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Return to the ArticleJuly 24, 2009

Rhetoric Meets Reality

Charles Krauthammer

WASHINGTON -- What happened to Obamacare? Rhetoric met reality.As both candidate and president, the master rhetorician could conjure aworld in which he bestows upon you health care nirvana: morecoverage, less cost.But you can't fake it in legislation. Once you commit your fantasies towords and numbers, the Congressional Budget Office comes along anddeclares that the emperor has no clothes.President Obama premised the need for reform on the claim that medicalcosts are destroying the economy. True. But now we learn -- surprise! --that universalcoverage

increases

costs. The congressional Democrats'health care plans, says the CBO, increase costs in the range of $1 trillionplus.In response, the president retreated to a demand that any bill he sign berevenue neutral. But that's classic misdirection: If the fierce urgency of health care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us onprecisely the same path to insolvency that Obama himself declaresunsustainable.The Democratic proposals are worse still. Because they do increasecosts, revenue neutrality means countervailing tax increases. It's not justthat it is crazily anti-stimulatory to saddle a deeply depressed economywith an income tax surcharge that falls squarely on small business andthe investor class. It's that health care reform ends up diverting for itsown purposes a source of revenue that might otherwise be used to closethe yawning

structural

budget deficit that is such a threat to theeconomy and to the dollar.

These blindingly obvious contradictions are why the Democratic healthplans are collapsing under their own weight -- at the hands of Democrats. It's Max Baucus, Democratic chairman of the SenateFinance Committee, who called Obama unhelpful for ruling out taxingemployer-provided health insurance as a way to pay for expandedcoverage. It's the Blue Dog Democrats in the House who wince atskyrocketing health-reform costs just weeks after having swallowedhemlock for Obama on a ruinous cap-and-trade carbon tax.The president is therefore understandably eager to make this a contestbetween progressive Democrats and reactionary Republicans. He seizedon Republican Sen. Jim DeMint's comment that stopping Obama onhealth care would break his presidency to protest, with perfectdisingenuousness, that "this isn't about me. This isn't about politics."It's

all

about him. Health care is his signature reform. And he knowsthat if he produces nothing, he forfeits the mystique that both propelledhim to the presidency and has sustained him through a difficult first sixmonths. Which is why Obama's red lines are constantly shifting.Universal coverage? Maybe not. No middle-class tax hit? Well, perhaps,but only if they don't "primarily" bear the burden. Because it's abouthim, Obama is quite prepared to sign anything as long as it is titled"health care reform."This is not about politics? Then why is it, to take but the most egregiousexample, that in this grand health care debate we hear not a word aboutone of the worst sources of waste in American medicine: the insane costand arbitrary rewards of our malpractice system?When a neurosurgeon pays $200,000 a year for malpractice insurancebefore he even turns on the light in his office or hires his first nurse,who do you think pays? Patients, in higher doctor fees to cover theinsurance.And with jackpot justice that awards one claimant zillions while othersget nothing -- and one-third of everything goes to the lawyers -- wheredo you think that money comes from? The insurance companies, whothen pass it on to you in higher premiums.But the greatest waste is the hidden cost of defensive medicine: tests andprocedures that doctors order for no good reason other than to protectthemselves from lawsuit. Every doctor knows, as I did when I practicedyears ago, how much unnecessary medical cost is incurred with an eyenot on medicine but on the law.