The president’s Trojan horse

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During his recent speech to the American Medical Association, President Obama addressed what he called the “illegitimate concern” that “a public option is somehow a Trojan horse for a single-payer system.” Referring to such concerns, he added that “when you hear the naysayers claim that I’m trying to bring about government-run health care, know this: They’re not telling the truth.”

As the authors of “A Trojan Horse Plan” (Opinion, June 1), we are perhaps uniquely situated to respond. For our part, we’re prepared to believe that the president honestly thinks his “public option” isn’t a Trojan horse; that he honestly believes it won’t lead to government control of our health care system. What we don’t know is why he believes that.

The Lewin Group, a prominent consulting firm, estimates that, under a widespread, Medicare-like “public option,” 118 million Americans would lose their private health insurance and be switched onto government-run care. To the best of our knowledge, the president hasn’t cited any studies to the contrary. When you combine those 118 million with the 80 million people already covered by government health care, there wouldn’t be much room left in which private insurance could operate.

Because he doesn’t support a “single-payer” system, the president implies he doesn’t support “government-run health care.” But if, through payment policies, the government decides what doctors we use, what drugs we can take, and how much is charged, the system is government-run. So we can agree that Mr. Obama technically isn’t supporting a single-payer system. But he is supporting a government-run system that may well lead to a single payer.

Mr. Obama says that the “public option” would merely provide Americans with a new choice for health insurance: “If you like what you’re getting, keep it. Nobody is forcing you to shift.” In truth, however, millions of employers would choose the “public option” - for their employees.

Given a choice between accepting the cost, risk and burden of continuing to provide insurance, or having the government take over that responsibility, millions of employers would bolt. And anyone who believes a public option plan wouldn’t become a tax-subsidized plan hasn’t been watching very closely for the past 50 years.

The president says his proposal will be “deficit-neutral in the next decade.” Given its projected cost of $1.5 trillion over that decade - an amount greater than the annual gross domestic product (GDP) of Canada - this is quite a claim.

Keep in mind that we’re already running higher deficits - even as a percentage of GDP - than during the Great Depression. Only 55 percent of 2009 federal spending ($2.2 of $4.0 trillion) comes from tax revenue; the rest is borrowed money. Yet the creation of a massive new Medicare-like program won’t increase deficits?

The president says this unlikely result will be made possible through miscellaneous tax increases and Medicare spending reductions, but he never specifies the cuts. As secretary of health and human services, I took a budget to Capitol Hill containing half the reductions the president says Congress must make, and I was politically stoned by those in his party and many in mine. With all due respect, Mr. President, name the cuts. Show us the money.

Most of Mr. Obama’s claims would be impossible to believe even if there weren’t such a clear track record to support disbelief. In the 1960s, President Johnson and the Democratic Congress both projected that Medicare would cost $12 billion in 1990. Its actual cost was $111 billion - 9 times the original estimate. The Medicare Hospital Trust Fund is now projected to become insolvent in 2016, three years earlier than last year’s estimate.

So, we’re prepared to believe, as Mr. Obama watches Congress begin to build the “public option” Trojan horse, following the blueprint he has provided, that he honestly thinks this is merely a fine-looking gift for the American people, and not the vehicle through which government-run health care will pierce the gates, capture their wallets, and ration their health care. We’re just not prepared to believe he’s right.

Michael O. Leavitt, secretary of the U.S. Department of Health and Human Services from 2005-09, is a former director of the Environmental Protection Agency, and a three-term governor of Utah. Jeffrey H. Anderson is a senior fellow at the Pacific Research Institute.

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