House Speaker Nancy Pelosi just unveiled a hulking 1,990 page House health care bill (H.R. 3962). The latest product, which dwarfs the 1,342 page Clinton Health Plan of 1993, is the latest evolution of the House process, which started with H.R. 3200. The House Speaker made a number of general comments, saying that the legislation would lower costs for American families, enhance the solvency of the Medicare program, and add 36 million Americans to the health insurance rolls.

On the crucial question of financing, the Speaker made a point of saying that the bill is fiscally responsible and comes in under the $900 billion target set by President Obama, and would not expand the deficit. Of course, the Congressional Budget Office has not yet issued a formal “score”- or estimate- of the final product. So, it is hard to determine how, or if, the legislation would bend the health care cost curve downward, as President Obama has promised as a key ingredient in health care reform.

The House Speaker and the rest of the Congressional leadership want to fast track the legislation, and get it up on the floor for a vote as early as next week, if possible. Meanwhile, health policy analysts, economists, Congress watchers and ordinary citizens, will have limited time to examine the bill and make their own judgments. Taxpayers need to do their part. Here are some suggestions:

1. Check the Details for Yourself. The bill is now posted. You can find it at fixhealthcarepolicy.com. Congressional leaders were literally working on this bill late into the night before unveiling it this morning. At 1,990 pages, reading this will be an arduous task. But it will affect 300 million Americans and overhaul one sixth of the American economy. It is hard to imagine any piece of legislation having a bigger impact on one’s personal life, let alone the national life, of the country. Vigiliance, as Thomas Jefferson warned us, is the price of liberty.

2. Keep an Eye Out for Budget Gimmicks. Rest assured that there is already evidence that the Congressional leadership is going to resort to shell games and budget gimmicks to make the bill look like it doesn’t add to the deficit. This will be evident in how the bill is structured; it appears that they have decided to front load the revenues in the first five years, and run surpluses in the first five years, and put off the costs until the second five years, and then start running the deficits. So, while this might meet the temporary requirements of the first ten year Congressional Budget Office (CBO) score, it does not mean that the bill would really start to bend the spending curve downward, or that it will not contribute to the already devastating deficits Congress and the Administration have already incurred.

3. Pay no Attention to Words, Check the Actions. Congressional Leaders say a lot of things. But taxpayers need to pay close attention to what they do. It is evident that they are already breaking their promises to the representatives of the doctors and the pharmaceutical companies. Recall that they promised the doctors a permanent fix to Medicare payment. But, according to the October 29th Politico Pulse, now they have taken it out of the bill, and are going to do offer it in separate legislation. This is exactly what the Senate leadership tried and failed to do last week, in order to reduce the apparent cost of their health care agenda, and run up the spending on a separate bill to keep the Senate health care bill “deficit neutral.” Since the House leaders have decided the take Medicare payment fix out of the House bill, they will attempt to run the same play, and add the huge cost (approximately $250 billion over ten years) to the deficit on a separate track. This may work in the House, where the Congressional leadership commands huge majorities; it will not work in the Senate. The doctors will be played as pawns, once again, in the congressional liberals’ budget shell game. In any case, if they take health items out of the bills and add them to the deficit, the taxpayers continue to lose big time.

4. Don’t Trust New Promises. Also according to Politico Pulse, the House leadership has decided to cut drug payments in Medicare between $125 to $150 billion, as opposed to the $80 billion cuts they agreed to with the pharmaceutical industry. That broken promise is combined with a decision to impose price controls on Medicare drugs, and do away with private sector negotiation. This was, of course, the inevitable result of the creation of a universal drug entitlement. Seniors can expect drug rationing if such a provision is signed into law; not right away, but inevitably. Perhaps other K Street lobbyists will learn from this experience.

5. Don’t Depend on Old Promises. The President and Congressional leaders have made a litany of high profile promises: no middle class tax increases; you can keep your health plan if you like it; there will be no interference with your doctor-patient relationship; no funding for abortion or illegal immigration; the health care costs will fall on a future downward curve; we are going to cut Medicare Advantage plans but not Medicare benefits. These are all empty promises, and undermined by House and Senate legislation.

6. Forget Competition. House leaders praise the “ Public Plan” as a force for competition. It won’t, of course; and that is precisely why prominent “single payer” advocates in the House and Senate, champions of a government monopoly, are its strongest supporters. The new bill would force the new public plan to negotiate private rates with doctors and hospitals, and not be pegged to Medicare rates. If that’s true, congressional liberals are then right to ask : “what is the point of the public plan?” In fact, of course, the bill would not really sell out the Lefties. It will be a legally advantaged stalking horse for a single payer system. Even though they claim there is a level playing field for the public plan and the private health plans, that was clearly not true in the earlier versions of the House bill, where the taxpayers assumed the risk.

This is the next phase of the big debate. Both the House and Senate bills largely retain the same character: more control to Washington, less personal freedom.

Photo courtesy of Congressman Rob Wittman (R-Va)