- - Tuesday, April 3, 2012


By Rosemary Gibson and Janardan Prasad Singh
Rowman & Littlefield, $26, 190 pages

There is no question that debate over the Patient Protection and Affordable Care Act (PPACA) will be front and center in the presidential election in November. There is no dispute that the key goal for Americans is affordable, accessible, quality care. The crucial question is: How do we achieve that goal?

One vision relies on empowering doctors and patients, the other on increasing the role of government in our health care system. The latter vision is what President Obama was able to accomplish with the bill he signed into law on March 23, 2010. However, PPACA was not supported by the American people. Today, according to the latest Rasmussen poll, 53 percent of Americans would like to see the law repealed.

Rosemary Gibson and Janardan Prasad Singh, the authors of “The Battle Over Health Care,” have spent more than 30 years working in the health care policy field, so they are extremely well-qualified to unravel the health care onion, which has many layers and many tearful moments, and to recommend solutions on reform.

As the nation’s debt continues to spiral out of control and unemployment remains high, the key question is: How does the United States get its fiscal house in order? Health care spending is part of the equation. In 2010, the United States spent 17.6 percent of gross domestic product, or about $2.6 trillion, on health care. Is it too much? I don’t know, but Americans demand the very best in health care. This makes health care expensive.

Mr. Obama, in his quest to be the first president in 75 years to accomplish health care reform, promised the American people two things: universal coverage and lower cost. In “The Battle Over Health Care,” the authors point out correctly that the federal government will not be able to keep these promises. The law represents a profound shift in how Americans will receive and pay for their care.

I agree with their assessment that whether or not PPACA survives depends on two major events - the 2012 election results and the decision of the U.S. Supreme Court on whether the individual mandate is constitutional. It is expected that the court will rule by late June. If Mr. Obama is not re-elected, it is likely that the incoming president will work with Congress to support repeal and replacement of the 2,700-page law.

If the president is re-elected, it is likely that the legislation will move toward full implementation, with many of the cost drivers going into effect in 2014 - state-based exchanges, Medicaid expansion, new federal tax subsidies, the individual and employer mandates, the ending of insurance companies’ lifetime caps, and the hiring of about 16,000 new IRS agents to ensure that the American people can show on their tax returns that they have insurance, or they will pay a fine.

The book is divided into five parts, ranging from examining the deals made between the Obama administration and the health care industry to how the country’s economic security will play a key role in shaping our future health security. The authors decided to ignore the political aspects of the debate. I believe it is not possible to exclude the latter.

The final chapter offers 10 steps to more affordable health care, which the authors point out will not be popular with the health care industry. The first recommendation is to allow the Independent Payment Advisory Board (IPAB) to be implemented. They posit that it is the only meaningful part of health care reform that will directly rein in Medicare spending.

I disagree with this recommendation. IPAB is a 15-person board whose members will be appointed by the president. Members will make judgments on whether the federal government is spending too much on Medicare. My assessment is that IPAB is a rationing board and, if not repealed, will result in seniors being denied the care they need. Cost control will be more important than outcomes.

Today, there is bipartisan support for the repeal of IPAB. The only way to cut Medicare spending is to offer premium support so seniors can purchase health care in the private market with subsidies based on income, means testing and raising the age of eligibility for enrollment.

While I disagree with many of the authors’ solutions, they raise a lot of important issues, and the book is worthy of a read. I believe that the way to achieve affordable, accessible, quality care in this country is to allow the market to work. Increasing the government’s power in health care delivery will lead to long waiting lists, rationed care and lack of access to the latest technology and procedures. The United States needs more competition in the health care sector, not less. If PPACA is not repealed and replaced, health care will cost more, and the problem of the uninsured will not be solved.

Sally C. Pipes is president of the Pacific Research Institute. Her latest book is “The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare” (Regnery, 2012).

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