Published September 28, 2010
During the long national debate over the future of American health care, President Obama frequently chastised his opponents for launching exaggerated attacks on his plan for “reform.” He took particular exception to the criticism that the changes he was pushing amounted to a government takeover of the whole health sector. He knew full well that this kind of criticism might derail the entire effort in Congress, because most Americans recoil at the thought of a distant and bureaucratic federal government running the health-care system for everyone. So Obama vigorously denied that his program would lead to any such thing. In his Aug. 8, 2009, radio address, he described the “takeover” accusation as “outlandish” and characterized his approach as a mainstream and moderate attempt simply to reform the nation's private health-insurance system.
It's now been six months since Congress passed Obamacare — not a long time given the sweeping nature of the legislation and the long phase-in schedule for its most significant provisions. Even so, it is already abundantly clear that Obamacare's critics were dead right: The new health law has set in motion a government takeover of American health care, and a very hostile one at that. The Obama administration's clumsy and overbearing behavior since its passage proves the point.
First, there are the heavy-handed statements coming out of the Department of Health and Human Services (HHS). Two weeks ago, HHS secretary Kathleen Sebelius sent a letter to the nation's insurers with a plainly stated threat: Either the insurers conform to the political agenda of the administration and describe the reasons for premium increases in terms acceptable to the Democratic party, or they will be shut out entirely from the government-managed insurance marketplace. What could possibly have provoked a cabinet secretary to launch such an indiscriminate broadside against an entire industry? Simple: A handful of insurers had dared to utter the truth, noting that the new law has imposed costly insurance mandates that will raise premiums for everyone. For that offense, the federal government has essentially threatened to put the truth-telling insurers out of business. And what's truly astonishing, and telling, is that the new law almost certainly gives the HHS secretary the power to do so if she really wants to.
Then there is the matter of Dr. Donald Berwick. Recall that President Obama took more than a year to settle on Dr. Berwick as his nominee to head the Centers for Medicare and Medicaid Services (CMS) — and then moved in a matter of weeks to put him in place without Senate confirmation. The president tried to blame Republicans for this blatant end-run around constitutional checks and balances, even though Democrats control the Senate and could have held a hearing and a vote if they had wanted to. The truth is that Democrats didn't want Dr. Berwick to be confirmed in the Senate. They wanted him on the job, for sure, because he is an ardent government-takeover enthusiast, and is prepared to use all of the levers at his disposal to advance that objective. The president and his Democratic allies just wanted to get Dr. Berwick in place without the public's really noticing. So they chose to circumvent the normal process and put him in the CMS position with a time-limited recess appointment. For the next year and a half, Dr. Berwick is free to use CMS's enormous new powers to force doctors and hospitals to conform to his vision of effective health care, and he is essentially accountable to no one but the president.
To distract the public from these power plays, the administration decided to launch a series of “information” campaigns that are plainly political and filled with all manner of distortions. HHS sent a letter to the nation's Medicare beneficiaries supposedly explaining what the new law will mean for them. Somehow, it failed to mention that the law will cut Medicare by half a trillion dollars over a decade, and cut the value of Medicare Advantage by an average of 27 percent by 2017. HHS followed this up by putting the same distortions on television, in the form of an expensive advertising campaign featuring Andy Griffith.
In the meantime, busy beavers in various corners of the federal bureaucracy are laying plans for new fiefdoms. Thousands of new employees are planned for various offices in HHS, including the new office to regulate private health insurance nationwide. The IRS is gearing up both to enforce with tax penalties the requirement that everyone carry government-approved insurance, and to help administer the massive new entitlement program that will require income verification on tens of millions of applicants. States will also be forced to build new bureaucracies to carry out the scores of tasks the federal government will be ordering them to perform.
Massive bureaucracy. Disinformation campaigns. Blatant power plays. The politicization of decisions that should be made with a focus on patient care. The use of government power to threaten citizens and their livelihood.
This is what Obamacare has brought us. And that's just in its first six months.
James C. Capretta is a fellow at the Ethics and Public Policy Center. He was an associate director of the Office of Management and Budget from 2001 to 2004.