The Treatment

Obama's Secret Plan To Enact His Agenda

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The Wall Street Journal editorial page has an article critical of President Obama's recent moves to expand government health care programs. Shocking, I know. But what's particularly interesting about this latest essay, by Kimberly Strassel, is the way it frames the argument. Under the headline, "Democratic Stealth Care," she writes:

Tom Daschle is still waiting to be confirmed as secretary of health and human services, not that he's in any rush. Democrats are already enacting his and Barack Obama's agenda of government-run health care--entirely on the QT.

As Strassel tells it, the secret Democratic plan to take over health care began when "Nancy Pelosi whipped through a big expansion of the State Children's Health Insurance Program." (The Senate passed the same measure yesterday.) But it's with the stimulus package, Strassel says, that the Democrats have gotten really devious. There's more funding for Medicaid, not merely to help states cover the cost of existing beneficiaries but also to make more people eligible for it. There's an expansion of so-called COBRA assistance, which allows recently unemlpoyed workers to keep their employer-sponsored health insurance. And there's authorization for the federal government authority to set standards for electronic medical records. 

For the record, I happen to think all of these moves make a lot of sense, given how rising unemployment means millions of people are going to lose their job-based health insurance. Many if not most of these people won't be able to buy insurance on their own, since benefits in the individual market are far more expensive and, by the way, often not available to people with pre-existing medical conditions. I'm not actually familiar with the technology provision she cites. But given the desire to invest heavily in developing universal medical records--something virtually every public health expert says is essential to elminating deadly medical errors, reducing the costly duplication of services, and fostering more coordinated care of chronic disease--having the government set standards seems entirely appropriate.

But Strassel is entitled to her conservative worldview, in which any government intervention in the market is bad government intervention. What's more baffling is the suggesiton that Obama and the Democrats are somehow trying to pull a fast one on the public. Obama, in defending the stimulus proposal, has talked repeatedly about expanding health insurance eligiblity and IT investment. Here, for example, is his January 8, 2009 speech on the subject:

To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs - it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.

...

Finally, this recovery and reinvestment plan will provide immediate relief to states, workers, and families who are bearing the brunt of this recession. ... To help Americans who have lost their jobs and can’t find new ones, we’ll continue the bipartisan extensions of unemployment insurance and health care coverage to help them through this crisis.

And if that's not clear enough, there is also this little matter of last year's presidential election, in which health care was a defining issue.

Obama and the Democrats ran on a platform to expand programs like Medicaid and S-CHIP, to make insurance more affordable and available to individuals, and to invest heavily in information technology for medicine--in other words, precisely what the stimulus is doing. McCain and the Republicans attacked these ideas visciously, calling them "socialized medicine" and warning that Obama wanted a "government takeover of medicine."

Obama and the Democrats won--not just in the final tally but, according to every issue poll I've seen, on the specific issue of health care. And now they're following through on their agenda. How sneaky! 

--Jonathan Cohn 

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