Big-Government Ratchet Turns Another Click

Soon, Obamacare II could limit how much you spend on health care.


The government takeover of health care continues apace. Starting in 2014, the Affordable Care Act—i.e., Obamacare—will make you buy health insurance. Soon, Obamacare II could limit how much you spend on health care, too.

As critics warned, the Affordable Care Act will not "bend the cost curve downward" as promised. To the contrary, a June report by the Centers for Medicare and Medicaid predicts that national health spending through 2021 will continue to grow at a considerably faster clip than Gross Domestic Product.

That growth will not be even. Private health insurance spending will rise about 8 percent. Medicaid spending will grow about 20 percent. In a few years, government will account for 50 cents of every health care dollar spent in America. What's more, federal health care costs will consume a larger and larger share of the federal budget—and crowd out all other government functions in the process. If current trends continue, then by 2025 just four budget categories—Medicare, Medicaid, Social Security, and interest on the debt—will gobble up every last federal dollar.

This, naturally, has alarmed many progressives. But don't worry—as always, they have a plan.

According to The Washington Post's Ruth Marcus, "23 responsible Democrats—some of the left's leading thinkers in the health-care field—have just come up with a set of answers." And like a boozer who tries to drink himself sober, their answer is…wait for it…more government.

The group, Marcus writes, believes that "no matter how hard federal officials work to slow the rising trajectory of federal spending, their efforts will fail if overall health-care costs continue to rise. 'Health costs throughout the system drive federal health spending,' they write…'The only sustainable solution is to control overall growth in health costs.'"

Translation: Set a nationwide cap on all health spending, including private spending. This is the brilliant fix being offered by "responsible…leading thinkers" such as the Center for American Progress' John Podesta and former Obama health-care adviser Ezekiel Emanuel. (Just imagine what the irresponsible, second-rate thinkers would come up with.)

Pause for a second to review how we got here. Although numerous factors have contributed to the explosion of health-care costs—an aging population and expensive technology, for example—a chief driver is government itself. WWII-era wage controls, followed by the tax preference for employer-provided health insurance, combined to create the third-party-payer conundrum vexing us today. Medicare and Medicaid made the cost problem worse. It's the same dynamic driving up college tuitions: Massive government subsidies encourage massive price hikes, which then ostensibly justify yet more government intervention to bring prices down.

If you're wondering whether anyone could have seen this coming, the answer is: yes. Precisely the same story has played out in Massachusetts, thanks to Mitt Romney and Romneycare. According to The Wall Street Journal: "Health costs…will consume some 54 percent of the [Massachusetts] state budget in 2012, up from about 24 percent in 2001. Over the same period state health spending in real terms has jumped by 59 percent, while education has fallen 15 percent, police and firemen by 11 percent and roads and bridges by 23 percent."

So Massachusetts is imposing a cap on health spending, public and private. Here's the Journal again: "All Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure…They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics….An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017."

"Sweeping" is a woefully inadequate word to describe such policies, whose terminus is all too clear: If health-care spending hits the government-dictated ceiling, then even if you're willing to pay a doctor out of pocket for a consultation, the government won't let you.

The essence of Obamacare was the individual mandate—the decree that everyone must buy health insurance, whether they want it or not. Now, many of the same liberals who wanted government to make people spend money on health care also want to dictate the point at which they should stop. (And when that doesn't work, what then?)

Without knowing it, progressives are proving William Voegeli correct. "Liberals," he writes in Never Enough, "don't want the government to grow indefinitely. They just want it to be bigger than it is right now."

This column originally appeared in the Richmond Times-Dispatch.