Keene is a senior fellow at the Independent Women’s Forum and has worked in disability and higher education policy including at the US Department of Education in the Reagan, Bush and Bush Administrations.

In the 1970s Republicans promised to do more with less as better managers than the Democrats. Such promises kept Democrats in charge of Congress for twenty years.

Recent Gallup polling on health care has shown that Obama’s pundits have not fared any better among likely voters using similar arguments about bringing efficiency to the health care system. The public knows “assuring quality affordable health care for all Americans” while “lowering costs” cannot occur simultaneously, no matter how excellent the management.

So the party in power has changed its tune. Instead of weak arguments about using new technology to clear up inefficiencies, Obama’s spokesmen have started to hint at government rationing. As Health and Human Service Secretary Kathleen Sebelius said on Meet the Press this Sunday, “Insurance companies pick and choose every day who gets what benefits, who gets what drugs, whether or not you get the procedure your doctor ordered. This notion that we’re going to somehow ration in the–rationing is going on each and every day and it’s done in the private market.”

The implication is that since private insurance companies “ration” services, we shouldn’t be concerned about government rationing in an increasingly “public” healthcare system.

Who would get rationed in government healthcare? Those with the highest health costs. For example, the disabled.

The disability community depends on government for a multitude of services, and they tend to vote Democratic, believing that a growing government is more likely to fund their needs. When the Obama Inauguration closed bridges and forced thousands of people to walk long distances, the most affected were those who lacked the ability to walk then stand in long lines to attend the functions they had worked so hard to manifest. Even a motorized wheelchair can lose its charge and strand its occupant, and with all cell phone service in the District of Columbia blocked, this would be deadly on a cold night.

If disability associations felt slighted by their treatment during the inaugural, they were quickly appeased by promises of free health care for all. Yet surely they know that health care is never “free” and rationing under government care would become inevitable. The bill in Congress now attempts to keep politicians’ hands clean-using blue-ribbon panels like MedCare to determine what services are “efficient” and not. This topic is ignored on disability association websites.

The higher education community also votes overwhelmingly Democratic, but has a lot to lose in the government take-over of health care. Amazing amounts of prestigious university research is spent looking for medical breakthroughs because the profit potential upside warrants it. Prestige follows research and students follow prestige. Yet the push for medical research will be dampened as we creep toward socialized medicine. Without profit potential for businesses and with government using “comparative effectiveness” research, it is unlikely that America will remain the world’s engine for medical innovations. America will become like Canada, feeding off cheap drugs one generation removed from patent payments – except there won’t be a new generation of drugs without research. Obama’s first National Science Foundation budget slashed 22% from major research equipment and facilities construction – the very infrastructure so lauded in stimulus bills – to pay for other priorities. Other agencies face similarly slashed research budgets.

Likewise, the overwhelmingly New Age liberal voting block of alternative medicine has made great strides in acceptability as insurance companies find that patient-centered care is effective and can be less expensive than traditional Western medicine. Does the alternative medicine industry really envision Washington bureaucrats defending aromatherapy and acupuncture under tremendous pressure from lobbyists like the establishment AMA, the American Medical Association? Yet, assured that nothing bad will happen as long as the most liberal President since FDR is in charge, this community too remains as silent as conservatives are vocal.

Thatcher’s appointees privatized much of the moribund British socialist economy in the 1980s. We Reagan appointees were told it was like detonating a bomb, persuading constituencies of the upside of the free market then unleashing human initiative and encouraging entrepreneurialism in England. Obama’s ticking time bomb for changing America in the other direction rests on how long voters remain in a suspended reality where they will somehow be spared the steep costs of “free” health care.

Keene is a senior fellow at the Independent Women’s Forum and has worked in disability and higher education policy including at the US Department of Education in the Reagan, Bush and Bush Administrations.