The shortage of medical personnel that will inevitably accompany the expansion of the patient population will leave people without adequate care. Higher demand without extra supply will mean rationing, which will take its greatest toll on the elderly, forcing them to forgo elective surgery or do without life-prolonging treatment. We will all wait longer for care we now receive on demand.
Obama will cut Medicare and that portion of Medicaid which serves the elderly in nursing homes (75 percent) in two ways:

{mosads}(a) He will cut “hundreds of millions in waste and fraud and unwarranted subsidies in Medicare,” as determined by an executive branch commission, but largely in the form of lower payments to hospitals and doctors. Paid less, doctors will spend less time on each patient. Reimbursed less for MRIs or CT scans, they will order fewer of them. Getting less income, more doctors will retire and fewer will enter the profession, aggravating scarcity.

The president also plans to eliminate the Medicare Advantage program, an approach to managed care that permits the elderly a coherence and a coordination in their treatment that about one-third of them find valuable enough to sign up for.

(b) His newly established panel to cut Medicare will also “encourage the adoption of … common-sense best practices by doctors and medical professionals … [R]educing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.”

These are code words for rationing. The panel will “encourage” doctors to adopt the “best practices” the panel recommends by limiting reimbursement rates or banning alternatives. Likely guidelines will govern who can get elective surgery like hip replacements or new knees based on the number of “quality adjusted remaining years,” the patient has.

In Canada, the drug Avastin is barred by such a panel despite its proven record as the most effective anti-colon cancer drug. The ban is due not to safety concerns but solely to its $50,000 annual cost. As a result, 41 percent of Canadians with colon cancer die, compared to 32 percent of Americans. These are the kinds of “best practices” that the panel will have to impose to pay for Obama’s plan.

The panel will likely recommend limits on testing and screening, worsening rather than improving preventive care. In Canada, there is an eight-month wait for colonoscopies, which leads to a 25 percent higher incidence of colon cancer.

Cuts in Medicare will pay for more than half the subsidies in Obama’s program. What will the money be used for? To pay for medical coverage for people who are too young for Medicare, too wealthy for Medicaid and too old for the Children’s Health Insurance Program. The president claims that this coverage will be “affordable” for those now uninsured. But the bill’s guidelines indicate that a person making $30,000 will pay $2,400 a year. Many people now uninsured will find this onerous and unnecessary because they are young and healthy.

Obama claims that “our healthcare problem is our deficit problem. Nothing else even comes close.” He’s wrong. Medicare and Medicaid costs have risen by about 5 percent in the past year, while the budget deficit has quadrupled. The deficit is caused by the massive overspending in the TARP program bailing out banks and the equally gargantuan stimulus package, throwing money ineffectually at the recession.

The president says “the reforms I’m proposing will not apply to those who are here illegally.” This statement is a half-truth. Illegal immigrants will be eligible to buy health insurance from the insurance exchange Obama creates, taking advantage of the lower rates he claims it will allow through bulk purchasing. Without any effective provision for citizenship verification, illegal aliens will slip through the cracks and get subsidized coverage.

He boasts that “nothing in this plan will force you or your employer to change the coverage or the doctor you have.” But rationing will make insurance companies and doctors impotent in the face of federal mandates for reduced care.

The president’s plan is, essentially, a program to take medical care away from the elderly and give it to those who are younger, healthier and, in the main, richer.

Morris, a former adviser to Sen. Trent Lott (R-Miss.) and President Bill Clinton, is the author of Outrage and Fleeced. To get all of Dick Morris’s and Eileen McGann’s columns for free by e-mail or to order a signed copy of their new best-selling book, Catastrophe, go to dickmorris.com.