That is how Gov. Mitch Daniels describes his health care reform plan (which the Indiana legislature passed last night) in an email his staff helpfully forwarded my way.  According to the Indianapolis Star, Daniels’ plan will:

• Expand Medicaid eligibility for pregnant women and children
• Provide health insurance subsidies to individuals making $20,420 and families of four making $41,300 per year (i.e., 200 percent of the federal poverty level)
• Provide those beneficiaries with $500 of free preventive care and $1,100 in a health savings account
• Institute a “slacker mandate” that requires insurers to allow children to remain on their parents’ insurance policy up to age 24
• Increase the cigarette tax by $0.44/pack, to $0.995/pack

Daniels was understandably moved.  Here is his full quote:

The health plan passed last night can fairly be described as the most important health care legislation of our lifetimes.  I have asked a host of people whether they can think of a better example and nobody has.  I am excited about the passage of the plan and what it can mean for uninsured Hoosiers and for low-income children, and, of course, to try to bring down the second-highest smoking rate in America.

Did Gov. Daniels (R!!) bother checking with anyone who has actually set foot outside of Indiana?  Whatever the case, here are a few things the Daniels plan will also do:

• Crowd-out private coverage
• Encourage cigarette smuggling and related crime
• Trap more Indianans Hoosiers in low-wage jobs
• Re-create in Medicaid the dependence problems that Congress sought to eliminate with welfare reform
• Impose a brutally regressive tax on the poor.  According to Harvard’s Kip Viscusi: “The usual concerns about regressive taxes involve those that are regressive in percentage terms, that is, the poor pay a higher percentage of their income in taxes than do the wealthy. Cigarette taxes are actually so regressive that the poor pay a much higher absolute level of taxes than do the wealthy. In 1990, people who made under $10,000 per year paid almost twice as much in cigarette taxes as those who made $50,000 and above. The people who will bear the cigarette taxes are not the legislators who enact them but rather the janitors and support staff for the legislature.”
• Cost more than projected

When conservatives finally do start questioning why so many supposed good guys keep turning to the Dark Side, they might launch their inquisition with an examination of the Medicaid program, which makes Democratic and Republican governors alike this very tempting offer: big government at one-half the price.

In a recent post, Ezra Klein offers two arguments to beat back the “commenters hanging around demanding we redefine the word “uninsured,” attempting to downplay the problem of lack of coverage, denying all widely accepted measures of the uninsured, and, when that fails, writing the uninsured off as statistical artifacts of momentary lapses in coverage.”

Klein’s first argument is based on this chart:

According to this chart, 61 percent of those who were uninsured when surveyed reported that in the past year, they had one of the following problems:

• Did not fill a prescription
• Did not see a specialist when needed
• Skipped recommended medical test, treatment, or follow-up
• Had a medical problem but did not visit doctor or clinic

I see two problems with trying to get too much out of these data. 

1. The Commonwealth Fund survey asked respondents about their insurance status right now, but asked if they had to forgo medical care during the past year.  With the exception of respondents who were “insured all year,” it is not clear whether care was forgone while respondents were insured or uninsured.  Therefore, this survey says nothing about to what extent being uninsured caused respondents to forgo care.  (To his credit, Klein acknowledges that even those with coverage forgo care.  To my mind, the fact that medical care grows increasingly expensive even for those with coverage argues against reforms that would mindlessly cover the uninsured without changing the incentives faced by those with health insurance.)
2. These data say nothing about the health consequences of the care forgone.  Some of the uninsured suffer disastrous health consequences as a result of their lack of access to care, as Jonathan Cohn documents.  But these data do not tell us how much of the reported forgone care was necessary and how much was unnecessary.  So it’s a bit of a stretch to refer to these findings as “the effects of being totally uninsured.”

Klein’s second argument concerns the estimate that 45 million Americans lack health insurance.  That estimate is generated by the Census Bureau’s Current Population Survey.  It has been criticized for a number of reasons, which are not important for present purposes.

Klein argues that if the insurance industry uses that estimate then it must be valid.  That’s because the insurance industry “isn’t prone to overhyping the millions of Americans without insurance.”  Certainly the insurance industry has no interest in exaggerating the number of Americans without health insurance.

Evidently, Klein hasn’t been paying attention to the insurance industry’s political agenda, which includes massive subsidies to the insurance industry to provide health insurance to the uninsured.  (Will the Left express shock when the insurance industry hijacks “universal coverage” just as it is hijacking Medicare?  Consider yourselves warned.)

Health care reformers take note.  An article on Maine’s experience with its Dirigo health care program in today’s New York Times highlights some important lessons for those who would use command-and-control tactics to achieve “universal coverage.”

1. Government Coverage Crowds out Private Coverage

The Times reports:

When Maine became the first state in years to enact a law intended to provide universal health care, one of its goals was to cover the estimated 130,000 residents who had no insurance by 2009, starting with 31,000 of them by the end of 2005, the program’s first year.

So far, it has not come close to that goal. Only 18,800 people have signed up for the state’s coverage and many of them already had insurance.

In fact, some 60 percent of Dirigo enrollees previously had private insurance.  That’s consistent with recent estimates by economists Jon Gruber (MIT) and Kosali Simon (Cornell) that whenever government provides health insurance to 10 people, six people lose their private coverage.  Thus only four people gain coverage as a result of the expansion.

That’s government efficiency for you: covering four people for the price of 10.

2. Adverse selection happens.

More from the Times:

[P]remiums have increased, not become more affordable, because some of those who signed up needed significant medical care, and there are not enough enrollees, especially healthy people unlikely to use many benefits…

The program completely covers preventive care, subsidizes premiums and deductibles, and unlike most insurance plans, covers treatment for mental illness and does not exclude people for pre-existing medical conditions…

An Anthem spokesman, Mark Ishkanian, said the increase was necessary because medical claims of DirigoChoice customers were “substantially higher” than anticipated, about double those of non-Dirigo plans…

[A spokeswoman for the governor] said the state was surprised that more than half of DirigoChoice enrollees qualified for the highest subsidy, 80 percent, which meant the program has been more expensive for the state.

Hmm.  Benefits much more comprehensive than the market provides.  And enrollees were disproportionately high-cost.  Didn’t see that coming.

3. Predicted reductions in uncompensated care may not materialize.

Premiums are increasing under Dirigo.  (One diabetic man dropped out after his rates increased 13.4 percent.)  Part of Dirigo’s funding was to come from “assumed…savings because an increase in insured people would mean less charity care from hospitals.”  Guess not.  Gov. Romney, call your office.

4. For some, it’s not about better health care.  It’s about more government control.

When even the New York Times sees fit to run an article about how your big-government health plan is a disaster, it takes chutzpah to say that the answer is more mandates, more taxes, and more regulation:

[Democratic] Governor [John] Baldacci said in an interview that when the Legislature enacted the Dirigo Health Reform Act in 2003, it gave him less money and more compromises than he had wanted. He said his administration had now learned more about what works and what does not.

His new proposals include requiring people to have insurance and employers to offer it and penalizing them financially if they do not; making the subsidized insurance plan, DirigoChoice, more affordable for small businesses; creating a separate insurance pool for high-risk patients; instituting more Medicaid cost controls; and having the state administer DirigoChoice, which is now sold by Anthem Blue Cross.

“We’ve got a reform package that takes Dirigo to the next level,” Mr. Baldacci said. “It takes the training wheels off.”

Seems like the training wheels – indeed all the wheels – have already come off.