by Steve Breen

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Writing in the New York Times last month, President Barack Obama asked that Americans “talk with one another, and not over one another” as our health-care debate moves forward.

I couldn’t agree more. Let’s engage the other side’s arguments, and let’s allow Americans to decide for themselves whether the Democrats’ health-care proposals should become governing law.

Some 45 years ago Ronald Reagan said that “no one in this country should be denied medical care because of a lack of funds.” Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us.

We also know that our current health-care system too often burdens individuals and businesses—particularly small businesses—with crippling expenses. And we know that allowing government health-care spending to continue at current rates will only add to our ever-expanding deficit.

How can we ensure that those who need medical care receive it while also reducing health-care costs? The answers offered by Democrats in Washington all rest on one principle: that increased government involvement can solve the problem. I fundamentally disagree.

Associated Press

Common sense tells us that the government’s attempts to solve large problems more often create new ones. Common sense also tells us that a top-down, one-size-fits-all plan will not improve the workings of a nationwide health-care system that accounts for one-sixth of our economy. And common sense tells us to be skeptical when President Obama promises that the Democrats’ proposals “will provide more stability and security to every American.”

With all due respect, Americans are used to this kind of sweeping promise from Washington. And we know from long experience that it’s a promise Washington can’t keep.

Let’s talk about specifics. In his Times op-ed, the president argues that the Democrats’ proposals “will finally bring skyrocketing health-care costs under control” by “cutting . . . waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies . . . .”

First, ask yourself whether the government that brought us such “waste and inefficiency” and “unwarranted subsidies” in the first place can be believed when it says that this time it will get things right. The nonpartistan Congressional Budget Office (CBO) doesn’t think so: Its director, Douglas Elmendorf, told the Senate Budget Committee in July that “in the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.”

Now look at one way Mr. Obama wants to eliminate inefficiency and waste: He’s asked Congress to create an Independent Medicare Advisory Council—an unelected, largely unaccountable group of experts charged with containing Medicare costs. In an interview with the New York Times in April, the president suggested that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost . . . the chronically ill and those toward the end of their lives . . . .”

Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by—dare I say it—death panels? Establishment voices dismissed that phrase, but it rang true for many Americans. Working through “normal political channels,” they made themselves heard, and as a result Congress will likely reject a wrong-headed proposal to authorize end-of-life counseling in this cost-cutting context. But the fact remains that the Democrats’ proposals would still empower unelected bureaucrats to make decisions affecting life or death health-care matters. Such government overreaching is what we’ve come to expect from this administration.

Speaking of government overreaching, how will the Democrats’ proposals affect the deficit? The CBO estimates that the current House proposal not only won’t reduce the deficit but will actually increase it by $239 billion over 10 years. Only in Washington could a plan that adds hundreds of billions to the deficit be hailed as a cost-cutting measure.

The economic effects won’t be limited to abstract deficit numbers; they’ll reach the wallets of everyday Americans. Should the Democrats’ proposals expand health-care coverage while failing to curb health-care inflation rates, smaller paychecks will result. A new study for Watson Wyatt Worldwide by Steven Nyce and Syl Schieber concludes that if the government expands health-care coverage while health-care inflation continues to rise “the higher costs would drive disposable wages downward across most of the earnings spectrum, although the declines would be steepest for lower-earning workers.” Lower wages are the last thing Americans need in these difficult economic times.

Finally, President Obama argues in his op-ed that Democrats’ proposals “will provide every American with some basic consumer protections that will finally hold insurance companies accountable.” Of course consumer protection sounds like a good idea. And it’s true that insurance companies can be unaccountable and unresponsive institutions—much like the federal government. That similarity makes this shift in focus seem like nothing more than an attempt to deflect attention away from the details of the Democrats’ proposals—proposals that will increase our deficit, decrease our paychecks, and increase the power of unaccountable government technocrats.

Instead of poll-driven “solutions,” let’s talk about real health-care reform: market-oriented, patient-centered, and result-driven. As the Cato Institute’s Michael Cannon and others have argued, such policies include giving all individuals the same tax benefits received by those who get coverage through their employers; providing Medicare recipients with vouchers that allow them to purchase their own coverage; reforming tort laws to potentially save billions each year in wasteful spending; and changing costly state regulations to allow people to buy insurance across state lines. Rather than another top-down government plan, let’s give Americans control over their own health care.

Democrats have never seriously considered such ideas, instead rushing through their own controversial proposals. After all, they don’t need Republicans to sign on: Democrats control the House, the Senate and the presidency. But if passed, the Democrats’ proposals will significantly alter a large sector of our economy. They will not improve our health care. They will not save us money. And, despite what the president says, they will not “provide more stability and security to every American.”

We often hear such overblown promises from Washington. With first principles in mind and with the facts in hand, tell them that this time we’re not buying it.

By Mark Steyn

The other day, wending my way from Woodsville, N.H., 40 miles south to Plymouth, I came across several “stimulus” projects — every few miles, and heralded by a two-tone sign, a hitherto rare sight on Granite State highways. The orange strip at the top said “PUTTING AMERICA BACK TO WORK” with a silhouette of a man with a shovel, and the green part underneath informed you that what you were about to see was a “PROJECT FUNDED BY THE AMERICAN RECOVERY AND REINVESTMENT ACT.” There then followed a few yards of desolate, abandoned, scarified pavement, followed by an “END OF ROAD WORKS” sign, until the next “stimulus” project a couple of bends down a quiet rural blacktop.

I don’t know why one of the least fiscally debauched states in the Union needs funds from “the American Recovery and Reinvestment Act” to repair random stretches of highway, especially stretches that were perfectly fine until someone came along to dig them up in order to access “stimulus” funding. I would have asked one of those men with a shovel, as depicted on the sign, but there were none to be found. Usually in New Hampshire, they dig up the road, and re-grade or repave it, while the flagmen stand guard until it’s all done. But here a certain federal torpor seemed to hang in the eerie silence.

Still, what do I know? Evidently, it’s stimulated the sign-making industry, putting America back to work by putting up “PUTTING AMERICA BACK TO WORK” signs every 200 yards across the land. And at 300 bucks a pop, the signage alone should be enough to launch an era of unparalleled prosperity, assuming America’s gilded sign magnates don’t spend their newfound wealth on Bahamian vacations and European imports. Perhaps if the president were to have his All-Seeing O logo lovingly hand-painted onto each sign, it would stimulate the economy even more, if only when they were taken down and auctioned on eBay.

Meanwhile, in Brazil, India, China, Japan, and much of continental Europe the recession has ended. In the second quarter this year, both the French and German economies grew by 0.3 percent, while the U.S. economy shrank by 1 percent. How can that be? Unlike America, France and Germany had no government stimulus worth speaking of, the Germans declining to go the Obama route on the quaint grounds that they couldn’t afford it. They did not invest in the critical signage-in-front-of-holes-in-the-road sector. And yet their recession has gone away. Of the world’s biggest economies, only the U.S., Britain, and Italy are still contracting. All three are big stimulators, though Gordon Brown and Silvio Berlusconi can’t compete with Obama’s $800 billion porkapalooza. The president has borrowed more money to spend to less effect than anybody on the planet.

Actually, when I say “to less effect,” that’s not strictly true: Thanks to Obama, one of the least indebted developed nations is now one of the most indebted — and getting ever more so. We’ve become the third most debt-ridden country after Japan and Italy. According to last month’s IMF report, general government debt as a percentage of GDP will rise from 63 percent in 2007 to 88.8 percent this year and to 99.8 percent of GDP next year.

Of course, the president retains his formidable political skills, artfully distracting attention from his stimulus debacle with his health-care debacle. But there are diminishing returns to his serial thousand-page trillion-dollar boondoggles. They may be too long for your representatives to bother reading before passing into law, but, whatever the intricacies of Section 417(a) xii on page 938, people are beginning to spot what all this stuff has in common: He’s spending your future. And by “future” I don’t mean 2070, 2060, 2040, but the day after tomorrow. Democrats can talk about only raising taxes on “the rich,” but more and more Americans are beginning to figure out what percentage of them will wind up in “the richest 5 percent” before this binge is over. According to Gallup, nearly 70 percent of Americans now expect higher taxes under Obama.

But the silver-tongued salesman sails on. Why be scared of a government health program? After all, says the president, “Medicare is a government program that works really well,” and if “we’re able to get something right like Medicare,” we should have more “confidence” about being able to do it for everyone.

On the other hand, says the president, Medicare is “unsustainable” and “running out of money.”

By the way, unlike your run-of-the-mill politician’s contradictory statements, these weren’t made a year or even a week apart, but during the same presidential speech in Portsmouth, N.H. At any rate, in order to “control costs” Obama says we need to introduce a new trillion-dollar government entitlement. It’s a good thing he’s the smartest president of all time and the greatest orator since Socrates because otherwise one might easily confuse him with some birdbrained Bush type. But, if we take him at his word, then a trillion-dollar public expenditure that “controls costs” presumably means he’s planning on reducing private health expenditure — such as, say, your insurance plan — by at least a trillion. Or he’ll be raising a trillion dollars’ worth of revenue. Either way, under Obama nothing is certain but death panels and taxes — i.e., a vast enervating statism, and the confiscation of the fruits of your labors required to pay for it.

That’s why the “stimulus” flopped. It didn’t just fail to stimulate, it actively deterred stimulation, because it was the first explicit signal to America and the world that the Democrats’ political priorities overrode everything else. If you’re a business owner, why take on extra employees when cap’n’trade is promising increased regulatory costs and health “reform” wants to stick you with an 8 percent tax for not having a company insurance plan? Obama’s leviathan sends a consistent message to business and consumers alike: When he’s spending this crazy, maybe the smart thing for you to do is hunker down until the dust’s settled and you get a better sense of just how broke he’s going to make you. For this level of “community organization,” there aren’t enough of “the rich” to pay for it. That leaves you.

For Obama, government health care is the fastest way to a permanent left-of-center political culture in which all elections and most public discourse will be conducted on Democratic terms. It’s no surprise that the president can’t make a coherent economic or medical argument for Obamacare, because that’s not what it’s about — and for all his cool, he can’t quite disguise that. Apropos a new poll, the Associated Press reports that Americans “are losing faith in Barack Obama.”

“Losing faith”? Oh, no! Fall on your knees and beseech the One: “Give me a sign, O Lord!”

But he has. They’re all along empty highways across rural New Hampshire: “This Massive Expansion of Wasteful Statism Brought to You by Obama Marketing, Inc.”

President Obama and the far-left in Congress say that a “public option” health insurance plan is necessary because the profit motive results in too much coverage denial, therefore America needs a non-profit option to “keep the insurance companies honest.”

In Colorado, Obama explained it this way:

The argument around public option is, should one of the choices — not the only choice — but one of the choices on that exchange be a public option? And the idea here would be that a government-run non-for-profit would have its own option that people could sign up for — they wouldn’t have to, but they could sign up for it — and if it could keep its costs lower and provide a good-quality service and good benefits, then that would help keep the insurance companies honest because the idea being — the idea being that as a non-for-profit, potentially with lower administrative costs, they could do a good job.

Rebutting concerns that the public option would be a government-subsidized plan, Obama has said repeatedly that it won’t be. Rather, it would function as a nonprofit insurer.

He said in Colorado, “a public option can only work if they have to collect premiums just like a private insurer and compete on a level playing field.”

If that is true, then there is no need for a public option plan because roughly half of Americans who have private health insurance get it from the same type of entity Obama says he wants to create — a nonprofit insurer.

According to the same Census report that produced the figure of 46 million uninsured Americans, 202 million of us are covered by private insurance. According to the Alliance for Advancing Nonprofit Health Care, an industry group, “Of the 138 health plans in the United States with at least 100,000 medical enrollees, 84 or 61% are nonprofit.” Nearly half — 48 percent — of the people covered by the country’s 138 largest insurers are enrolled in a non-profit health plan, the Alliance reports. That’s 97 million people. That doesn’t include those covered by small, non-profit insurers.

Advocates for left-leaning health care reform like to target the small-group market, meaning the market for small employers, usually defined as businesses with fewer than 100 employees. They often cite a shortage of competition in this market as a reason or the primary reason health care is so expensive and there are so few options. Fingers are usually pointed at big, for-profit insurers. Conveniently ignored are the big non-profits.

The Congressional Budget Office surveyed the small group market in 2005, and reported this finding:

Thirty of the 40 states supplying information identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier offering health insurance in the small group market, and in all but 1 of the remaining 10 states, a BCBS carrier was among the five largest carriers.

The median market share of all the BCBS carriers in the 34 states supplying information was about 44 percent, with a range from about 6 percent in Wisconsin to about 93 percent in North Dakota.

The idea that for-profit insurers control the market with no serious nonprofit competition and therefore need a non-profit to “keep them honest” is nonsense. Nonprofit health insurers such as Blue Cross/Blue Shield and Kaiser Permanente already cover scores of millions of Americans and are often the dominant insurer in a given state or region.

And that doesn’t even get into the issue of nonprofit health care providers, which often dominate care in large portions of the country. For example, Excela Health is the sole health care provider, and the largest employer, in Westmoreland Co., Penn., the largest county in the state.

Now, there are lots of reasons why nonprofits might function essentially as for-profits when it comes to health insurance (the need to avoid becoming a dumping ground for the sickest of the sick, for instance). And there are lots of reasons why nonprofits might not be able to offer significantly cheaper alternatives (state coverage mandates, for instance). But no one is proposing reforms that make sure nonprofits are fulfilling their stated missions (and thus justifying their tax-exempt status) by actually offering low-cost coverage for high-risk populations. And no one is talking about bringing for-profit hospitals or physician networks to compete with monopoly or dominant nonprofit hospitals and physician groups.

Instead, they are attacking for-profit insurers and suggesting that the profit motive itself is the real masked villain here. That argument simply doesn’t hold when one realizes how much of the market nonprofit insurers (and providers) claim.

What President Obama and the Democrats want is not a nonprofit alternative to for-profit insurers. The United States is chock full of those. They want a government-run alternative. But the type of alternative Obama claims the “public option” would be already exists. So what, one wonders, is he really trying to create?

by Andrew C. McCarthy

It’s this week’s fashion on the left, and among such fashionably contemplative moderates as Mort Kondracke, to blast Rush Limbaugh for comparing Democrats to the Nazis. It’s no surprise that the Obama hardcores are misrepresenting the sequence and substance of events, but I would have hoped that Kondracke would at least have noted that Rush’s comparison — even if Kondracke thought it unwise — was neither gratuitous nor demagogic.

To recap, the speaker of the House, Nancy Pelosi, started this episode by comparing American citizens who oppose Obamacare to the Nazis and asserting that her political opponents were donning “swastikas.” (Sen. Barbara Boxer simultaneously ripped Obamacare dissenters for their Brooks Brothers suits — it’s not altogether clear where on the twill the swastika goes.) Pelosi’s tactic was the shopworn smear we on the right have dealt with for six decades. There is no conceivable substantive connection between opposition to Obamacare and German National Socialism — they are antithetical. By invoking the Nazis, Pelosi was patently slandering dissenters as racist thugs.

Rush responded, and the response did not smear Democrats. He repeatedly and explicitly qualified that no one was saying Obama was Hitler, that Pelosi was Goebbels, or that the Democrats were engaged in the genocidal barbarity of the Third Reich. The comparison he drew was a substantive one: between the Democrats’ proposal for socialized medicine and the German installation of socialized medicine beginning with Bismarck and reaching its shocking apotheosis with Hitler’s National Socialism. (A transcript of what he actually contended is here, and his website has other relevant transcripts, since the argument was reiterated other times during the week.) The point was to show that if Pelosi wanted to engage in Nazi comparisons, the health-care policies of Nazi Germany had far more in common with the health-care policies of the Democrats than with those of the conservative opposition, which wants health care kept private and reforms to be market-based.

Whether you agree with that or not (I happen to think it’s undeniable), Rush was also making a larger point that is not only fair argument but essential argument. There is a trajectory of socialism, regardless of the good intentions of many socialists. As he framed it, you take things such as health care, things that are traditionally understood as within the ambit of individual liberty and free choice; you move such things into the ambit of state responsibility as the welfare state emerges and grows, on the theory that it is government’s responsibility to provide for everyone’s needs (by redistributing resources); as more things are moved from private to public control, the state by definition becomes totalitarian; and, inexorably, the totalitarian state gets bad leaders and the society comes to reflect the policy choices of those leaders.

Now, we can argue until the end of time about whether that trajectory really exists and whether it is inevitable. But however you come out, it is an argument very much worth having. It goes to what kind of society we are going to be, to what the proper relationship between the citizen and the state is.

Nazi Germany is a useful historical example of socialism run amok. The genocide and terrorism ultimately practiced by the Nazis were horrible — that goes without saying. But National Socialism went on for a dozen years, it was the last stage in a progressive nationalization of German society, and there was a lot more to it than genocide and terrorism. It cannot be that because there was genocide and terrorism, the socialist aspects of National Socialism are outside the lines of acceptable political discourse. Given the immense popularity of Jonah Goldberg’s Liberal Fascism, one of the most important political books of the last quarter-century, it doesn’t look like Americans are as convinced as Mort Kondracke seems to be that these comparisons are verboten.

Let’s put aside the Left’s propensity to slander conservatives with comparisons to Adolf Hitler, who was patently a man of the Left. Earlier this year, one New York Times writer seemed to find comparisons to National Socialism quite worthy when — at least in the telling — those comparisons worked in the Left’s favor. While Americans were hotly debating the merits of the Obama “stimulus” in April, the Wall Street Journal’s James Taranto called attention to a very interesting economic analysis offered by David Leonhardt. Leonhardt wrote:

In the summer of 1933, just as they will do on Thursday, heads of government and their finance ministers met in London to talk about a global economic crisis. They accomplished little and went home to battle the crisis in their own ways.

More than any other country, Germany — Nazi Germany — then set out on a serious stimulus program. The government built up the military, expanded the autobahn, put up stadiums for the 1936 Berlin Olympics and built monuments to the Nazi Party across Munich and Berlin.

The economic benefits of this vast works program never flowed to most workers, because fascism doesn’t look kindly on collective bargaining. But Germany did escape the Great Depression faster than other countries. Corporate profits boomed, and unemployment sank (and not because of slave labor, which didn’t become widespread until later). Harold James, an economic historian, says that the young liberal economists studying under John Maynard Keynes in the 1930s began to debate whether Hitler had solved unemployment.

After all due qualifiers about how terribly uncomfortable he felt about invoking lessons from the Nazis, Leonhardt somehow summoned the inner fortitude to make the obvious explicit:

Here in the United States, many people are understandably wondering whether the $800 billion stimulus program will make much of a difference. They want to know: Does stimulus work? Fortunately, this is one economic question that’s been answered pretty clearly in the last century. Yes, stimulus works.

As Taranto correctly observed, whatever you may think of the merits of Leonhardt’s argument, it was appropriate for him to make it: The wisdom vel non of policies adopted during over a decade of Nazi socialism cannot be off the table simply because, in the end, the Nazis were monsters. We may find the seeds of their monstrousness in those policies, or we may not. But the thought that we should not talk about them is absurd. Notably, Leonhardt’s piece ran without any teeth-gnashing from Mort Kondracke and our other Beltway chaperones.

National Socialism is banned from the Right’s case against socialism, but is somehow acceptable when leftists use it as a smear or when the Left’s nuanced geniuses, after their very thoughtful consideration, decide its invocation is suitable for mature audiences? I don’t think so.

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Liberals in Congress say they want a public plan to compete against private health insurance in order to give Americans more choice and competition. Ponder that.

The reason that argument is so puzzling is that it is routinely made by Congressmen who have been stalwart champions of a single payer system of national health insurance. Single-payer means just that. Government monopoly. No competition.

So, yes, it is hard to believe that officials who have whined from time immemorial about the waste and inefficiency of multiple private payers for health coverage would suddenly become champions of personal freedom of choice and competition in health insurance markets.

So, don’t believe it.

In the House bill (H.R. 3200), there is no truly level playing field for competition between the public plan and the private health plans. While the bill says that the public plan will be initially financed by appropriations for start up costs, it also says that the Secretary of HHS can enter into contracts to administer the public plan, just like the Secretary enters into contracts with private firms to administer Medicare, but these contracts cannot, in the words of the House bill, “involve the transfer of insurance risk” to these private firms. In other words, the taxpayer is on the hook for the risks of the public plan. The bill says that the government plan must be self-supporting through premiums. But since the purpose is to create a low-cost plan, one can imagine that this will be quickly eroded, that the government will not want to charge full freight, and future Congresses will appropriate taxpayer money to bail it out.

Members of Congress will say that the public plan should compete on its own, financed by its own premiums, and that it will be allowed to fail. They say that. But they say a lot of things. It is hard to believe that the public plan, another government sponsored enterprise, like Fannie Mae and Freddie Mac, would be allowed to fail. If automakers, AIG and other financial institutions are “too big to fail”, it strains the imagination that Congress would not bail out its own creation, especially if it enrolls millions of Americans who have been dumped out of their private health insurance coverage. The Lewin Group, one of the nation’s top econometric firms, estimates that as many as 88 million Americans would be shifted out of their employer’s health insurance coverage under the terms and conditions of the House bill. That is a large consitutency for bailouts.

While the House bill provides that enrollees in the public plan will have the same rights as Medicare beneficiaries have today, that’s not enough. Sure Medicare beneficiaries today have access to the federal courts to secure their statutory entitlement, but Medicare beneficiaries can’t sue the Secretary of HHS for damages for injury arising out of wrongful coverage denials decisions in the same way they can sue private insurance executives. No way.

Private health plans are routinely subject to federal and state laws governing torts and contracts, and private health plan executives can be sued for violations of these laws. If Congress wanted to really secure a level playing field, they would allow ordinary Americans to sue the officers of the public plan for the same reasons in the same way.

For a truly level playing field, there are even more laws that would have to apply to the public plan as well as the private plans: anti-trust laws, consumer protection and solvency rules in any states where the public plan competes with private insurers, and federal and state tax laws.

On the last day before the House recess, July 31st, Congressman George Radanovich (R-Ca) offered an amendment in the House Energy and Commerce Committee that would have subjected the public plan to all the same rules and standards that apply to private health plans, including the payment of state taxes. The Committee’s Democratic majority defeated the Radanovich amendment. So much for the level playing field.

So, would Congress or could Congress create a level playing field? To think so, in the face of the evidence, would require more hope for a change in congressional behavior than normally sober people can summon.