- - Wednesday, October 9, 2013

On health care, the president’s pile of broken promises keeps getting a little higher. Consider this gem from Aug. 20, 2009: “Let’s be clear about the fact that nobody has proposed anything close to a government takeover of health care.”

Well, yes, somebody did. President Obama is now well on his way to orchestrating the federal government’s “takeover” of Americans’ health care.

Commandeering the resources of major federal departments, particularly the Department of Health and Human Services and the Internal Revenue Service, the administration and its allies in Congress have created numerous federal bureaus, commissions and programs, issued thousands of pages of rules, regulations, guidelines and directives, reinforced by unprecedented mandates and new taxes, fees, fines and penalties. Central planning and coercion holds this sprawling thing together.

The president’s supporters insist this isn’t a “government takeover.” That’s a “myth,” they say, because private insurance plans and providers will still exist.

Sure, they will. As long as they do as they are told. Virtually all key health care decisions will be made by government officials. Not you. Not your employer. Not your insurance company.

Beginning on Jan. 1, government officials will require you to buy a federally approved health plan or pay federal fines or tax penalties. They will define and redefine, at their pleasure, the content of your health benefits package, meaning the medical treatments and procedures you must have; the kind and level of preventive health care services you must have; the level of coverage that you must have; the level of cost sharing, deductibles and co-payments that are acceptable — to them, not you.

Writing in the October 2010 edition of the New England Journal of Medicine, Sara Rosenbaum, professor of law at George Washington University and supporter of the law, perhaps best described the Obamacare’s transformative effect on private insurance: “It will take on certain characteristics of a public utility.” In other words, private insurance will be “private” in name only.

As a “public utility,” you get what government officials say you will get, and you will learn to like it. As the president and his allies keep telling us, it’s the law of the land. We are not going to “relitigate” it. So get over it, get used to it, and shut up.

Washington’s control is broad and deep. Because the statutory language is often vague, “experts” at the Department of Health and Human Services and the IRS are free to write detailed regulations that cover a multitude of thorny items, such as the definition of “quality care” or “value” in doctor- or hospital-care delivery. In writing the thousands of pages of rules that will directly affect your life, they will fill in all those nasty, little nitty-gritty “details” that are missing from — or deliberately left out of — that telephone book-sized statute.

Of course, officials who make the rules can make exceptions to the rules they make, issuing waivers or exemptions, or securing special treatment for favored groups. The most obnoxious example is the Office of Personnel Management’s decision to give hefty taxpayer subsidies to members of Congress and congressional staff to offset their premium costs in the new health insurance exchanges next year. Those special subsidies are bereft of statutory authority.

States are reduced to branch offices of the federal government. Under Section 1311, states “shall” establish health insurance exchanges. If they don’t, the Health and Human Services secretary will. Whether the health exchanges are run by the states or the feds, the feds define legally “acceptable” health plans, and federal rules govern insurance rating, cost sharing and deductibles, allowable administrative expenses, and “justifiable” premiums.

State flexibility is thus a joke. States can add more restrictions, not fewer. Forget free-market experimentation.

Obamacare empowers officials to control, oversee or supervise medical plans and providers. The law transforms private health plans into tightly regulated public utilities. It hikes government spending and new taxation to finance a new federal entitlement and Medicaid expansion.

This will encourage a further “crowd-out” of private coverage and a consolidation of the private markets. Government officials will exercise more control over the flow of your health care dollars, and subject you to mandates and penalties. Your personal freedom will be curtailed by those who claim to know what is best for you.

Meanwhile, the president and his allies will insist that what you are witnessing firsthand is not a “government takeover” of health care.

You can either believe them or your own eyes.

Robert E. Moffit is a senior fellow in the Center for Health Policy Studies at the Heritage Foundation (heritage.org).

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