The ObamaCare Leviathan

As the Democrats inexorably slog toward the finish line, lugging and wrenching their malformed health care bill, the most passionate debate has been on contentious issues like abortion, the public option, and Medicare cuts. Yet the overriding danger of the Senate bill and its House counterpart is the massive government bureaucracies that will emerge as the legislation takes effect.

The Democrats' colossal experiment threatens to unleash forces that will ultimately overwhelm the doctor-patient relationship, ration our health care, and stifle innovation and excellence in the medical field. A massive government bureaucracy soon acquires a life of its own, with dominion over its constituency that no politician dares attempt to rein in.

Perhaps the greatest expansion of power will be in the Department of Health and Human Services. The Secretary of HHS will become the monarch of the health care kingdom. The Washington Examiner said the Senate health bill contains the word "secretary" 2,500 times, and that "[t]he legislation lists 1,697 times where the Secretary of Health and Human Services is given the authority to create, determine or define things in the bill."

In a massive power shift, the Secretary of HHS would take over insurance regulation from the states and would define qualified plans, what they cover, what they should cost, and whom should be covered. Competition and choice, the president's favorite buzz words, will disappear as HHS becomes the focal point of central planning for health care.

A second epicenter in the new health care infrastructure will be the IRS, which is poised to assume a powerful role in rulings, collections, and enforcement of health care mandates and taxes. There is a provision in the Senate bill for a reporting requirement similar to the current W-2. It would require, in Section 1502, the name, address, tax ID number, dates insured, and plan qualification, among other things. An expanded IRS is likely to become even more intrusive, dispelling any remaining illusions of a compassionate government-run program.

Embedded in the legislation in section 3403 is the Independent Medicare Advisory Board, one of 118 new boards, commissions, and programs making up a third power center that will have immense control over life and death.

This board, with fifteen members appointed by the president, would have extraordinary powers, not subject to judicial review, to dictate what is covered and thus what treatments, drugs, and procedures patients can get. The bill's wording says the purpose of the board is to "reduce the per capita rate of growth in Medicare spending," a simple but chilling statement. With a set budget, the board would become a rationing commission in a "radical change for U.S. health care," as the Wall Street Journal describes it:

... the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year-and then invest an unelected board with extraordinary powers to dictate what is covered ...

The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.

The Senate bill contains a labyrinth of regulations defining the operation of the Medicare Advisory Board -- "target growth rate," "implementation year," "inflationary payment update," "direct subsidy payments," "base beneficiary percentage"...and on and on. The language even includes a note prohibiting "any recommendation to ration health care." Yet as the Journal points out, the hard budget-cap rules mean there "is only so much money to be divvied up for care." 

The bill's green eye-shade language may be numbing, but its long-term effect on health care will be devastating, as physician discretion is displaced by government fiat. The mention of "death panels" by Sarah Palin sent the Democrat left over the edge in denying, disparaging, and demonizing, perhaps because that is precisely the effect of what is in the bill.

A fourth empire is the expanded burden of unfunded Medicaid mandates on the states. A massive Medicaid increase will initially be federally subsidized, but after five years, it will be shifted back to the states. The House bill increases Medicaid up to 150% of the poverty level, and the Senate bill increases it up to 133%.  Dick Morris summarizes the impact on his web site:

... in California ... the already fiscally beleaguered state would have to increase its Medicaid spending on poor people by 50%, at least an extra $2 billion a year and perhaps more...

In many Southern states, the Medicaid program only covers a portion of those living below the poverty level ... In Arkansas and Louisiana, where swing Senators Pryor, Lincoln, and Landrieu come from, the cost could exceed $1 billion for each state each year.

The question now is whether the governors of the fifty states, particularly the Democrats, are going to sit idly by and let their budgets be destroyed by the health care bill.

Offloading some of the increased insurance cost to the states by adding to the Medicaid rolls further disguises the real cost of the legislation. The American Spectator quotes Sen. Lamar Alexander (R-Tenn.):

There's an air of unreality here. ... The language is, 'we'll shift it back to the states' as if the states had the money or a printing press. But this isn't just a little increase. This is a bankrupting increase for most states.

A fifth enormous burden of a perversely different sort is the rampant Medicare fraud that stands to expand in a Medicare-for-all health system. The federal government has had forty years to figure out how to control Medicare fraud, but it is still pervasive. A Washington Times article quotes an Inspector General saying his office "finds fraud everywhere it looks." The Times quotes another source saying "3 percent to 10 percent of the $800 billion spent on Medicare and Medicaid each year 'is lost to waste, fraud and abuse.'" A recent CNN headline tells the story: "Organized crime's new target: Medicare."

So we have the HHS, the IRS, the Medicare Advisory Commission, expanded Medicaid, and expanded turf for Medicare and Medicaid fraud, each a leviathan of big government excess in its own right.

The Republicans are correct in strongly challenging the Democrats on topical issues, but there are larger forces at work that will have staggering implications on our future as the juggernaut of big government consumes all in its path.