Column: Healthcare reform will create poorer Americans

We keep hearing from a few readers about how great Medicare is as an argument for national healthcare. I don't know much about how Medicare works from a patient's perspective, but I do know it has obligations totaling about $35 trillion and no funds to pay for it over the long haul.

Social Security and Medicaid are in pretty much the same boat. There is any number of estimates about the combined obligations of the three entitlement programs, and $60 trillion is probably low, but try to wrap your mind around that number - 60,000,000,000,000. It's more than four times the United States' annual gross domestic product.

Now I'm certain there are some people out there perfectly comfortable with the idea you can be fined and sent to prison for not buying health insurance. I'm not a fan of command and control government, though. I've looked at the cost of Obamacare and I'm wondering if I'll be able to afford it and make the house payment.

In other words, it's not "free" or anywhere near affordable. And with the government in charge, does anyone truly believe healthcare will be delivered more efficiently?

Betsy McCaughey offered her own take on the 2,000-page health bill in the Wall Street Journal. Below are excerpts:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services.

If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17 percent of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20 percent of its pre-tax income.

Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice - basic, enhanced and premium levels - but the benefits are the same. Only the co-pays and deductibles differ.

You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5 percent of the cost, and a smaller share of family coverage, or incur an 8 percent payroll tax. Small businesses with payrolls from $500,000 to $750,000 are fined less.

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee.

The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider.

Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20 percent of seniors).

Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

There's more, but the larger point to me regards why this is happening. Most people like the coverage they have now, and a majority oppose the radical makeover from the House now being contemplated in the Senate.

Cap-and-trade won't make our skies any bluer and won't cool the planet, but it will make us poorer.

Obamacare addresses the issue of a few million uninsured (some because they'd rather use their money to buy other stuff) as an excuse to mess with everybody's insurance - and it will make us poorer.