Qualms and Questions About Obama's Health Plan

Michael Barone
Thursday, June 11, 2009

Barack Obama has said he wants to pass a national health care bill this year, with a government insurance policy option. Democratic congressional leaders have called for passage of such a bill before the beginning of the August congressional recess. What they want more than anything else is a government insurance program that will tend over the next few years to crowd out private insurance. We are told that a government insurance plan reduces the amounts spent on health care by using "comparative effectiveness research" -- in other words, by rationing care and limiting options through the use of statistics. Unfortunately, statistics are constantly in flux and do not capture the differing needs of actual patients as well as skillful practitioners can.

Obama and his party are pursuing an ambitious goal. It could drastically change health care in the United States. But Congress has yet to write an actual bill, although there are some drafts around. And there's not much time. Congress is scheduled to be in session for only six weeks from next week to the August recess. Six weeks of Tuesday-to-Thursday sessions means 18 days for actual legislating. There are other things before Congress, like annual appropriations and cap-and-trade. Still, Obama and the Democratic congressional leaders see this as a rare chance to make "transformational" changes in America. They may be right.

Still, there are some things out of kilter here. First, there are nagging questions about money. As Clinton White House deputy domestic policy adviser William Galston points out in the New Republic blog, "Congress has thus far given the cold shoulder to most of the administration's proposals for raising revenues dedicated to health reform." So if Democrats want to pass their health bill using the reconciliation process, which requires that they get only 50 votes in the Senate, they will have to come up with $150,000,000,000 in annual revenue or offsetting spending or else add to the $900,000,000,000 in yearly budget deficits projected by the Congressional Budget Office. As Galston points out, the CBO is unlikely to agree with administration projections of savings from comparative effectiveness research. So money is a problem.

So is public opinion. An April tracking poll conducted for the Kaiser Family Foundation shows that voters rank changing health care below strengthening the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit on a list of eight possible priorities. Democrats rank it higher, Republicans rank it at the bottom, and independents, on this issue like many others this year, look more like Republicans than Democrats.

The blunt fact is that most Americans are satisfied with their health insurance and don't believe major legislation will improve things for them. This gives opponents of the Democrats' rush to legislate a strong talking point.

Third, the segment of the electorate that did most to produce the Obama victory and give the Democrats large majorities in Congress is the least concerned and least informed about health care. That segment is the 18 percent of voters under 30. Young voters preferred Obama to John McCain by a 66 percent to 32 percent margin, according to the exit poll. Voters 30 and over preferred Obama by only a 50 percent to 49 percent margin. Some 63 percent of the young voted Democratic for the House of Representatives. Only 51 percent of the rest of Americans did so. Without the young, the votes would clearly not be there for what the Democrats are trying to force through.

But what do the young know or care about health insurance? They have the fewest medical problems of the whole population. Their image of health care, at least until they become pregnant and have babies, is university health services. You come in if you feel like it, someone else pays, you get some pills or some counseling, or whatever. As for the downside of government insurance, pollster Scott Rasmussen reports that the young favor capitalism over socialism by only a 37 percent to 33 percent margin. The rest of us prefer capitalism by a 57 percent to 17 percent margin.

But while young voters may be open to government health insurance, they surely don't care very much about the issue. Voters with experience dealing with doctors and insurance companies care more. Democrats hope they can assemble the votes and finagle the financing before anyone much notices. Those who oppose them have some material to work with.

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