“[I]f we’re able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role.”

–President Barack Obama, at his New Hampshire town hall, Aug. 11, 2009

“[W]e will eventuaolly be spending more on Medicare than every other government prgram combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close.”

–President Barack Obama, in his televised address to Congress, Sept. 9, 2009

So which is it, Mr. President? Is Medicare a disaster or so “right” that we should convert our entire U.S. health-care delivery system into a government-run Medicare program for all ages?

The answer, of course, is that Obama wants to have it both ways: As an editorial in today’s Wall Street Journal points out:

Medicare’s unfunded liability—the gap between revenues and promised benefits—is currently some $37 trillion over the next 75 years. Yet the President uses this insolvency as an argument to justify the creation of another health-care entitlement, this time for most everyone under age 65. It’s like a variation on the old Marx Brothers routine: “The soup is terrible and the portions are too small.”

As astonishing, Mr. Obama claimed he can finance universal health care without adding “one dime to the deficit, now or in the future, period,” in large part by pumping money out of Medicare. The $880 billion Senate plan he all but blessed this week would cut Medicare by as much as $500 billion, mainly by cutting what Mr. Obama called “waste and abuse.” Perhaps this is related to the “waste and abuse” that Congresses of both parties have targeted dozens of times without ever cutting it.

As the Journal points out, the main ways that Obama proposes to not add “one dime to the deficit” is by cutting $177 billion from Medicare Advantage, the popular supplemental program enrolled in by 24 percent of seniors on Medicare. The reason: Medicare Advantage is run by evil private insurance companies, not the government.

Then there’s Obama’s perennial promise, reiterated in his Sept. 9 speech, to “create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.” As the Journal’s editorialists write:

That kind of board is precisely what has many of the elderly worried about government rationing of treatment: As ever-more health costs are financed by taxpayers, something will eventually have to give on care the way it has in every other state-run system.

Also in today’s Journal, Grace-Marie Turner of the Galen Institute and Joseph R. Antos of the American Enterprise Institute list 10 reasons why expanding the nearly bankrupt Medicare program to the rest of America would destroy our now-superlative health-care system. Here are three of their reasons.

Private payers are bailing out Medicare. According to Milliman, an independent actuarial firm, Medicare—and to an even greater extent, Medicaid—underpays doctors and hospitals, shifting costs to private insurers. Milliman estimates that the average family in a private PPO health plan pays an additional $1,788 a year to compensate for underpayments by Medicare and Medicaid, representing a “hidden tax” on commercial payers totaling $89 billion a year.
Medicare short­-changes seniors. Medicare exposes patients to unmanageable costs if they become seriously ill—even limiting the total number of days a patient may spend in the hospital. The program covers only about 50% of the health costs of seniors, and most have supplemental insurance to fill in the gaps. This is not a model for comprehensive coverage.
Payments are too low. Washington decides how much doctors, hospitals and other providers will be paid down to the smallest detail, with mountains of regulation and paperwork to track the politically driven process. Medical professionals are in a perpetual battle with Congress over their payment rates, and many physicians refuse to accept new Medicare patients because payment rates are so low. With few exceptions, Medicare’s solution to cost containment is the club of price-controls, not innovation and efficiency.

Congressional Democrats are currently demanding the head of Rep. Joe Wilson of Arizona for yelling, “You lie!” when Obama said in his speech that his health-care plan would not pay for medical care for illegal immigrants. It would be churlish to repeat Wilson’s charge when it comes to what the president has been saying about Medicare, but the expression “forked tongue” does come to mind.