NCPA - National Center for Policy Analysis


October 21, 2009

The debate over health care reform has sparked all sorts of controversy over costs, regulations and choices.  But one feature seems to have escaped notice: the built-in lack of accountability of our elected leaders for what health care will be like after the plan is implemented, says Robert A. Book, a Senior Research Fellow at the Heritage Foundation.

Proponents claim we need reform now to solve an immediate health care crisis.  "If we don't act, 14,000 Americans will continue to lose their health insurance every single day," President Obama claimed on July 22.  Yet the bills he urges us to support will not actually provide any health care until 2013 -- by which time, if the president's claim is correct, an additional 17 million Americans will have lost their insurance, explains Book.

Why the delay?  The best way the people have to hold their elected leaders accountable for results is by threatening to withhold their votes.  But this bill seems expressly designed to eliminate that source of accountability, says Book:

  • By the time Americans experience the effects of this health care bill (except for the tax increases), not only will President Obama have run for re-election, but so will two-thirds of the senators -- and every House member will have been up for re-election twice.
  • Their votes on health care reform will be old news.
  • If it goes very badly, it will be too late to vote those responsible out of office.

The House bill leaves all the knotty details and controversial issues to the newly created "Health Choices Commissioner."  That's the person whose job it will be to make a lot of our health care choices for us.  The Senate Finance Committee (Baucus) proposal gives that authority to the secretary of Health and Human Services.

Issues such as whether to:

  • Permit people with Health Savings Accounts (HSAs) to retain the high-deductible health plans required by the HSA law.
  • Allow low-cost catastrophic plans.
  • Permit insurance companies to cover treatment of otherwise terminally ill patients.
  • Require (or prohibit) coverage of abortion.
  • Cover new cancer drugs or controversial procedures like (as the Center for American Progress has called for) transgender operations.

These and other issues will be left to an appointed official.  Elected leaders will never have to face the voters and defend these crucial decisions that affect the life and health of every American, since the decisions will be made by an unelected bureaucrat, says Book.

Source: Robert A. Book, "If it's so urgent, why would two elections pass before health reform takes effect?" Heritage Foundation, October 19, 2009.


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