Even as Democrats inveigh against President Trump for his alleged norm-shattering and contempt for the rule of law, their health care plans show a growing embrace of authoritarianism. For instance, Rep. Adam Schiff (D-CA) recently <a href="https://www.usnews.com/news/politics/articles/2019-09-25/schiff-trumps-comments-a-classic-mafia-like-shakedown" data-saferedirecturl="https://www.google.com/url?q=https://www.usnews.com/news/politics/articles/2019-09-25/schiff-trumps-comments-a-classic-mafia-like-shakedown&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNGwkxR4Q6ZOFaNqd4M8yJdUm134cA">dubbed</a> the president’s July 25 call with Ukrainian President Volodymyr Zelensky “a classic mafia-like shakedown.” He knows of which he speaks, because the Democratic Party agenda on health care now includes threats to destroy any entities failing to comply with government-dictated price controls.
The latest evidence comes from Colorado, where several government agencies recently submitted a <a href="https://www.colorado.gov/pacific/sites/default/files/HB19-1004%20Draft%20Report%20Colorado%20State%20Coverage%20Option%20and%20Appendix.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.colorado.gov/pacific/sites/default/files/HB19-1004%2520Draft%2520Report%2520Colorado%2520State%2520Coverage%2520Option%2520and%2520Appendix.pdf&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNFDkt31ZlobGZ-HQwefFU-NC7beBQ">draft report</a> regarding the creation of a “state option” for health insurance. The plan would not create a state-run health insurer; instead, it would see agencies dragooning private sector firms to comply with government diktats.
The plan would “require insurance carriers that offer plans in a major market,” whether individual, small group, or large group, “to offer the state option as well.” In these state-mandated plans that insurers must offer, carriers would have to abide by stricter controls on their administrative costs — in the form of medical loss ratio requirements — than those dictated by Obamacare.
For medical providers, the Colorado plan would use “payment benchmarks” to cap reimbursement amounts for doctors and hospitals. And if hospitals decline to accept these government-imposed price controls, the report ominously says that “the state may implement measures to ensure health systems participate.”
In comments to reporters, Colorado officials made clear their intent to coerce providers into this price-controlled system. Insurance Commissioner Michael Conway <a href="https://coloradosun.com/2019/10/09/colorado-health-public-option-hospitals/" data-saferedirecturl="https://www.google.com/url?q=https://coloradosun.com/2019/10/09/colorado-health-public-option-hospitals/&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNEdfFeIqjhxySRoTgjO7RycSEOHhA">admitted</a> that “[i]f our hospital systems don’t participate, this won’t work &#8230; [w]e can’t allow that to happen.” The head of Colorado’s Department of Health Care Policy and Financing, Kim Bimestefer, <a href="https://coloradosun.com/2019/10/07/colorado-public-health-insurance-option-proposal/" data-saferedirecturl="https://www.google.com/url?q=https://coloradosun.com/2019/10/07/colorado-public-health-insurance-option-proposal/&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNGvUest7eeWAQmR2Zl20j5M7mzlAw">said</a> that “if we feel that the hospitals are not going to participate, we will require their participation.”
State officials did not elaborate on the mechanisms they would use to compel participation in the state option. But they could attempt to require hospitals and insurers to participate in the new plan to maintain their license to operate in Colorado — a likely unconstitutional condition of licensure.
In threatening this level of coercion — agree to price controls, or we’ll shut down your business — Colorado Gov. Jared Polis imitated his fellow Democrat, House Speaker Nancy Pelosi. Pelosi’s proposed drug pricing bill, up for a vote in the House as soon as next month, would impose excise taxes of up to 95% of a drug’s sale price if companies refuse to “negotiate” with the federal government.
In its <a href="https://www.cbo.gov/system/files/2019-10/hr3ltr.pdf" data-saferedirecturl="https://www.google.com/url?q=https://www.cbo.gov/system/files/2019-10/hr3ltr.pdf&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNHtCPW1KJ1eddfASQamnbb-cBFA-g">analysis</a> of Pelosi’s legislation, the Congressional Budget Office (CBO) noted that, because drug makers could not deduct the 95% excise tax for income tax purposes, “the combination of income taxes and excise taxes on the sales could cause the drug manufacturer to lose money if the drug was sold in the United States.” Perhaps unsurprisingly, CBO concluded that the excise tax would not generate “any significant increase in revenues,” as “manufacturers would either participate in the negotiating process” — because they have no effective alternative — “or pull a particular drug out of the U.S. market entirely.”
CBO also noted, in a classic bit of understatement, that Pelosi’s bill “could result in litigation,” for threatening losses on any company that dares defy the government’s offer of “negotiation.” But the Left seems uninterested in abiding by limits on government power — or the consistency of its own arguments. As I <a href="https://www.wsj.com/articles/dems-new-plan-would-ban-private-medicine-11557688457" data-saferedirecturl="https://www.google.com/url?q=https://www.wsj.com/articles/dems-new-plan-would-ban-private-medicine-11557688457&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNFNRhLOlmEwRWTbqkNbJt_yGEVBpw">noted this spring</a>, other proposed legislation in Congress would abolish the private health care market. Less than one decade after forcing all Americans to buy a product for the first time ever, in the form of Obamacare’s insurance mandate, liberals now want to prohibit all Americans from purchasing care directly from their doctors.
These recent proposals continue a virulent strain of authoritarianism that has permeated progressivism’s entire history. Franklin Roosevelt threatened to invoke emergency powers during his first inaugural address, and Rahm Emanuel infamously <a href="http://www.youtube.com/watch?v=_mzcbXi1Tkk" data-saferedirecturl="https://www.google.com/url?q=http://www.youtube.com/watch?v%3D_mzcbXi1Tkk&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNEqUQZt1ngA3w0MxGoRCLRx9FlQDQ">said</a> during the Great Recession that “you never want a serious crisis to go to waste.” Make no mistake: The health care system needs patient-centered reform. But the true crisis comes from the progressives who would utilize blunt government force to seize control of one-fifth of the nation’s economy.
&nbsp;
Mr. Jacobs is Founder and CEO of Juniper Research Group, and author of the book The Case Against Single Payer. He is on Twitter: <a href="http://www.twitter.com/chrisjacobsHC" data-saferedirecturl="https://www.google.com/url?q=http://www.twitter.com/chrisjacobsHC&amp;source=gmail&amp;ust=1572027551149000&amp;usg=AFQjCNH6oeMTNLARnFthxB33FurVWA3XYw">@chrisjacobsHC</a>.

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JACOBS: The Left’s Health Care Vision Is A Prescription For Brute Government Force

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July’s Democratic presidential debates left <a href="https://twitter.com/CitizenCohn/status/1156734863359303680?s=20" target="_blank" rel="noopener noreferrer">seasoned</a> <a href="https://twitter.com/sarahkliff/status/1156724790931185664" target="_blank" rel="noopener noreferrer">health</a> <a href="https://twitter.com/jrovner/status/1156362475102711810?s=20" target="_blank" rel="noopener noreferrer">policy</a> <a href="https://twitter.com/StephArmour1/status/1156733727378202624?s=20" target="_blank" rel="noopener noreferrer">professionals</a> confused, struggling to understand both the candidates’ policies and the differences among them. But working families should find the Democrats’ health care debate taxing for another reason. For all their vows that Americans can obtain unlimited “free” health care while only “the rich” will pay, the major candidates are writing out checks that will end up on middle-class families’ tab.
In this debate, Sen. Bernie Sanders (I-VT) wins credit for candor, in the sense that he has dissembled less than his opponents. Admitting that his single-payer plan will require tax hikes, in April Sanders <a href="https://www.sanders.senate.gov/download/medicare-for-all-2019-financing?id=860FD1B9-3E8A-4ADD-8C1F-0DEDC8D45BC1&amp;download=1&amp;inline=file" target="_blank" rel="noopener noreferrer">proposed</a> a 4% income tax, along with a 7.5% payroll tax, among other revenue increases to fund his system.
Unfortunately for Sanders, however, the Committee for a Responsible Federal Budget <a href="https://thehill.com/policy/finance/456831-health-care-fight-among-2020-democrats-shifts-to-taxes" target="_blank" rel="noopener noreferrer">believes</a> the tax increases he has proposed to-date will pay for only about half of the more than $30 trillion cost of his single-payer scheme. In that, the organization echoes experience from Sanders’ home state of Vermont. In 2014, Gov. Peter Shumlin <a href="https://www.washingtonpost.com/national/health-science/why-vermonts-single-payer-effort-failed-and-what-democrats-can-learn-from-it/2019/04/29/c9789018-3ab8-11e9-a2cd-307b06d0257b_story.html" target="_blank" rel="noopener noreferrer">abandoned efforts</a> to enact a state-based single-payer system, because the accompanying tax increases created “a risk of an economic shock.” Shumlin said single-payer in Vermont would have required a 9.5% income tax and an 11.5% payroll tax — far higher levels than Sanders has proposed.
While Sanders admits that the middle class will pay more taxes to fund single-payer, both he and Sen. Elizabeth Warren (D-MA) argue that families will save overall, because the program would eliminate premiums, deductibles, and other forms of cost-sharing. Unfortunately, studies from across the political spectrum — from the conservative <a href="https://www.heartland.org/_template-assets/documents/publications/Medicare4AllJK2.pdf" target="_blank" rel="noopener noreferrer">Heartland Institute</a> to former Clinton administration official Kenneth Thorpe — disagree.
In 2016, Thorpe <a href="https://www.healthcare-now.org/296831690-Kenneth-Thorpe-s-analysis-of-Bernie-Sanders-s-single-payer-proposal.pdf" target="_blank" rel="noopener noreferrer">concluded</a> that 71% of households would pay more under a Sanders plan fully funded by tax increases. Low-income households would get hit even worse, with 85% of families on Medicaid paying more. Since then, Sanders has only increased the generosity of his single-payer proposal, meaning taxes on the middle class could rise even more than Thorpe had originally estimated.
Perhaps to elide the tax landmines, Sen. Kamala Harris’ (D-CA) plan breaks with Warren and Sanders, delaying the move to a single-payer system for a decade. She <a href="https://medium.com/@KamalaHarris/my-plan-for-medicare-for-all-7730370dd421" target="_blank" rel="noopener noreferrer">claims</a> the delay “will lower the overall cost of the program” — but only until the program phases in fully. At that point, her pledge not to raise taxes on families making under $100,000 will prove unsustainable. But if Harris has her way, a 10-year delay until full implementation of single-payer could punt the tax problem to her successor.
As for former Vice President Joe Biden, he has tried to portray himself as protecting middle-class families from the tax hikes he calls inevitable under the other major contenders’ plans. But Biden has two problems.
First, Biden <a href="https://www.cnbc.com/2019/07/05/joe-biden-vows-to-bring-back-obamacare-individual-mandate-penalty.html" target="_blank" rel="noopener noreferrer">supports</a> restoring Obamacare’s individual mandate penalty, which Republicans eliminated in 2017. The Supreme Court in 2012 dubbed the mandate a tax — and that tax happens to hit the middle class hard. The <a href="https://www.irs.gov/statistics/soi-tax-stats-historic-table-2" target="_blank" rel="noopener noreferrer">most recent IRS data</a> show that in 2016, of the $3.6 billion in mandate penalties paid by American households, nearly 63% came from households with incomes under $50,000, and more than 88% came from households with incomes below $100,000.
Second, as The Wall Street Journal <a href="https://www.wsj.com/articles/joe-biden-used-tax-code-loophole-obama-tried-to-plug-11562779300" target="_blank" rel="noopener noreferrer">reported</a> back in July, Biden over the past two years deliberately utilized tax loopholes to avoid paying Obamacare taxes. By classifying more than $13 million in proceeds from books and speeches as profits from his corporations, rather than wage income, Joe and Jill Biden circumvented nearly $500,000 in self-employment taxes — taxes that fund Obamacare and Medicare.
Biden’s behavior, which multiple experts interviewed by the Journal called legally questionable, belies both his “Middle Class Joe” reputation and his support for Obamacare. Apparently, Biden supports Obamacare only if someone else will pay for it. But if a one-percenter like Joe Biden finds paying for the Affordable Care Act unaffordable for him, then whom would Biden hit to pay the $750 billion price tag of his Obamacare expansion efforts? Why, the middle class, of course.
Biden’s unwillingness to pay the taxes associated with an Obamacare law he purportedly wants to protect epitomizes Margaret Thatcher’s axiom that socialists eventually run out of other people’s money. At the rate he and his fellow candidates are racking up costly health care promises, that moment seems very near at hand.
Mr. Jacobs is Founder and CEO of Juniper Research Group, and author of the forthcoming book, &#8220;The Case Against Single Payer.&#8221; He is on Twitter: <a href="http://www.twitter.com/chrisjacobsHC" target="_blank" rel="noopener noreferrer">@chrisjacobsHC</a>.

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JACOBS: Democrats’ Taxing Health Care Promises

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Chris Jacobs

JACOBS: The Left’s Health Care Vision Is A Prescription For Brute Government Force

JACOBS: Democrats’ Taxing Health Care Promises