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Two Steps Forward, No Steps Back

The latest version of ObamaCare

David Harsanyi
March 3, 2010

It's not the size that matters.

Today President Barack Obama will unveil health care proposal Part VII. The new House bill, according to Speaker Nancy Pelosi, will be "much smaller" than previous efforts.

After surveying the brutal political conditions facing them, Democrats, it seems, believe that if they lay claim to more modest legislation, they lay claim to a less horrid bill.

If only that were true.

Though a political victory is a must for the Obama presidency, those who are invested ideologically in the promise of government-run health care understand that even a small victory today can be an enduring one.

Once Washington gains a toehold—and considering government controls 49 cents on every health care dollar spent, by "toehold" I mean "bearhug"—it is an inescapable reality that whatever it comes up with will be expansive and expensive.

That's the message Pelosi was telegraphing to her allies when—in addition to pointing out how itty-bitty the bill will be—she added that it will be "big enough" to put the country on a "path" toward sustainable health care reform.

The righteous "path," naturally, ends at the gates of a single-payer system. The infrastructure to reach this objective—price controls, new entitlements, and wide-ranging mandates—will be set in place once Democrats use reconciliation to pass the bill, deal with the short-term electoral consequences and let history work itself out.

You know how it goes: Did you hear about the appalling conditions those children are living under? Gotta expand it. How about the old lady who has 12 prescriptions when she only needs eight? Gotta control costs.

A minor victory for liberalism today also would be a colossal triumph tomorrow because it's improbable—implausible, actually—that Republicans ever would have the fortitude (or the votes in Congress) to repeal most of Obamacare should they regain power.

Remember that state participation in Medicaid is voluntary. What governor would pull out of that or any entitlement program?

Remember that Congress estimated Medicare's cost at $12 billion for 1990 (adjusted for inflation) when the program kicked off, in 1965. Medicare cost $107 billion in 1990 and quickly is approaching $500 billion. Who's going to stop it?

The template is used over and over again. Government is a growth industry.

When you unwrap today's health care reform legislation, nearly every Democratic initiative, small or large, is designed to affect the choices people make through some mechanism of top-down control.

On the flip side, so far, reform legislation has been devoid of any meaningful market-based solutions that would spur a healthier private-insurance sector, guaranteeing consumers will see rates rise and Democrats will have a boogeyman to point to as they "fix" the bill down the road.

I remember asking liberal Rep. Diana DeGette of Colorado—after she, for the umpteenth time, claimed that Republicans had presented no ideas in the health care debate—what she thought of the GOP bills in the House at the time. She replied that they were too small and not "comprehensive" enough to really matter.

Now, apparently, small is OK. Why? It never has been an issue of how comprehensive a plan is, but how invasive it could be.

And no matter how many iterations of health care "reform" are foisted on the nation by Democrats—or what the exact dimensions of those iterations may be or how many public relations angles are deployed to sell them—the core issue has not changed.

Though, it is clear, the tactic of incremental "progress" has been relearned. Don't be fooled. The endgame has not changed.

David Harsanyi is a columnist at The Denver Post and the author of Nanny State. Visit his Web site at www.DavidHarsanyi.com. This column previously appeared at Reason.com.

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