...First, Democrats want the government to create a national insurance exchange, or marketplace, in which all comers could buy into a range of heavily regulated private policies at group rates. These private plans would then "compete" with a new public insurance option, i.e., a program managed by the government and modeled after Medicare. Lower-income earners would get subsidies to make coverage "affordable." Businesses that didn't cover their employees would pay a tax on some portion of their payroll.
... Even if Congress doubled all individual and corporate tax rates, it still wouldn't raise enough revenue to pay for Medicare and Medicaid.
The Obama-Baucus solution to this slow-motion catastrophe is to add tens of millions more people to the federal balance sheet. Because the public option will enjoy taxpayer sponsorship, it will offer generous packages to consumers that no private company could ever afford or justify. And because federal officials will run not only the new plan but also the "market" in which it "competes" with private programs -- like playing both umpire and one of the teams on the field -- they will crowd out private alternatives and gradually assume a health-care monopoly.
Many proponents of plans similar to Mr. Baucus's openly cite this as one of their goals. Eventually, the public option will import Medicare's price controls into the private sector as it tries to manage the inevitable cost overruns. When that doesn't work, Congress will deal with the problem by capping overall spending and rationing care through politics (instead of prices) -- like Canada does today.
Whether the advocates of the Democratic plan(s) open admit it or not, this is the natural logic of their ideas.
...I also believe that there are enough people, limousine liberals included, who would never tolerate a Canadian system in which they would have to wait to see an overworked, governmental employee who calls himself a doctor. Even they will pay for real doctors. So I think we are destined to have an English system, in which people with means pay for good care and the rest get a diluted form of Medicare medicine. The only way that excellence will be preserved will be inside the private arena, which is why I believe our movement will grow.
(From private correspondence, quoted with his permission.)
I hope he's right. If Arizona's "Freedom of Choice in Health Care Act" (which would have guaranteed that, "No law shall interfere with a person's right to pay directly for lawful medical services") had passed, then concierge medicine would remain a viable option.
But if the federal government decides to outlaw this practice (on some supposed grounds of "equal access" or "fairness"), then we'll all suffer. Whether this happens is up to us.