I’ve been through this three times. You’d think that someone would notice a pattern. Learn lessons. Avoid repeating dumb mistakes. Alas, it was not to be.
First there was the Medicare Catastrophic Care Act of 1988. A drug benefit added to Medicare was passed one year and repealed the next. It was the first repeal of a major federal welfare program in 100 years. Grass-roots negative reaction was so intense that House Ways and Means Chairman, Dan Rostenkowski, was chased down the streets of Chicago by angry senior citizens. Then there was HillaryCare. After working for a year, the designers of this plan met ignoble defeat. There was never a hearing. Not even a vote. And now there is ObamaCare.
In all these cases, politicians and special interests met behind closed doors to carve up huge chunks of the medical marketplace. They then emerged and announced their plan to push everyone around and tell them what to do in the most intimate and personal aspects of their lives. In all three cases, the voters replied “no.”
The reaction of nonseniors to the latest reform is easy to understand. How many times did Barack Obama say, “If you like the health plan you are in, you can keep it”? Inside the Beltway, I’m sure no one bothered to count. They weren’t listening anyway. That’s because no one in Washington — whether Republican or Democrat, man or woman, old or young, tall or short, fat or thin — no one took this promise seriously from the get-go.
But out in the Hinterland, people did take it seriously. And when it was obvious that the promise was not going to be kept and that no one who voted for ObamaCare could explain why the promise was not being kept, the negative reaction was palpable. Adding to the understandable fear and anxiety was a threat by McDonald’s to abolish health insurance for 30,000 employees and 3M’s announcement that it would end coverage for its retirees.
Folks, this is only the beginning. Over the next two years, many more people will get hit with similar unpleasant surprises. In an earlier Health Alert, I predicted that this election would not go well for people who devised the Affordable Care Act (ACA). If this Rube Goldberg contraption is not opened up and seriously repaired, we will have another election in 2012 just like this one.
As for seniors, this is all a no-brainer. For every $1 of benefits under the new bill, they will bear $10 of cost. As Joe Newhouse explained in Health Affairs, by the end of the decade their access to care will be worse than low-income families on Medicaid. (See the very excellent chart prepared by the Office of the Medicare Actuary.) Not only will seniors have to turn to community health centers and safety net hospitals for their care, they will be the least preferred patients in the waiting lines.
Here the only question was whether seniors’ access to the facts and their perception of reality could be overcome by Madison Avenue advertising techniques. Could Obama’s townhall meetings, slick taxpayer-funded brochures, taxpayer-funded Andy Griffith commercials and AARP propaganda convince seniors that the ACA was actually good for them? Answer: No.
Notice that there is one major reform not on my list: The Medicare Modernization Act of 2004 (MMA). This measure created a new drug benefit under Medicare (Part D) with a 75-year unfunded liability greater than that of Social Security! This time the only protests came from Democrats in Congress, some of whom tore up their AARP cards. Their complaint? They wanted a program twice as large.
[Yes, I am aware of the irony. George W. campaigned on a promise to eliminate Social Security’s unfunded liability and worked hard to do it. Yet he left office having doubled the size of the problem!]
The lessons here are twofold: 1) If you give people something for nothing and pay for it with increased debt, everyone is happy and 2) there seems to be no limit to the public’s willingness to pile up obligations for future generations.
Perhaps the last election signaled that these lessons no longer hold. Let’s hope so.