As Andrea Tantaros has just reminded us in the New York Daily News (“Obama’s death panels return: Rationing is at heart of President’s health plan”), Obama has long known that the health care rationing at the core of Obamacare would be a hard sell.
In an interview (prematurely titled “After the Great Recession”) shortly after his inauguration with David Leonhardt of the New York Times, Obama observed that the costs would have to be constrained for “the chronically ill and those toward the end of their lives [who] are accounting for potentially 80 percent of the total health care bill out here.” Asked by Leonhardt “how do we deal with it” by Leonhardt, Obama replied:
Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance….
That, I think, was a very revealing comment. First, it shows Obama’s belief that “conversation,” to be constructive, involves talking to people, not listening to them. Because Obama is certain people will never choose the solutions he believes necessary “through normal political channels,” i.e., having their representatives enact legislation that actually reflects the preferences of their constituents, the “very difficult democratic conversation” he wants must be directed by the “guidance” of experts. Obama’s version of “democratic conversation,” in short, is to democracy what democratic centralism was to socialism: its subversive nemesis.
Thus, despite the fact that centralized top-down health rationing was vociferously rejected in spontaneous “conversations” that erupted around the country as Obamacare was being debated, the Independent Payment Advisory Board nevertheless exists, sitting atop the Obamacare system with 15 presidentially-appointed bureaucrats empowered to act, as Congress Paul Ryan has charged, as “a rationing board.” Indeed, its powers are so draconian that even some Democrats oppose it.
The existence and power of the IPAB is eloquent testament of what “democratic conversation” means to Obama, a meaning that he eloquently expressed back in 2009 when he told critics to shut up and get out of the way. “I don’t want the folks who created the mess to do a lot of talking,” he said to a cheering audience in Richmond. “I want them to get out of the way so we can clean up the mess.”
The right to speak in an Obamian “conversation” is thus limited to those who, guided by professional experts, toe the party line.
