Instead of the miraculous cost savings the president claimed for his reform plan, healthcare rationing will be a much more likely outcome. Take comparative effectiveness research as an example. The new health reform law creates a new office of comparative effectiveness research that will study the value of one treatment or therapy to another to determine which is more effective. To be sure, this process can generate important knowledge that saves lives-we want to know which treatments are most effective, which medicines are more efficacious, and which approaches are best practices.

Secular socialism, however, has put comparative effectiveness research in the United States on the same path as in Britain: toward becoming a bureaucratic cost-control measure. The United Kingdom, which has a nationalized, single-payer health system, explicitly uses comparative effectiveness to ration medical care. Government uses this research to decide, sometimes with devastating consequences, which treatments its citizens can get.

Let's say a government uses comparative effectiveness to determine the efficacy of new drug treatments. The research reveals drug A works 70 percent of the time and drug B works 50 percent of the time. The government would then decide to cover drug A. But what if, as often happens in medicine, 30 percent of the people who did not respond to drug A did respond to drug B? Or what about the even smaller groups that may have responded best to drug X, Y, or Z? Not wanting to cover less effective drugs, the government may simply decree those people are out of luck. These are the problems patients face when the government is empowered to decide what medicine they can have.

Consider this: what happens when one drug is more effective than another but costs three times as much? Do you want government to decide that relieving your pain and suffering isn't worth the cost? That's what happens in Britain. Government approves and government decides-not patients and doctors. Here is what Britain's National Health Service (NHS) tells its citizens:You have the right to drugs and treatments that have been recommended by NICE [National Inst.i.tute for Health and Clinical Excellence] for use in the NHS, if your doctor says they are clinically appropriate for you. You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you. [emphasis added]

During the healthcare debate, House and Senate Republicans offered amendments to prohibit the federal government from using comparative effectiveness research to deny or ration care. Democrats rejected them all and moved full steam ahead. But because of the citizen backlash against the federal government using comparative effectiveness research to ration care, the bill that the president signed deceptively renames the new federal body the "Patient Centered Outcomes Research Initiative."

All this was unsurprising: in healthcare, the goal of the secular-socialist machine is to use the power of government to control Americans' health decisions. This goal is both an ideological imperative that places the power of government over the rights of citizens and a raw power grab. It is a symptom of secular socialism's creeping totalitarianism-a mindset completely opposed to historic American values.

TAXES.

Economics 101 states that when government levies a tax on business, it is not the business that will ultimately pay it-consumers will. And the Left's health reform has plenty of new taxes. The $28 billion tax on drug makers won't dent the companies' revenue; the firms will just raise the price of your medications. And health insurers will recoup the new $70 billion tax on them by raising your premiums-so said Congressional Budget Office (CBO) director Douglas Elmendorf when discussing the original proposed fee on insurers: "Our judgment is that that piece of the legislation would raise insurance premiums by roughly the amount of the money collected."

Look at what the Left will do to medical technology companies. There are more than 80,000 medical devices in the United States, everything from artificial heart valves, pacemakers, and NICU incubators to thermometers and toothbrushes. The new law will impose a 2.9 percent tax on the sale of medical devices. That will raise prices for thousands of medical products because these costs will be pa.s.sed on to consumers through higher prices, higher insurance premiums, or through lost wages when an employer has to pay. Thomas Barthold, chief of staff of the Joint Committee on Taxation, commented, "We have a.n.a.lyzed this as largely falling on the consumer."

And the law has even more tax increases, over half a trillion dollars in higher Medicare payroll taxes; new taxes on investment income; taxes on random services like indoor tanning facilities; and fees on all insurance policies to fund federal comparative effectiveness research.

All these taxes will drive up costs. Yet, while campaigning for president, Barack Obama promised that his plan "will save a typical American family up to $2,500 every year on medical expenditures."

With all the new taxes pa.s.sed on to consumers, and with all the new federal programs, departments, offices, and subsidies, could he truly believe that costs will go down? Why should the American people believe that spending trillions of tax dollars will somehow reduce healthcare costs? As CBO chief Elmendorf noted in summer 2009, "In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for healthcare costs." Sadly, little changed in the final product that was signed into law.

Despite all this, the president boldly declared to Congress, "I will not sign [a healthcare reform bill] if it adds one dime to the deficit, now or in the future, period." That promise was absurd, and the American people knew it. My friend, the pollster Frank Luntz, reported that by a 61 to 14 percent margin, more people believed scientists will discover life in outer s.p.a.ce than believed the Democrats' healthcare plan wouldn't increase the deficit.

MEDICARE CUTS.

Throughout the healthcare debate, most Americans asked a question to which they never got an honest answer: "How will reform impact me?" For seniors, it was easy to answer: you're in trouble.

To put seniors and Medicare in context, remember that the nonpartisan Medicare Trustees projects Medicare will be broke in six years-two years earlier than previously estimated. That is just the beginning of the problems. Medicare is already burdened with an unfunded liability of up to $85 trillion in benefits that have been promised future generations with nothing saved to cover them.

Democrats did nothing to fix the structural problems behind this shortfall. Instead, the law simply guts the program for today's seniors to create a new healthcare ent.i.tlement. The cuts to Medicare will pay for the other aspects of the reform plan, like government subsidies and Medicaid expansion. They simply rob Peter to pay Paul while failing to fix Medicare's fundamental problems.

The chief actuary at the Centers for Medicare and Medicaid Services, which administers both programs, estimated that the law would cut Medicare by $494 billion. This breathtaking figure is the amount of money that would have gone to doctors, nurses, and other providers who deliver care and coverage to seniors. According to CMS, the new law cuts deep and wide, including home health ($39 billion); hospitals ($131 billion); skilled nursing facilities ($22 billion); and Medicare Advantage benefits ($101 billion).

Clearly, you cannot cut Medicare by more than a half a trillion dollars and not jeopardize seniors' access to care. Medicare access is already declining. The Mayo Clinic announced that on January 1, 2010, its Arizona facilities would stop seeing Medicare beneficiaries because the federal government does not pay the clinic enough to even cover its costs. According to Lynn Closway, spokeswoman for Mayo, the clinic lost $840 million in 2008 treating Medicare patients. And that's before the Democrats' half a trillion in cuts.

Jeff Korsmo, executive director of the Mayo Clinic Health Policy Center, said with these kinds of cuts, "We will have to violate our values in order to stay in business and reduce our access to government patients."

Just days before the president signed the legislation into law, Walgreens, the nation's largest retail pharmacy chain, announced it would no longer accept the new Medicaid patients in Washington state. Why? Because the government pays the store so little to fill prescriptions for Medicaid beneficiaries that it loses money. Government often tries to control costs by cutting Medicaid reimburs.e.m.e.nts to providers, cuts which Walgreens described as "extreme." With 20 million Americans being pushed into Medicaid by the new law, this is an ominous sign of things to come.

MACHINE POLITICS IN THE HEALTH BILL.

On the day that President Obama was sworn into office, the White House launched a new website that included this pledge: "President Obama has committed to making his administration the most open and transparent in history."

As the debate over health reform heated up that summer, the president made another pledge:So I just want everybody to know, Congress will have time to read the bill. They will have time to debate the bill. They will have all of August to review the various legislative proposals. When we come back in September, I will be available to answer any question that members of Congress have. If they want to come over to the White House and go over line by line what's going on, I will be happy to do that.

Did the health reform debate live up to the president's standard? Hardly. The American people were promised a fair, bipartisan, transparent process, but instead the Democrats wrote trillion-dollar, 2,000-plus page bills in secret with no Republican input and no public oversight. Republicans repeatedly offered constructive ideas, only to be shut out and denounced as obstructionists. The one time the president actively sought out Republican ideas-the televised "Blair House summit" in February 2010-was a cynical public relations ploy to appear bipartisan at a time when Democrats had already pushed radical bills through the House and Senate on party-line votes, despite the president's campaign promises not to do so.

Already opposed to the socialist bent of the reform bills, Americans were further disgusted by the ugly machine politics the Left used to ram the bills through Congress.

We already discussed President Obama's disregard for his repeated promises to broadcast reform negotiations on C-SPAN. But there's more. The administration and its congressional allies set artificial deadlines, not for any legitimate reason, but simply to rush the bills through at maximum speed. The president long demanded the House and Senate pa.s.s their respective bills by the August 2009 recess. When that deadline was missed, new ones were set in September . . . then October . . . then Thanksgiving . . . then Christmas . . . and then Easter recess. These self-imposed, politically-driven deadlines left little time for sound policymaking, public input, or even time for members to the read the ever-changing proposals.

"READ THE BILL!"

Even if the process had been transparent and had a reasonable timeline, many lawmakers still probably wouldn't have understood the bills' mind-numbing complexity. "I don't expect to actually read the legislative language because reading the legislative language is among the more confusing things I've ever read in my life," said Delaware Democratic senator Tom Carper. Michigan Democratic congressman John Conyers put it even more bluntly: "What good is reading the bill if it's a thousand pages and you don't have two days and two lawyers to find out what it means after you read the bill?" And he's chairman of the House Judiciary Committee, which has jurisdiction over matters like the federal courts and const.i.tutional interpretation.

Such outrageous statements led to pet.i.tion drives and gra.s.sroots protests demanding that lawmakers "Read the Bill!" There was even a high-profile website, www.readthebill.org, demanding that representatives actually know what they were voting on. Ignoring these appeals, Washington Democrats tried to recreate the panicked sense of crisis they had exploited to stampede Congress into approving the stimulus.

Things got so bad in the Senate that a group of eight Democratic senators sent Majority Leader Harry Reid a letter demanding he slow the process down and shine a light on what they were voting on. They demanded that the bill, amendments, and budget estimates be publicized seventy-two hours before any vote.

But even that modest request was too much for the Senate Finance Committee, which rejected an amendment by Republican senator Jim Bunning that would have required a 72-hour period for public review. All but one of the committee's Democrats voted to keep the process at warp speed-and the public in the dark.

The secrecy continued even after one committee pa.s.sed its bill. The Senate Health, Education, Labor, and Pensions Committee voted for its health reform bill on a party-line vote over the summer, but it took two months for the final text to be made public. Only then was it apparent that Democratic staff had made more than seventy-five changes to the final legislative text that senators had approved.

While voting on bills that no one had read is outlandish enough, Pelosi had an even more outrageous idea. A Washington Post front-page headline said it all: "House may try to pa.s.s Senate health-care bill without voting on it." The plan was to bundle three bills together, including the bill that pa.s.sed the Senate on Christmas Eve, whereby a vote on the combined bill would "deem" the underlying bills to have pa.s.sed. Pelosi spelled out what attracted her to this strategy: "I like it because people don't have to vote on the Senate bill," she said. She wanted to spare Democrats from making a recorded vote for seedy, widely condemned payoffs like the Cornhusker Kickback and the Louisiana Purchase. After a fierce outcry from the public and even fellow House Democrats, the strategy was ultimately abandoned.

IGNORING THE AMERICAN PEOPLE.

We remember the people's anger boiling over in August 2009, when Americans from all walks of life demanded answers and accountability from their representatives about healthcare reform. We saw budget hawks recoil in horror at the trillion-dollar price tags. We saw seniors outraged by the hundreds of billions of dollars in Medicare cuts. We saw people with disabilities speak out against the specter of government deciding the fate of their medical care. We saw pro-life supporters denounce proposed federal funding for abortion. We saw citizens demand that their tax dollars not pay for healthcare for illegal immigrants.

These protestors rose up in virtually every congressional district in the country. Afraid of facing their own const.i.tuents, some House Democrats stopped having townhall meetings. Others opted for safer "town calls" where they could screen partic.i.p.ants over the phone. Virginia Democratic congressman Jim Moran even demanded to see the driver's license of one townhall attendee to verify he was a real const.i.tuent. (He was.) Meanwhile, Harry Reid compared congressmen who wanted a slower, more deliberative process to supporters of slavery.

As public anger erupted and the healthcare reform bills plunged in the polls, Washington Democrats continued their march ahead. They a.s.sumed machine politics could override the needs and desires of the American people.

Poll after poll showed Americans repudiating every aspect of the Democratic plan. Back in April 2009, an NBC/Wall Street Journal poll had found 33 percent of Americans favored the plan, with 26 percent opposed. By January 2010, the same poll showed support steady at 33 percent, while opposition shot up twenty points to 46 percent. Similarly, a January 2010 Rasmussen poll found just 12 percent of Americans believed the legislation would achieve the stated goal of reducing healthcare costs, while 60 percent thought it would increase costs.

The more the American people learned about the reform, the more adamantly they rejected it. Americans knew the Democrats' efforts were more about ideology than about solving real problems. Even the president said as much, telling House Democrats, "We need courage, that's what we need. . . . We need an up or down vote-it's time to vote." Ask yourself this: why would members of Congress need courage if the American people supported what they were doing?

So why did Obama press ahead against the determined opposition of the American people? Because public opinion had nothing to do with the real goal of healthcare reform: to increase the power of the secular-socialist machine.

WHY WASN'T MEDICAL MALPRACTICE INCLUDED?

Medical malpractice reform enjoys near universal support: doctors, hospitals, businesses, insurers, and voters all want to fix tort law to eliminate frivolous lawsuits.

According to Rasmussen, by a margin of 57-29 percent, Americans want to limit the amount of money juries can award a plaintiff in medical malpractice lawsuits. Forty-seven percent believe restricting jury awards for medical malpractice lawsuits would significantly reduce the cost of healthcare in the United States, while just 28 percent disagree. And 48 percent believe it's too easy to sue for medical malpractice, while only 19 percent believe it's too hard.

Americans have long known that the threat of being sued forces doctors to practice medicine differently. They order more tests, do more procedures, and otherwise go out of their way to minimize the risk of a trial lawyer accusing them of not doing enough. Jackson Healthcare and Gallup asked doctors what percentage of their care is solely due to the threat of lawsuits. Doctors estimated 26 percent of their services-costing more than $650 billion every year-doesn't benefit the patient at all. In fact, it endangers patients by exposing them to higher risks of hospital-acquired infections, medical errors, and medication errors.

And all this unnecessary care drives up costs; even the Congressional Budget Office, one of the most risk adverse inst.i.tutions in Washington, reported in September 2009 that medical liability reform would save $54 billion over ten years through lower malpractice insurance and more appropriate care. Some experts like Dr. Mark McClellan, who ran the Food and Drug Administration and the Centers for Medicare and Medicaid Services, peg the cost of defensive medicine at $120 billion every year.

You would think congressional Democrats, who were so desperate to fund their government takeover that they included a tax on indoor tanning services, would have jumped at the chance to save $54 billion. But tort reform went nowhere, despite wide public support from businesses to doctors to the public. President Obama only gave it a token acknowledgement after the Blair House summit, when he magnanimously suggested that Congress give $50 million to state pilot programs for tort reform. As Charles Krauthammer remarked, the president was offering "a few ridiculously insignificant demonstration projects amounting to one-half of one-hundredth of 1 percent of the cost of Obama's health-care bill." As if this proposal wasn't hollow enough, who did Obama task with overseeing tort reform? Kathleen Sebelius, Secretary of Health and Human Services-a former executive director of the Kansas Trial Lawyers a.s.sociation.

Why do Democrats oppose tort reform? Former Democratic National Committee chairman Howard Dean answered that candidly at an August 2009 townhall meeting: "The reason why tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth."

He's right. Why would the Left take on trial lawyers, a key part of the secular-socialist machine? According to Federal Election Commission data, the a.s.sociation of Trial Lawyers of America (now deceptively called the "American a.s.sociation for Justice") has contributed more than $28 million to Democratic candidates since 1990-and less than $3 million to Republicans.

Nearly every aspect of the health reform debate-from process to policy-has followed this corrupt pattern: reward friends, punish and destroy enemies.

HOUSE MUSCLE.

Of all the groups the Democrats demonized during the healthcare debate, health insurers topped the list. Speaker Pelosi called them "evil," "immoral," and "villains." In the spirit of Joe McCarthy, Energy and Commerce Committee chairman Henry Waxman and Oversight and Investigations Subcommittee chairman Bart Stupak sent a letter to fifty-two of the nation's largest health insurance companies that contained a not-so-veiled threat.

The letter demanded detailed information about the companies' executive pay, conferences and corporate outings, and business practices. For any employees or officers making more than $500,000 a year going back to 2003, the congressmen demanded details on salaries, bonuses, pensions, and other compensation. They also insisted that insurance companies disclose the ident.i.ty of all board members and their compensation.

Imagine that: two powerful Democrats launched an investigation of health insurance companies during a national debate over health insurance reform. Although Stupak later threatened to oppose the final reform bill because it allowed federal funding of abortion, he was always a strong advocate of Democratic reform and ultimately helped to deliver the key votes to pa.s.s it in the House. The message of the letter he and Waxman wrote to insurers was clear, if unstated: get on board with "reform," or we'll embarra.s.s and investigate you until you do.

They were using raw political power to silence their opponents, plain and simple. If not, why did they single out insurance companies? Why didn't they ask the same questions of others, like physician groups, hospitals, and drug companies? It's no coincidence that the main lobbying organizations of the groups being left alone by Congress supported the Democrats' reform, while the insurance industry largely opposed it.

THIS IS USUALLY CALLED A BRIBE.

To win final pa.s.sage of his bill in the Senate, Harry Reid didn't use muscle. He used political payoffs. We already discussed the most egregious ones: Ben Nelson's Cornhusker Kickback, Senator Mary Landrieu's Louisiana Purchase, and the rest. The Democrats' own Russ Feingold, senator from Wisconsin, commented simply, "These 'sweeteners' are unjustifiable."

But perhaps the most outrageous of all sweetheart deals was struck by the congressional leaders, the White House, and organized labor. Union leaders adamantly opposed a provision in the Senate bill that would have levied a 40 percent tax on high-value health insurance plans, also known as "Cadillac" plans. These types of insurance plans, common among labor unions, are expensive because they cover so many services at very low costs to the individual.

This tax was a critical piece of the Senate bill that would have raised $149 billion, according to the CBO. But congressional Democrats could hardly afford to alienate such an important part of their machine as organized labor. So congressional Democrats struck a deal giving unions, along with state and local government workers, a 5-year exemption from the tax. Non-union plans would still pay, of course. AFL-CIO president Richard Trumka bragged that the payoff was worth $60 billion. Unsurprisingly, after securing the deal, Trumpka triumphantly announced union officials would support Obama's reform. Going even further, the final law pushed back the effective date of the tax to 2018 and raised the threshold so that only a few of the richest plans would be hit.

People know that deals happen every day in Washington. But the Left's health reform was something different-a parade of brazen political payoffs to ensure victory for a radical, deeply unpopular reform. In the world of the secular-socialist machine, it's called negotiating. In the real world, it's called bribery.

This naked display of the secular-socialist ideology and machine politics led to a stunning electoral upset in the special election to the U.S. Senate in Ma.s.sachusetts. According to an exit poll by Tony Fabrizio of Fabrizio, McLaughlin & a.s.sociates, 39 percent of those who voted for the winner, Republican Scott Brown, did so specifically because of his opposition to the Democrats' health reform plan-and this occurred in one of the most heavily Democratic states in the country. This was for the Senate seat that had been held since 1962 by Ted Kennedy, who called universal healthcare the "cause of my life." It could not have been a clearer repudiation of the machine's healthcare machinations-and the Democrats ignored it anyway.

Repealing Obamacare and replacing it with a market-oriented, patient-focused, commonsense healthcare vision will be a central fight of the 2010 and 2012 elections. As I said earlier, reforming healthcare is one of the most critical problems we face. Our system kills people. It eats money. It threatens the future of our country. We have to fix it. I founded the Center for Health Transformation to create and advocate for the right ways to do that. You will find real health solutions in chapter fifteen of this book.

CHAPTER SIX.

The Secular- Socialist Machine and ACORN's Vote Fraud Since the secular-socialist machine has to lie about its misuse of government money and power, it is a short step to engineering dishonest elections. Voter fraud, along with corruption and deceptive language, form a triad of dishonesty that the machine relies upon to maintain power among a people who decisively oppose its goals.