By Wesley J. Smith
Monday, March 11, 2019
Obamacare failed. There is no denying it anymore. The
supposed “signature achievement” of the 44th president isn’t just opposed by
Republicans. The Affordable Care Act has now been jilted also by many
Democrats, who, like so modern-day Lotharios, have abandoned their once-burning
ardor for state insurance exchanges to pursue “single-payer” health care.
Some readers are yelling, “That was the plan all along!”
Yes, but the stew is not fully cooked. I doubt President Obama and the Pelosi
Congress of 2009 and 2010 planned for their party to move so radically this
soon. Oh well. With burning hatred for everything Trump as the accelerant — and
with polling popularity of Bernie Sanders’s “Medicare-for-all” legislation of
last year serving as a justification — much of the Democratic party now
unapologetically embraces outright socialized medicine.
The newly filed 120-page “Medicare for All Act of 2019,”
authored by Pramila Jayapal (D, Wash.), already has 106 co-sponsors — nearly
half of the Democratic caucus — and it seeks to yank America hard toward the
port side of the political spectrum. The bill — which resembles Medicaid more
than it does Medicare — would transform our entire health-care system into an
iron-fisted centralized technocracy, with government bureaucrats and
bioethicists controlling virtually every aspect of American health care from
the delivery of medical treatment, to the payment of doctors, to even, perhaps,
the building of hospitals. It would obliterate the health-insurance industry
and legalize government seizure of pharmaceutical manufacturers’ patents if
they refuse to yield to government drug-price controls.
Here are some of the plan’s most destructive features:
It Would Drown the
Country in Red Ink: True to its title, the bill promises comprehensive and
encompassing “free” health care for everyone, including primary care, hospital
and outpatient services, dental coverage, vision, audiology, women’s
reproductive health services, long-term care, prescription drugs, mental-health
and substance-abuse treatment, laboratory and diagnostic services, ambulatory
services, the list goes on and on. Last year’s version of the plan authored by Bernie
Sanders (I., Vt.) — which didn’t include coverage for dental and long-term care
— was estimated to add $32 trillion
to the budget over ten years. It is also not irrelevant that the current
Medicare — which is far more limited — is scheduled to go broke in 2028.
Yes, There Would be
Rationing: The bill creates a Physician Practice Review Board “to assure
quality, cost effectiveness, and fair reimbursements for physician-delivered
items and services.” The term “cost-effectiveness” is code for rationing, which
the law acknowledges by prohibiting the use of assessment methods of
determining “any value or cost-effectiveness that discriminate against people
with disabilities.”
Private Payment for
Covered Health Services Would Effectively Be Banned: The bill requires that
all covered medical services be provided without any out-of-pocket cost to
patients. The only fee to which a doctor, hospital, or other service provider
would be entitled would be that paid by the government. Kiss the
health-insurance industry goodbye.
Doctors and
Hospitals Would Become Government Contractors: The state would not,
strictly speaking, employ doctors directly. But doctors would be coerced into
becoming government contractors by the requirement that they sign a
“participation agreement” to be eligible to receive payments from the
government. The participation agreement forces medical professionals and
institutions to:
• Accept the
government fee as payment in full.
• Allow the
government to inspect their books for a variety of purposes and bury themselves
in administrative duties, such as filing periodic reports.
• Accept other
provisions regulators may impose later — which, as we saw with Obamacare, could
be onerous and intrusive and aimed as much at effecting social change as
providing access to medical treatment.
Doctors who object to the provisions of a participation
agreement would have little choice if they wanted to continue their careers,
since they could be compensated for services only if they were deemed
“qualified providers,” a status restricted to those who sign the agreement.
(This is known in law as a “contract of adhesion,” meaning providers have no
bargaining power or ability to negotiate terms.) If an individual provider’s
agreement were revoked, he or she would be ineligible to be hired by a hospital
or medical group, because their
participation agreements require that they not employ any provider whose
participation plan was “terminated for cause.”
Private-Pay Health
Care Would Be Destroyed: What about doctors who wish to operate concierge
practices, that is, accept cash directly from patients? Outside of the few
non-covered fields such as cosmetic surgery, good luck! The doctor cannot have
signed a participation agreement, since qualified providers “may not bill or
enter into any private contract with any individual eligible for benefits under
the Act for any item or service that is a benefit under this Act.” That means
the doctor’s entire practice would
have to be made up of people who opted not to be covered by the government, a
very small pool of patients — the few very wealthy who could afford to foot
their entire medical expenses out of their own pockets, and I suppose, “medical
tourists” who travel to the U.S. for the purpose of obtaining treatment.
The Bill Seeks to
Remove Profit in the Health-Care Sector: True to its socialist roots, the
would eliminate profit in health care. Indeed, the bill states quite
explicitly:
It is the sense of Congress that
tens of millions of people in the United States do not receive healthcare
services while billions of dollars that could be spent on providing health care
are diverted to profit. There is a moral imperative to correct the massive
deficiencies in our current health system and to eliminate profit from the
provision of health care.
To enforce the “sense of Congress,” the bill forbids
bureaucrats who determine the medical fees that will be paid to providers —
which includes institutions as well as doctors and group practices — from
taking into account the costs of “marketing” the “profit or net revenue of the
provider, or increasing the profit or net revenue of the provider” or
“incentive payments, bonuses, or other compensation based on patient
utilization of items and services, or any financial measure applied with
respect to the provider.” You think doctors have trouble receiving adequate
compensation from Medicare and Medicaid now? Just you wait!
The Government
Could Steal Pharmaceutical Patents: The bill requires the government to
negotiate the price of medicines with drug companies. The bargaining power in
that negotiation would — as with participation agreements — be all with the
government. If a company refused to agree to the government’s price, the bill
states, “The Secretary shall authorize the use of any patent,” by another
company “for purposes of manufacturing such drug for sale under Medicare for
All Program,” with compensation paid to the patent-owning company in an amount
determined by the bureaucracy. How willing would pharmaceutical executives be
to green-light the billions in investments required to develop new medicines
knowing that the government could simply seize their patent and license another
company to manufacture the drugs if they refused to sell it at a price the
government demands?
Illegal Aliens
Would Receive Free Health Care. Eligibility to receive benefits is not
limited to citizens and aliens here legally. Rather, the bill reads: “Every individual who is a resident of the
United States is entitled to benefits for health care services under this
Act.” Illegal aliens living here are residents. Talk about a migration magnet.
The only limitation on coverage for aliens is a provision that forbids
eligibility to anyone traveling here “for the sole purpose of obtaining health care items and services provided
under the program.” That’s much less than meets the eye. If an illegal alien
traveled here to work, to escape violence, or to be with family, the exclusion
clause would not apply. Further demonstrating the intent to cover those here
illegally, enrollment in the program would be automatic “at the time of birth
in the United States (or upon establishment of residence in the United
States).” Residency could conceivably be established by a state driver’s
license — now widely allowed illegal aliens — or even a utility bill. And get
this: Unlike today’s Medicare identifier, the new Medicare Card would
specifically not include a Social
Security number, which many illegal aliens don’t possess.
Women Would Receive
Free Abortion: Currently, the “Hyde Amendment” prohibits federal funding of
abortion. That rare bit of culture-wars comity would be destroyed by the bill,
which provides: “Any other provision of law in effect on the date of enactment
of this Act restricting the use of Federal funds [i.e., Hyde] for any
reproductive health service shall not apply to monies in the Trust Fund [the
government entity that would be established to pay health-care costs].”
The Medicare for All Act of 2019 won’t become law while
there is a Republican Senate and president. But the 107 co-sponsors in the
House have put the country on notice. If the Democrats take over the government
in 2021 as they — and some Never Trump Republicans — hope, by 2022, the United
States health-care system will become a wholly controlled subsidiary of the
United States government, bereft of liberty, increasingly sclerotic, managed by
unelected bureaucrats churning out thousands of pages of onerous regulations, a
centralized authoritarian mess from which the country’s health-care system
would never recover.
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