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in 2009 there is no bigger issue

Why Obama Bombed on Health Care

The public wasn't dumb enough to believe the public option would save money.

HOLMAN W. JENKINS, JR,  WSJ, Sept 30, 2009

Someday this country will have a health-care debate that's not abject in its idiocy.

It will involve a term used by Congressional Budge Office chief Doug Elmendorf, who has become a notoriety for harping on the word "incentives." The same word was used the other day by Warren Buffett, about what's missing from the health-care plan on Capitol Hill.

We actually prefer the formulation of Duke University's Clark Havighurst, who speaks of restoring the "price tags" to health care.

Now that's a concept that the public could actually make sense of.

President Barack Obama made a "public option" his centerpiece not because it's the answer to what's broken in the U.S. system, but because it's a halfway house to a single-payer setup that liberal Democrats have always wanted.  Team Obama also knew the public is concerned about rising costs, so they jammed together a hooey-filled argument that the public option was somehow the solution to rising costs.

The public is not as dumb as it's made out to be, and Mr. Obama's public option died a bipartisan death yesterday in the Senate Finance Committee.  What's left is a package of "reforms" that are mere trite extensions of what we've been doing for decades. That is, piling up mandates on private insurers and then lying that this somehow isn't driving up the cost of health insurance; piling up subsidies for health consumption and then lying that this somehow isn't responsible for runaway health-care spending.

Yes, the politics are difficult when it comes to restoring price tags. Voters would have to understand how a tax code that allowed them to choose for themselves how much of their incomes to devote to health care would serve their interests.

They would have to be persuaded of the benefits of a marketplace where insurers are free to design policies to appeal to different budgets and needs.

They might have to decide for themselves whether they have better uses for their income and savings than extending life at all cost.

In that sense, the jabbering on Capitol Hill is irrelevant to the central problem, wherein consumers see larger and larger chunks of their income mysteriously and involuntarily sucked into health care for questionable benefit.

A few brave legislators, including Democrat Ron Wyden, are willing to say as much. But as Max Baucus put it in an unguarded comment to the Washington Post: "Basically the president is not helping."

Mr. Obama may be "not helping" because he doesn't understand or believe in the role of absent price tags in creating our current woes. He may genuinely favor a system in which government decides who will receive what care.

However, he's certainly also "not helping" because his base in organized labor doesn't want real reform.

Union members not only like the tax-free, open-ended healthcare benefits they're used to getting.  More important and often overlooked, organized labor itself is increasingly made up of health-care workers who benefit from an incentive system that artificially force-feeds great gobs of GDP into the industry's maw.

Their long retreat elsewhere in the economy may continue unabated, but unions are steadily growing their clout in government and health care, two sectors that increasingly overlap and would become even more overlapped under the bills in Congress. Consider a scheme being test-driven in Missouri, where Democratic Gov. Jay Nixon, AFSCME and SEIU last year backed a ballot proposition to create a "Missouri Quality Homecare Council."

As the A.P. matter-of-factly reported: "The ballot summary shown to voters said nothing about making it easier for in-home care providers to unionize."  But that was precisely the function. Now some 13,000 home health workers hired by patients but paid for by Medicaid are on the verge of being recognized as a union.

But won't collective bargaining inevitably mean higher Medicaid costs for Missouri taxpayer?  Gov. Nixon, whose campaign reportedly received $650,000 from SEIU and AFCSME, obviously has other priorities.

In Canada, where health care is largely government controlled, 61% of health-care workers are unionized. In the U.S., it's only 11%. Democrats are bent on changing that and the bills floating around Capitol Hill are rife with provisions to replicate the Missouri scheme nationally.

Mr. Obama's health-care thinking always lacked the bite of real "reform." He never claimed he was a wonk. He claimed he was a political mobilizer.  He meant it.

He might have honestly sold the Democratic dream of a single-payer system, forthrightly explaining how resources would be allocated.  He might have spoken of putting the price tags back on health care so consumers could decide instead.  He did neither—and has botched an opportunity for real progress.