President Obama’s recent reversal on mandates for Americans to purchase health care insurance draws a clear distinction from candidate Obama who campaigned against it in the Democratic primaries. In a debate November 2007 he said,“Senator Clinton is arguing that the only way to get every American covered is if you force every American to buy health care. And unfortunately she hasn’t told anybody how she would enforce this mandate.” With the introduction of H.R. 3200, the America’s Affordable Health Choices Act of 2009 (AAHC), he has clearly had an epiphany. One wonders what method of enforcement he has at the ready to apply.

Today on his weekly Saturday address, Obama said he would not sign a health reform bill that would add to the national budget deficit. He obviously practices duplicity as the Congressional Budget Office (CBO) has projected more than a trillion dollars worth of deficit balanced by unrealized savings procured from his plan and cost cuts (mostly to Medicare) which will still lead to a calculated 239 billion dollars of deficit over the next decade. I do not believe that anyone is actively shielding the President from this information. Per their report on the AAHC, the CBO admits this estimation lacks any consideration--not one dollar--for administration costs created by the new bureaucracy of H.R. 3200.

Consider this: if the approximate 1700 people on staff under White House auspices make $50,000 (some less, some much more) this adds up to $85 million dollars before one computer is purchased. It should cause taxpaying Americans to shudder when considering the tens of thousands of bureaucrats and government employees necessary to support this reform.  To not include some projection of administrative cost in this report is negligent.

Should this legislation get to the President’s desk in its current form will he sign it anyway? Probably. What example do we look to see where H.R. 3200 will take us? With his acquiescence to insurance mandates and a public option for health care, President Obama’s vision appears a virtual carbon copy of the Massachusetts health system.

For the last three years the Commonwealth of Massachusetts has enforced a mandate requiring all people to purchase health insurance. Prior to this, Massachusetts had a low percentage of uninsured citizens at 10.4%, currently standing at 2.6%; meaning they overhauled their health care system for a net 7.4% of its populace. The CBO estimates, even with the Obama reforms, 17 million people will remain uninsured in the US. There are approximately 6.5 million people in Massachusetts by contrast.

Unaware of basic economic tenants, Massachusetts increased demand for medical services without an equal increase in the supply of doctors--leading to reduced access for all--with waiting times increasing to approximately eight weeks to see a primary care doctor and longer still to see a specialist. 

Did it save costs? Not exactly, as costs have increased 10% each year to cover the newly insured 169,000 people the program serves, exceeding the program’s projected budget by tens of millions of dollars and contributing to the state’s $6 billion dollar budget deficit projected for fiscal year 2009-2010.

Yet Jon Kingsdale, Executive Director of the Commonwealth Health Insurance Connector Authority (which oversees the subsidized portion of the plan) calls it “an unqualified success.” In the July 2009 edition of Medical Economics he stated, “Cost is clearly the next frontier but in terms of the primary goal of getting everybody covered it’s been an unqualified success.” This is consistent with the logic which existed in the housing industry prior to it reaching its natural conclusion.

If he remains consistent in mirroring the Massachusetts plan President Obama will be guilty of another fabrication-allowing you to keep your own doctor. The Massachusetts Medical Society is litigating against a system that categorizes doctors by “tiering” them based on evaluation guidelines set up by the Group Insurance Commission which oversees health insurance for about 300,000 state and local public employees. Physicians are rated or tiered based on billing claims data. Physicians deemed more costly are assigned lower tier rating and their patients are penalized with higher co-pays. Obviously if a doctor cares for a sicker population of patients they will naturally incur a greater cost to the system. Many of these sicker patients, usually poorer, will likely need to choose another doctor and not necessarily a better one. 

Dr. Sally Ginsburg, a Massachusetts pediatrician, is frustrated by this system. She states, “They have used claims data, not clinical data, as the basis of this approach [tiering]. There is no way [that] the average Joe/Joan out there is looking at this information and thinking that I am as good as my fellow MD with a Tier 1 rating. Is this slander? Yes, I think it is, particularly if the methodology used is biased and the data employed are flawed.” Doctors who succumb to this will do the government’s bidding by denying and rationing care to claim a Tier 1 rating.

On pages 16 and 17 of the onerous 1018 page H.R. 3200 is the true testimony to the President’s poverty of principle when it comes to being forthright with the American people on his designs for health care. Here is where mouthing platitudes rubs against reality. Mr. Obama states that you will be able to keep your current health insurance if you so desire. What he does not tell you, and what is clear in this section of the bill, is that after year one of this bill’s passage there will be no choice for independent private insurance. All insurance will need to pass muster with the government to enter a health insurance exchange like in Massachusetts or it will not be available at all. 

When will the Janus mask of this administration be pulled away to reveal its true features? I pray now.