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BY GRACE-MARIE TURNER— House Speaker Nancy Pelosi raised millions of eyebrows in early March when she told reporters, we have to pass the health reform bill “so that you can find out what is in it.”

It goes without saying that few, if any, of the federal lawmakers who voted to pass the legislation had any idea of what was lurking in its 2,801 pages.

Nevertheless, Pelosi, Senate Majority Leader Harry Reid and other Democratic leaders on Capitol Hill did have a crystal clear vision of its implications.  They knew it would put the nation on the fast-track to a government-run, single-payer system.

Indeed, many of the provisions are so broadly and vaguely written that their interpretation and enforcement will be left to a small cadre of high-level bureaucrats appointed by President Obama. 

Topping that list is former Harvard professor Donald Berwick, whom Mr. Obama chose to head the Centers for Medicare and Medicaid Services using a controversial recess appointment in July.

The President didn’t use the recess route because he lacked enough Senate votes to confirm Dr. Berwick, but solely to prevent opposition senators from questioning the nominee about his radical views in front of a battery of TV cameras. 

Dr. Berwick, a pediatrician, is an unwavering admirer of the British National Health Service — ironically at a time when Britain’s new coalition government is trying to dismantle parts of the regulatory bureaucracy atop the creaky 62-year-old system.

And Dr. Berwick has been clear in his intention to ration medical care to curb rising costs.  “The decision is not whether or not we will ration care — the decision is whether we will ration care with our eyes wide open,” he told an interviewer last year.

Given his ideological zealotry and his hostility to private enterprise, there’s little doubt that Dr. Berwick and his fellow bureaucrats at the Department of Health and Human Services will muster their vast new powers to try and harness — and eventually eliminate — most of the key private sector players in the health sector in America.

To accomplish this, they can call on the avalanche of new mandates, taxes and regulatory requirements flowing from ObamaCare.  More importantly, the fuzziness of the act’s provisions will allow him and his cohorts to define the terms by which the law will be administered.

Thus the president’s promise that government would ensure that all Americans have health coverage has turned into a mandate that we all must have insurance defined by the government and with the government determining what our “choice” of health policies will be.  

 A prime example of this will unfold as the Obama Administration begins to define what must be counted as medical care and what counts as administrative expense in health insurance.

According to the new law, private insurers must spend between 80 and 85 percent of premium revenue on patient care and the rest on business expenses like fraud detection, profits, etc. — the so called “Medical Loss Ratio” or MLR. 

That may sound like a simple and straightforward issue, but a world of challenges and complexity lies beneath the surface. 

When state insurance commissioners met in Seattle in early August, they largely declined to endorse the narrow medical loss ratios favored by congressional Democrats.

 A powerful cluster of Democratic chairmen — including California’s Henry Waxman (House Commerce), Montana’s Max Baucus (Senate Finance) and Michigan’s Sander Levin (House Ways and Means) — then wrote a letter to Health Secretary Sebelius to “clarify” their legislative intent.

The chairmen claim that even though the law they wrote calls for “excluding federal and state taxes and licensing or regulatory fees” from the medical loss ratio, they now claim that they actually meant that federal and state taxes should be included.

Their “Alice in Wonderland” backtracking allows federal regulators to impose what amounts to a new tax on the net corporate income of private health insurers. 

These and a plethora of other decisions relegated to federal regulators could make it almost impossible for private insurance companies to comply. Those that survive will become little more than regulated utilities — leading inevitably to a government-run health system. 

It now is clear that decisions about what kind of health insurance we have, how much we must pay, what it covers or doesn’t cover, will be made by politicians and bureaucrats, not by us.

And, just five months after the health overhaul law was enacted, we see how the regulatory bureaucracy may well push us into the single-payer health care system that even the very liberal 111th Congress couldn’t enact.

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization that specializes in patient-centered ideas for health reform.  Readers may write her at PO Box 320010 or e-mail her at galen@galen.org.

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