Americans are engaged in a healthy democratic donnybrook over "Obamacare," the generic term for health care reform legislation that would remake the current American medical system. What a spectacle—citizens yelling at their elective representatives; the Speaker of the House of Representatives testily calling democratic organizing and agitation "un American," the President of the United States forced by political pressures to take to the road to sell the plan.
In all the hue and cry, it is not easy to discern fact from fiction, truth from propaganda. This job is made particularly difficult by the length of the legislation—the House bill alone exceeds 1100 pages—and the difficulty of zeroing in on terms that have yet to be finalized. Still, the general outlines are becoming increasingly clear. So, here is a quick primer on what Obamacare would—and would not—mean for the American people.
- Would the law allow me to keep my current insurance policy? Yes, but there is a reason proponents always emphasize the word "current." If you change policies after the law becomes effective, your choices—whether public or private—would be limited to plans approved by the federal government.
- What about health care rationing? That's a reasonable fear. The plan calls for a centralized board or boards to establish uniform practice guidelines so as to control medical costs. Critics worry that these boards would impose a system of rationing (hence, Sarah Palin's fear about "death panels"), as occurs under a similar system in the United Kingdom. Adding to the worry, some of Obama's closest health care advisers have explicitly advocated the imposition of age and "quality of life"-based health care cost controls.
- Would Medicare be affected? Definitely. The more than $1 trillion federal price tag would be partially paid for through a proposed $500 billion cut in Medicare payments to physicians and other health care providers.
- What about waiting lines for tests and procedures? The president assures us that there won't be any, but that seems an empty promise. When more than 40 million additional people obtain health insurance without materially increasing the number of physicians, nurses, and health care facilities, bottlenecks are sure to form—evidenced by the long waits for tests and some procedures in countries with universal coverage like Canada, the UK.
- Will the elderly be forced to undergo end of life counseling? Not according to the president and the bill's authors. They claim that the controversial section merely allows physicians and nurses to be paid for such counseling. However, since the point of the counseling would be to cut costs, critics worry that in actual practice, seniors would be pushed toward refusing care—as studies have shown pre natal genetic counseling after a diagnosis of Down syndrome is often directed toward abortion. Even though the controversy roiled the public square for weeks, supporters have not amended the legislation to explicitly ensure that counseling remains fully voluntary for both provider and patient.
There is one more important concern rarely mentioned in the debate about this complicated and mind-numbingly arcane bill. The legislation is only the general outline, the skeleton if you will—of what the remade American health care system would ultimately look like if the bill becomes law. The flesh and blood would be created beneath the public radar by unelected bureaucrats in the federal departments and agencies through the promulgation of thousands of additional pages of rules and regulations. Thus, whatever bill is ultimately passed, it will still be a pig in a poke. The devil, as they say, will be in the regulatory details.