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Issue Analysis

    Obamacare: It's The Bureaucracy, Stupid

    While being interviewed by a progressive author for a book about conservatives a few years ago, I was asked why I thought the government shouldn't be running health care in America. I replied that it wasn't so much that I thought it shouldn't but that I thought it couldn't, at least with any semblance of efficiency or cost-effectiveness. 

    Bureaucracies are inherently bloated, inefficient monsters that, in the end, seek only to further bloat themselves. Any enterprise with a never ending supply of capital that it can extort through taxation has no motive whatsoever for behaving in an economically efficient manner and Obamacare has already proven that it will not be the exception to the rule

    The problem with such well-intended bureaucratic efforts almost always begins with the projected costs of a program. One need only look at the federal government's most notable forays into "helping", Medicare & Medicaid, to see that what's proposed and what actually happens are very different.

    In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.

    In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.

    In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.

     A $144 billion ("billion" used to be a big number even to bureaucrats at one time) overrun would be frowned upon in a real business conducted in the real world. In the artificial land of the bureaucracy, it's merely a reason to "tax the wealthiest Americans" to cover the initial bad math. 

    Despite layer upon layer of "oversight", bureaucratic endeavors (especially at the federal level) are targets for fraud. Perhaps the temptation to bury nefarious activity in the mountains of paperwork is too strong to resist

    The contractors have been submitting reports highlighting potential fraud since 2007. But federal health officials did not begin developing procedures to deal with it until 2010 and still lack a process to make sure the problems are resolved, the report said.

    The agency has been criticized for lax oversight of Medicare contractors in the past. Lawmakers have mandated the agency add various types of contractors over the years so the system has grown into a complex labyrinth that experts say is less than ideal.

    In some cases, fraudulent behavior is prosecuted but only after large amounts of money that will never be repaid are swindled. 

    Before even being fully implemented, Obamacare is already showing the potential to dwarf its government health care predecessors. It began spawning bureaucratic offshoots, all of which have to be funded, from Day One. 

    Of course, the time-honored tradition of bureaucratic cronyism is already in full swing

    A shadowy $10 billion Obamacare agency with zero oversight just awarded first lady Michelle Obama’s pet patient-dumping scheme at the University of Chicago Medical Center a $5.9 million taxpayer-funded grant. It will enable Mrs. Obama’s cronies to build a government-sponsored electronic medical record-sharing system.

    The Chicago program, known as the Urban Health Initiative, is run by one of President Obama’s closest golfing buddies, scandal magnet Eric Whitaker, who has been entangled with Illinois corruption celebrities Rod Blagojevich and Tony Rezko over the past decade.

    Obamacare overseers have adapted Nancy Pelosi's "We have to pass the bill to see what's in it..." philosophy and are taking a "We have to disperse the money in a hurry before anyone finds out what we're doing" approach

    Having written numerous other federal grant applications as a medical researcher, I was surprised by the very short time allotted to review 12 applications, each of which ran more than 100 pages. We had only two weeks to assemble a team and grade the applications on such criteria as the promise of the project design and its workforce goals.

    Applications to the government's National Institutes of Health or the Patient-Centered Outcomes Research Institute, by contrast, undergo months of thoughtful review by scientists who are well-regarded in their fields. I began to wonder how much CMMI was interested in high-quality input from the grant reviewers.

    Typical "efficiency" ensues, of course.

    In May, the innovation center announced the first batch of grant recipients, 26 in all. George Washington University earned $1,939,127 because it expected to reduce health costs by a mere $1.7 million. Similarly, the Center for Health Care Services in San Antonio received $4,557,969 to save $5 million. At least CMMI didn't pick one of the thinly veiled handout requests that I personally oversaw, such as a for-profit company that claimed to offer holistic healing through human touch.

    It only costs $1.9 million to save $1.7 million? Can a Nobel in economics be far behind? 

    The costs of collecting the taxes and funding the oversight and disbursement of the grants more than likely makes the above numbers take on a steroidal look. 

    These are the realities of a massive government attempt at "helping". They are many and, quite often, complex. Free market conservatives have a more difficult time making the case against these misguided monstrosities than proponents do for them because cold, hard facts don't move the electorate the way a good tug on the heartstrings does. Facts, figures and history can be provided in detail ad nauseam only to be undone by the president trotting out one tear-jerking anomalous success story during the State of the Union address. 

    Personally, I have had far more success railing against "the bureaucracy" than "the government" when attempting to change people's minds. Democrats, especially those on the progressive left, have almost successfully removed any stigma associated with "the government" in the minds of American voters who don't follow politics 24/7. We on the right still cringe at the thought of it and too often assume we can easily bring many to that opinion. 

    Almost nobody has a favorable association connected with a bureaucracy, however. That's the word that conjures up memories of lines at the DMV or the post office. 

    Messaging is more important than ever in the digital age and conservatives have grudgingly come to realize this. We can't play the game on the battlefield of emotional false pretenses but we can slowly begin to define our own terms in ways that can reach voters more quickly and have a better chance of resonating. 

    Let the Democrats have their ostensibly neutered "government". But let us relentlessly focus on portraying the insatiable, inefficient money gorging "bureaucracy" for exactly what it is.