Even without 'public option,' government would run health care

Amid the debate over whether health-care reform should include a government-run "public option" plan, everyone seems to be missing one critical fact. Even without a public plan, the reform bills under consideration will impose such rigid control on private health plans that it amounts to a government-run health-care system — even if the insurance companies remain technically under private ownership.

Both the House bill that recently passed and the Senate bills that have been reported out of committee give unprecedented levels of control to federal bureaucrats to pre-empt patient choice and block competitive innovation. The House bill would create a new federal office — Health Choices Commissioner — to make health choices for the entire nation, specifying precisely what services health plans must cover, may cover and must not cover.

The Senate bills would give comparable authority to the secretary of Health and Human Services. In both cases, the requirements could make packages of covered services nearly identical for all plans from all companies. Except for a limited range of financial options (three or four "levels" of "actuarial value"), you would have no flexibility to choose a health plan that meets your individual needs.

With all benefits and coverage conditions specified by government regulations, there will be no room for people to choose what's right for them. There will be no room for health plans or providers to innovate and find more efficient and cost-effective ways to deliver health care.

All of the inefficiencies of the current system — inefficiencies President Barack Obama himself often describes in detail — will be locked in permanently. We'll still pay providers to "do procedures" rather than keep us healthy. We'll still have a fragmented system with little accountability. We'll still penalize providers who provide high-quality care and subsidize those who make mistakes.

If one of these bills becomes law, even without a "public option," we will have government-run health coverage. It will merely be administered by private companies. The federal government would be running all private health plans — individually-purchased plans starting in the year 2013 or 2014 (depending on which bill), and employer-sponsored plans starting five years later.

Furthermore, the House bill also empowers — actually, requires — the Health Choices commissioner to determine the premiums private health plans can charge. The bill states, "The commissioner shall deny excessive premiums and premium increases," but nowhere does the bill define what "excessive" means. That would be entirely up to the discretion of the commissioner.