Please go to rallies. Please go to town hall meetings. Save your country.
Editor's Note: The op-ed below has been added to TIA's new health care page, which gathers together all of my recent columns on health care. From this page, you can get printable versions of the article, or you can e-mail them to a friend. Feel free to send them on to as many people as possible, particularly to your elected representatives.—RWT
The smear against small-government advocates who have confronted their congressmen at town hall meetings is that they are an "angry mob" who just want to shout down advocates of Obama's health-care bill. In fact, these protesters have come to the meetings to ask some tough questions—questions that should have been asked by the mainstream media. So when you head off to a local town hall meeting during the August recess, focus on asking good questions. I don't mean just rhetorical questions intended to make a point, but also real questions that require a substantive answer.
As a guide to help you prepare for your local town hall meeting, here are my suggestions for 20 questions you can ask your elected representatives about the economics, history, politics, and morality of Obama's health-care plan. If your elected representative will answer these questions, it will tell you a great deal about his principles (or lack of them) and his goals. It might also tell you about his method of making decisions: does he just repeat canned talking points, or does he really think about your questions? And if he won't answer your questions—if he doesn't have the guts to do anything but preach to the converted at union-sponsored rallies—well, that gives you all the answers you need right there, doesn't it?
But don't just ask these questions of your congressmen. Ask them of your friends and neighbors, of newspaper columnists and reporters, of local doctors and businessmen and others in positions of influence. These are the kinds of questions we should all be thinking about and trying to answer, if we are going to subject this legislation to the scrutiny it needs before Congress votes on it.
1. The government has been "reforming" health-care for sixty years—tax breaks for employer-provided health-insurance, Medicare, Medicaid, encouraging HMOs and managed care, and government health-insurance at the state level in Massachusetts, Maine, Oregon. Government health-care has expanded until it is now more than 50% of all health-care spending. Yet after sixty years of government "reform," the problems with health-care are just getting worse. So why should we believe that even more government is the solution?
2. President Obama keeps telling us that he's not trying to get rid of private health insurance. But the bill being debated in Congress would require all new insurance policies to be offered through a government-run exchange, in which the rates that can be charged and the coverage that has to be provided will be dictated by the government's so-called "Health Choices Commissioner." Employer-provided health-insurance will fall under the same regulations in five years. How is this insurance going to be "private" if the government controls everything about it?
3. A video on YouTube shows Barack Obama back in 2003—only six years ago—saying that he is in favor of a "single payer" system. The "single payer" is government, so this means he was in favor of socialized medicine. And just a few weeks ago, Barney Frank—one of the Democratic leaders in the House—said that he considers the current bill a step toward "single payer." So when Obama and the Democrats tell us this bill won't lead to a government takeover of health-care, why should we believe them?
4. Medicare is broke. Social Security is broke. Federal tax receipts are falling, and Congress has already voted on trillions of dollars of stimulus and bailouts in the last year. The national credit card is maxed out. So how can you justify voting for a bill that will require even more money that we don't have?
5. The health-care bill that is being discussed includes huge taxes on businesses to force them to provide more health insurance for their employees, as well as a whole set of mandates telling health insurance companies who they have to cover and what they have to cover them for. This is an enormous increase of costs for businesses and insurers. Have you considered how they're going to pay for all of this, or whether they will even be able to pay for it? How many of these companies will go out of business or lay off more workers after the government forcibly increases their expenses?
6. One of the main demands of the health-care bill is that insurers are required to cover people with "pre-existing conditions." That's like getting insurance on your car after you crash it. It's just a way of getting someone to bail you out for something that has already happened. This isn't insurance, it's a handout. So doesn't that mean that the rest of us will have to pay more for our insurance to absorb the cost of those handouts?
7. The health-care bill will mandate what costs insurance companies have to cover. For example, they will have to pay for routine check-ups and physicals, or they will have to provide every woman with maternity coverage. But what if you don't want to pay for that extra coverage? Right now, if you're young and healthy and don't need frequent check-ups, you can save money with a high-deductible insurance that doesn't cover them. Or if you don't want children, or already have children, you can save money by dropping the maternity rider on your policy. By taking those choices away from us, won't this bill actually make our insurance more expensive, not less?
8. A lot of people have been upset about Congress passing bills that they haven't had time to read—and they haven't even finished writing the health-care bill yet. But what I want to know is, with a bill this big and complex, have you taken the time to read it and understand it? Can you really say that anyone has had the time to figure out how all the parts will work together and what all of the consequences will be? With a bill this big, is it even possible to figure out all of that and really know what you're voting for?
9. President Obama and the Democratic leadership are making us a lot of promises about what we will get and what we won't get from this health-care bill. But what is or isn't in this one particular bill is not the end of the story. For example, how many times has Medicare changed over the last forty years? As more and more of us become dependent on the government for our health-care coverage, won't we have to worry about what some future Congress or some future bureaucrat will decide to cover or not cover?
10. The defenders of the health-care bill claim that it's going to lead to all sorts of savings, not by actually cutting any services or denying care, but just by finding "inefficiencies" that will save money. Do you think this is remotely plausible? When has anybody ever said, "This project has to be lean and efficient—let's get the government do it"?
11. One of the ways that has been proposed for government-provided health insurance to save money is by substituting Medicare reimbursement rates for market rates when paying doctors and hospitals. But many private hospitals and medical practices have said that if they have to accept these lower rates, they can't cover their expenses, and they will go out of business. So doesn't this bill guarantee an immediate shortage of doctors and medical services?
12. Medicare cuts costs by paying lower rates to doctors and hospitals, who then shift these costs to those of us with private health insurance, who get charged higher rates. But if the government takes over and starts dictating Medicare reimbursement rates for everyone, who will the costs get shifted to then?
13. When the government starting portraying people in the financial industry as villains and started limiting their pay and subjecting them to more regulations, banks reported a "brain drain" as smart and well-educated people left the industry or went overseas looking for better pay and less stress. But the term "brain drain" was originally coined in the 1960s when doctors and medical researchers left Britain to escape socialized medicine. Aren't you afraid we might see the same kind of brain drain from the medical profession here in America?
14. Do you know the meaning and significance of the term "quality adjusted life year"? (For this question, you will need the answer, which you can supply if your congressman is forced to admit that he doesn't know it—preferable after some stammering and a long, awkward pause. "Quality adjusted life year" is a term used under socialized medicine to determine whether elderly patients are allowed to get expensive drugs or treatments, depending on some bureaucrat's calculation of how many good years they have left. You should ask your congressman: Can you assure us that the same thing won't happen here?)
15. One of the proposals for how the government is going to save money is that it's going to have a panel of medical experts who will dictate from Washington, DC, what the proper medical practices are that should be paid for, and what practices are supposedly "wasteful" and "unnecessary." Won't this mean interfering with decisions that would normally be made by me and my doctor? And won't this discourage innovation by requiring any new idea to get approved by a board of establishment "experts" before a doctor can even try it out?
16. Government-run health-care is not some new, untested idea. In Britain, it has led to a "postcode lottery," where the medical procedures you are allow to get depend on where you live. In Canada, it has led to a shortage of doctors and waiting lists for major surgeries. In America, Medicare ended up costing far, far morethan anyone expected. Massachusetts and Maine spent enormous amounts of money to extend government coverage to very few people. The Oregon Health Plan may not cover your cancer treatment—but it will cover assisted suicide. Given all of this experience, what makes you think that somehow this will be the exception that will avoid all of the problems that government health-care has always led to?
17. Why does "reform" always mean more government? Are you aware of proposals that have been put forward for free-market reforms of health care? Congress has already approved Health Savings Accounts, where individuals buy their own high-deductible health insurance and save money tax-free, which they can use for their out-of-pocket health-care expenses. This gives people more control over their spending on routine medical treatments while keeping them covered for a serious illness, and it allows them to keep their health insurance if they change jobs. But this program has been limited in size. Are you open to ideas like this, for free-market reform of health-care?
18. A lot of doctors say that medical malpractice insurance is what is really driving up health-care costs. Doctors have to charge more to cover their expenses, and they also have to practice "defensive medicine," ordering unnecessary extra tests just to make sure they can defend themselves in court if something goes wrong. So why isn't tort reform—for example, limiting excessive jury awards in malpractice lawsuits—being considered as part of health-care reform?
19. What part of your decision on this bill, if any, is affected by a consideration for liberty, individual rights, and the Constitution? Would you consider opposing this bill for no other reason than because it gives more power to government at the expense of the freedom and property rights of private businesses and individuals? Would you consider opposing it simply because it grants powers to the government that are not authorized anywhere in the Constitution?
20. Thomas Jefferson said, "A wise and frugal government which shall restrain
men from injuring one another, which shall leave them otherwise free to regulate
their own pursuits of industry and improvement, and shall not take from the
mouth of labor the bread it has earned. This is the sum of good government."
Notice what is not on his list: government-provided housing, or
government-provided food, or government-provided health care. And
Jefferson's views on the role of government were widely shared by America's
Founding Fathers. So my question is: Please explain where you disagree with the
vision of our Founding Fathers, and why.