Get Ready for ObamaCare Rationing

John Goodman,

There were two recent announcements that I hope you paid attention to:

  • The American Medical Group Association, representing medical groups that provide care for roughly 1 in 3 Americans, said that 90% of its members would not participate in the new Accountable Care Organization (ACO) model the Obama administration wants to impose on Medicare providers.
  • Secretary of Health and Human Services Kathleen Sebelius, exercising new powers conferred upon her by health reform (ObamaCare), said insurers would have to justify any rate increases greater than 10%.

So what does one announcement have to do with the other? A lot. I’ll connect the dots below.

Here’s the bottom line. The administration uses the rhetoric of choice and competition and some isolated souls within it may actually think competitive pressures can reduce health care costs. But if that doesn’t work out, it’s goodbye to volunteerism and hello to another way of constraining costs: global budgets and rationing.

The core of Obama administration health reform is managed competition, instituted through a health insurance exchange. In embracing this reform, the administration is following the lead of Mitt Romney in Massachusetts and before that Hillary Clinton’s failed attempt in 1993/94. But the idea really harks back to a book written by Stanford professor Alain Enthoven in the early 1980s. Enthoven argued that the entire health care system should be patterned after the Federal Employees Health Benefits system. (See a brief history and analysis.)

Here’s the difference. Enthoven believed (and still does believe) that competition in health insurance can actually work. Mitt Romney believed that as well. Maybe Hillary Clinton did too. But almost no one in the Obama administration believes that. When is the last time you heard any federal official praising the virtues of a competitive market for any good or service?

For Obama, the purpose of the health insurance exchange is not to bring needed competition to an imperfectly competitive market. The purpose is to exert control over the industry. If you believe in competition, then you want lots of competitors. But the administration is imposing rules and regulations that are driving insurers from the market, as we have previously reported here, here and here. In fact, some careful observers believe that by the time the exchanges become operational (in 2014) there will be only one or two insurers left in most markets….

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How (Not) to Lose Egypt to Islamic Fanaticism

Ben Johnson,

Egypt rolls the dice on its future.

Since the riots in Egypt broke out last week, Barack Obama has attempted to hit the snooze button on his 3 a.m. phone call. After much uncertainty about the American position, Egyptian President Hosni Mubarak announced today he will step down as president-for-life at the end of his term this September. There is no word on whether this will satisfy the majority of rioters in his country, nor what government may follow him, but apparently it did not satisfy Obama. Shortly after the announcement, Obama declared, “orderly transition…must begin now.” As to what government will follow, a member of the Obama administration has allegedly met with a member of the Muslim Brotherhood, the radical fundamentalist organization that incubated the leadership of al-Qaeda. The Brotherhood is uniquely positioned to take advantage of these region-wide uprisings. The good news is this fate could be prevented; the bad news is there is no evidence Barack Obama has any idea how to bring this about.

Choosing Among No Good Solutions

Leading up to today’s announcement, Obama had called for an “orderly transition” to a post-Mubarak government following open, democratic presidential elections in September. However, Hillary Clinton said Sunday that Mubarak must take “concrete steps toward democratic and economic reform… immediately.” However, she added, “We are not advocating any specific outcome.”

None of us is privy to the behind-the-scenes negotiations — at least until the next WikiLeaks dump — so we can hope direct talks took a smarter ring than public rhetoric. Unfortunately, reports indicate the Obama administration is already legitimizing the Muslim Brotherhood’s role in a post-Mubarak government. The foreign policy elite insist there is little cause for concern; that these are “democratic” rallies with broad-based support, and the Brotherhood plays a tiny role in the proceedings. Its talking heads state we “can’t” exclude the MB from a democratically elected future regime, but its representatives will be drown out by more liberal figures such as Mohamed ElBaradei. Some conservatives insist America must bog itself down on the banks of the Nile and advance “the freedom agenda” despite its likely beneficiaries. The table seems set for a replay of foreign policy disasters past, beginning with media disinformation.

Nobody Here But Us America-Lovin’ Democrats

One is always impressed by the discipline, if not the originality, of talking heads spouting talking points. No facts, logic, or human intellectual impulse can keep them from repeating their rote catechism of the moment like a Victrola wound by the hands of their party leadership. Since the demonstrations broke out, they have reassured us that the crowds are diverse, opposition to Mubarak is wide, and– here’s their new phrase of the hour — “the Muslim Brotherhood came late to the party.”

The Washington Post illustrates this by quoting Mohammed el-Rady, a 32-year-old government accountant who told reporters:

We want to be like America. We want to choose our president. This movement is not about Islam. It’s not about religion. It’s about people who have been suffering for 30 years who want democracy.

Readers of a certain age or political sophistication can virtually hear echoes of Mao Tse-tung being described by a Communist-riddled State Department as an “agrarian reformer” or Fidel Castro as the George Washington of the Cuba Unlike those media manipulations, the media line on Egypt is not altogether false. The Egyptian people, including its Muslim majority, do not favor the Muslim Brotherhood’s vision of a theocracy dedicated to converting or killing the nation’s substantial Coptic Christian population.

But popular will has never restrained a well-organized minority of fanatics let loose against a large, unorganized majority. It appears the Muslim Brotherhood is riding legitimate dissent all the way to national power.

Hide in Plain Sight

The Brotherhood’s leaders have made clear, yes, they were “late to the party,” but they intend to take control once the other guests are sufficiently inebriated. Mohammed Mahdi Akef, the 82-year-old recently retired leader of the Muslim Brotherhood, told The Washington Post….

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