Due to pressure from enraged Americans, the most pernicious features of Obama's health care legislation have, for now at least, been stripped from his bill. This is no time for complacency, however, since the liberals are trying to push back and get the provisions back in.
As the bill now stands, it doesn't have any teeth.
— Without the public option, the government does not have the financial clout to enforce the decisions of the new secretary of health about the protocols of care to be followed. The left had hoped that the federal public option insurance company would put the private firms out of business and leave a single, governmental payer in place.
This single payer could slice reimbursements to providers at will and bring them into line offering low cost, long waiting lists and rationed medical care. But with no expansion of Medicare to those over 55 and no federal public option, the secretary of health won't have the power to force bad medical care down the throats of the American people.
— Relatively few new people will get health insurance. The costs of coverage are too high, the subsidies too shallow and the punitive fines too low to force people to buy policies they don't want and think they don't need. What young, childless couple is going to pay 8 percent to 12 percent of their income for insurance rather than just pay the $1,000 fine for not having coverage? Oddly, this bill is really just a tax on the uninsured.
— Without the feared flood of new patients into the system, the rationing that threatened may not be as bad as it once seemed. With only a few newly insured people, the long waiting lists and shortages of medical personnel Massachusetts is experiencing under Romney-care may not happen nationally.
— The cuts in Medicare are to be proposed by a special commission in the Executive Branch akin to the federal base-closing commission that decides which military bases to shutter. But then they will have to be approved each year by Congress. A former secretary of health and human services under a Republican president told me recently that he expects that the cuts will be vetoed by Congress each year and never really take effect.
He says that the savings won't materialize and the additional costs of Obama's program will just be financed through even more deficit spending. He cites, for example, the refusal of Congress each year to approve the automatic 6 percent cut in physicians' fees that the legislative branch has laid over for each of the past five years.
What's left is a bill that expands Medicaid to cover more of the poor and working poor. It requires that all states cover everyone making 150 percent or less of the poverty level. This will end the practice of many states of restricting Medicaid, in effect, to the elderly in nursing homes.
Arkansas, for example, only covers up to 17 percent of the poverty level (about $4,000 of income). Under the new law, anyone in the state whose income is less than about $27,000 will have to be covered. This provision will, of course, mean much higher state taxes throughout the South and in Texas, California, Pennsylvania and Florida, states will low Medicaid thresholds.
The rest of the bill is essentially a consumer protection statute that bars insurers from denying coverage to anyone and stops them from charging more for those who are sick. Both the expansion of Medicaid and this reform of insurance company practices could have been achieved in considerably less than the 2,000 pages of dead trees that this bill consumed.
There are still bad parts of the legislation:
— Medicare Advantage, an important program for 10 million elderly, will be gutted and replaced by Medigap insurance, which is more limited in coverage, higher in cost and more profitable to the AARP.
— Medical devices — from pacemakers to automated wheelchairs — will still be taxed, and sick people will be forced to pay higher taxes and deduct fewer of their medical costs.
— Reimbursements under Medicare are likely to continue to drop, forcing more and more providers to refuse to treat patients under the program.
But Obama is left with the symbol of a victory but not much substance. He will still sign the bill — if it ever passes — with great fanfare, but the substance of the legislation will be painfully thin.
We haven't dodged the bullet yet. The Left is still to be heard from. But the momentum against the bill and the focus on its worst provisions is paying off.