by accelerating the financial ruin of hospitals and doctors across the country,” the Mayo Clinic has noted.

That’s not the only problem with the Medicare expansion. Andrew Rettenmaier and Thomas Saving of the National Center for Policy Analysis have pointed out that expanding Medicare would have a number of unintended consequences, not least inducing aging baby boomers to exit the labor market sooner than they otherwise would. As for the extravagant claim that opposing Medicare expansion means causing deaths, studies show that Medicare has no clear impact on elderly mortality rates.

Still, it is political calculation, not conceptual failure, that explains why Democrats abandoned the Medicare buy-in plan this week: Absent Lieberman’s vote, they don’t have the 60 votes necessary to overcome a Republican filibuster and pass the health care bill.

That doesn’t mean, however, that ObamaCare is dead and buried. Democrats are still bent on passing the legislation, even if their end-of-year deadline now seems too ambitious by half. Moreover, even shorn of the public option and the Medicare expansion, the health bill remains deeply troubling – not least because resisters like Lieberman and Nebraska’s Ben Nelson may yet join forces with Democrats to ensure its passage.

First and foremost, there is the matter of costs. In a statement on the pending legislation, President Obama insisted yesterday that the potential price tag of health care reform, and its impact on the federal deficit, has been overstated by critics. Citing the Congressional Budget Office, the president said that in “terms of deficits” the health care bill would be a “deficit reduction – not a deficit increase.”

Unfortunately for this defense, the CBO is an imperfect ally for the administration. For one thing, the CBO’s initial cost estimates found that health care would require nearly $1 trillion in new federal spending over the next ten years – not exactly a prescription for trimming the deficit. Indeed, even Christina Romer, chair of the White House Council of Economic Advisers, has acknowledged that in the short term health care will increase costs. “We are going to be expanding coverage to some 30 million Americans. Of course, that’s going to up the level of health-care spending. You can’t do that and not spend more,” Romer has said.

Nor is it quite true that ObamaCare will cut spending over time. Instead, according to Romer, the legislation could slow the runaway growth of Medicare and Medicaid by 2019 – largely by reducing payments to Medicare providers, a solution with problems with of its own. In the best-case scenario, government spending on health care would increase at a marginally lower rate. As Romer has put it, there could be “a dramatic impact on where we are relative to where we might otherwise have been.” Whether or not that turns out to be the case, pitching the health care bill as a “deficit reduction” seems a particularly dubious form of government accounting.

Fuzzy math aside, the administration’s estimates don’t factor in the hidden costs of health care legislation. The Cato Institute’s Michael Cannon notes that the official estimates are “incomplete” because they don’t include the cost of the mandates that health care legislation would impose on state governments and the private sector. A version of the Senate bill supported by Harry Reid, for instance, would force state governments to spend an additional $25 billion on Medicaid over the next 10 years. Add to that the costs of mandates that require individuals and employers to buy health insurance – in effect, a tax on the uninsured that could total $8 billion – and the cost of ObamaCare soars even higher.

It’s no wonder that health care reform has become a dirty phrase. The latest ABC News/Washington Post poll finds that 51 percent now oppose Congress and the Obama administration’s proposed changes to the health care system, with majorities saying that the increased costs would not be worth it. A recent CNN poll found that 61 percent of Americans now oppose the Senate version of ObamaCare. Alongside the defeat of left-wing favorites like the public option, and the growing dissent of critical votes like Lieberman, the political picture for Democrats would appear grim.

If Democrats don’t seem deflated, it may be because the passage of the health care bill – in any form and with whatever support – would still constitute a victory for the Left and its vision of expanded government control over health care. Liberal blogger Nate Silver writes that the enactment of a health care bill, even without a public option, would be a “huge achievement for progressives.” Democrats have echoed that claim. Iowa’s Tom Harkin beamed this week that the passage of the health care bill would be a “giant step forward” because it would change “the paradigm of health care in America.”

Democrats may not get everything they want in the health care bill. But they may get enough to transform American health care for years to come. And even Joe Lieberman, mass murderer and all, may not be powerful enough to stop them.