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Yet More “Plus ça change …” You Can Believe In December 16, 2009

Posted by rogerhollander in Barack Obama, Health.
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Published on Wednesday, December 16, 2009 by Salon.com

White House as Helpless Victim on Health Care

by Glenn Greenwald

Of all the posts I wrote this year, the one that produced the most vociferious email backlash — easily — was this one from August, which examined substantial evidence showing that, contrary to Obama’s occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it.  From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House — hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama’s campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN).  Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn’t pass it.  The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party — rather than the GOP – will continue to be the prime recipient of industry largesse.

As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage.  Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this — the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional “centrists.”  Right.  The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives.  The administration is getting the bill which they, more or less, wanted from the start — the one that is a huge boon to the health insurance and pharmaceutical industry.   And kudos to Russ Feingold for saying so:

Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.

This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth,” said Feingold. “I think they could have been higher. I certainly think a stronger bill would have been better in every respect.”

Let’s repeat that:  “This bill appears to be legislation that the president wanted in the first place.”  Indeed it does.  There are rational, practical reasons why that might be so.  If you’re interested in preserving and expanding political power, then, all other things being equal, it’s better to have the pharmaceutical and health insurance industry on your side than opposed to you.  Or perhaps they calculated from the start that this was the best bill they could get.  The wisdom of that rationale can be debated, but depicting Obama as the impotent progressive victim here of recalcitrant, corrupt centrists is really too much to bear.

Yet numerous Obama defenders — such as Matt Yglesias, Ezra Klein and Steve Benen — have been insisting that there is just nothing the White House could have done and all of this shows that our political system is tragically “ungovernable.”  After all, Congress is a separate branch of government, Obama doesn’t have a vote, and 60 votes are needed to do anything.  How is it his fault if centrist Senators won’t support what he wants to do?  Apparently, this is the type of conversation we’re to believe takes place in the Oval Office:

The President:  I really want a public option and Medicare buy-in.  What can we do to get it?

Rahm Emanuel:  Unfortunately, nothing.  We can just sit by and hope, but you’re not in Congress any more and you don’t have a vote.  They’re a separate branch of government and we have to respect that.

The President:  So we have no role to play in what the Democratic Congress does?

Emanuel:  No.  Members of Congress make up their own minds and there’s just nothing we can do to influence or pressure them.

The President:  Gosh, that’s too bad.  Let’s just keep our fingers crossed and see what happens then.

In an ideal world, Congress would be — and should be — an autonomous branch of government, exercising judgment independent of the White House’s influence, but that’s not the world we live in.  Does anyone actually believe that Rahm Emanuel (who built his career on industry support for the Party and jamming “centrist” bills through Congress with the support of Blue Dogs) and Barack Obama (who attached himself to Joe Lieberman when arriving in the Senate, repeatedly proved himself receptive to “centrist” compromises, had a campaign funded by corporate interests, and is now the leader of a vast funding and political infrastructure) were the helpless victims of those same forces?  Engineering these sorts of “centrist,” industry-serving compromises has been the modus operandi of both Obama and, especially, Emanuel.

Indeed, we’ve seen before what the White House can do — and does do — when they actually care about pressuring members of Congress to support something they genuinely want passed.  When FDL and other liberal blogs led an effort to defeat Obama’s war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):

The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won’t get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday.  “We’re not going to help you. You’ll never hear from us again,” Woolsey said the White House is telling freshmen.

That’s what the White House can do when they actually care about pressuring someone to vote the way they want.  Why didn’t they do any of that to the “centrists” who were supposedly obstructing what they wanted on health care?  Why didn’t they tell Blanche Lincoln — in a desperate fight for her political life — that she would “never hear from them again,” and would lose DNC and other Democratic institutional support, if she filibustered the public option?  Why haven’t they threatened to remove Joe Lieberman’s cherished Homeland Security Chairmanship if he’s been sabotaging the President’s agenda?  Why hasn’t the President been rhetorically pressuring Senators to support the public option and Medicare buy-in, or taking any of the other steps outlined here by Adam Green?  There’s no guarantee that it would have worked – Obama is not omnipotent and he can’t always control Congressional outcomes — but the lack of any such efforts is extremely telling about what the White House really wanted here.

Independent of the reasonable debate over whether this bill is a marginal improvement over the status quo, there are truly horrible elements to it.  Two of the most popular provisions (both of which, not coincidentally, were highly adverse to industry interests) — the public option and Medicare expansion — are stripped out (a new Washington Post/ABC poll out today shows that the public favors expansion of Medicare to age 55 by a 30-point margin).  What remains is a politically distastrous and highly coercive “mandate” gift to the health insurance industry, described perfectly by Digby:

Obama can say that you’re getting a lot, but also saying that it “covers everyone,” as if there’s a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don’t get it from their employer. I guess you can call that progressive, but that doesn’t make it so. In fact, mandating that all people pay money to a private interest isn’t even conservative, free market or otherwise. It’s some kind of weird corporatism that’s very hard to square with the common good philosophy that Democrats supposedly espouse.

Nobody’s “getting covered” here. After all, people are already “free” to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won’t make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn’t or didn’t want to write. Indeed, it actually looks like the worst caricature of liberals: taking people’s money against their will, saying it’s for their own good — and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don’t miss the money as much when they never see it.

In essence, this re-inforces all of the worst dynamics of Washington.  The insurance industry gets the biggest bonanza imaginable in the form of tens of millions of coerced new customers without any competition or other price controls.  Progressive opinion-makers, as always, signaled that they can and should be ignored (don’t worry about us — we’re announcing in advance that we’ll support whatever you feed us no matter how little it contains of what we want and will never exercise raw political power to get what we want; make sure those other people are happy but ignore us).  Most of this was negotiated and effectuated in complete secrecy, in the sleazy sewers populated by lobbyists, industry insiders, and their wholly-owned pawns in the Congress.  And highly unpopular, industry-serving legislation is passed off as “centrist,” the noblest Beltway value.

Looked at from the narrow lens of health care policy, there is a reasonable debate to be had among reform advocates over whether this bill is a net benefit or a net harm.  But the idea that the White House did what it could to ensure the inclusion of progressive provisions — or that they were powerless to do anything about it — is absurd on its face.  Whatever else is true, the overwhelming evidence points to exactly what Sen. Feingold said yesterday:  “This bill appears to be legislation that the president wanted in the first place.”

Copyright ©2009 Salon Media Group, Inc.

Glenn Greenwald was previously a constitutional law and civil rights litigator in New York. He is the author of the New York Times Bestselling book “How Would a Patriot Act?,” a critique of the Bush administration’s use of executive power, released in May 2006. His second book, “A Tragic Legacy“, examines the Bush legacy.

Health Care Industry Officials, Lobbyists Met With Obama During Debate On Reform November 25, 2009

Posted by rogerhollander in Barack Obama, Health.
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Wednesday 25 November 2009

by: Jason Leopold, t r u t h o u t | Report

Top health care officials met with Barack Obama and other administration officials just as the president pushed Congress to pass legislation to overhaul the health insurance industry, newly released White House visitor logs show.

According to an analysis by the Associated Press, the 1,600 records the White House released Wednesday show that a “broad cross-section of the people most heavily involved in the health care debate, weighted heavily with those who want to overhaul the system.”

Some of these individuals include:

Laird Burnett, a top lobbyist for insurer Kaiser Foundation Health Plan Inc., and a former Senate aide. Kaiser has spent some $1.7 million lobbying Congress over the past two years.

Joshua Ackil, a lobbyist whose clients include Intel, U.S. Oncology Inc., and Knoa Software Inc., all of which have reported lobbying on the health care overhaul. Ackil met with Dan Turton, the White House’s deputy legislative affairs director who works with the House, in August. Seven people were at the Aug. 21 meeting, the records show.

Alissa Fox, a lobbyist with the Blue Cross and Blue Shield Association, met March 31 with Peter Orszag, director of the Office of Management and Budget. Four people attended, the records show. The health insurance federation has spent at least $6.7 million lobbying this year.

Amador “Dean” Aguillen, a former aide to Nancy Pelosi who is now with Ogilvy Government Relations, where he lobbies for clients including pharmaceutical companies SanofiPasteur and Takeda Pharmaceuticals America, Pfizer Inc., and Amgen USA Inc., all of which reported lobbying on health care issues this year. Aguillen appears to have attended the same Aug. 21 meeting with Turton that Ackil did.

Bloomberg added that the visits also included representatives from pharmaceutical trade groups.

Karen Ignagni, president of America’s Health Insurance Plans, visited eight times, meeting twice with Obama and once with economic adviser Lawrence Summers. Former U.S. Representative Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America, had two meetings with deputy chief of staff Jim Messina among at least eight at the White House.

Ignagni’s group, whose members include Indianapolis-based WellPoint Inc., is lobbying against efforts to include a public insurance option to compete with the private companies that are members of her trade association. Phrma, whose members include Whitehouse Station, New Jersey-based Merck & Co., is pushing Congress to enact health-care legislation.

Norm Eisen, special counsel to the president for ethics and government reform, said Wednesday that the administration received more than 300 requests from the public during the month of October seeking access to the visitor logs, which were posted on the White House’s website.

“Consistent with our earlier announcement that we will only release records that are 90 days or older, this group of records covers the time period between January 20, 2009 to August 31, 2009,” Eisen wrote in a blog post.

Eisen noted that many of the names on the list may appear to be well-known figures, but he cautioned that these indivudals are not who they would appear to be.

“With an average of 100,000 White House access records created each month, many White House Visitors share the same name as celebrities,” Eisen wrote. “In October, requests were submitted for the names of some notable figures (for example Michael Jordan and Michael Moore)…The famous individuals with those names never actually came to the White House, but we have included the individuals that did visit and share those names.”

Heavyweights in the energy and banking industries, were also among the individuals who met with Obama and senior members of his administration.

Blue Double Cross May 24, 2009

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Paul Krugman

www.nytimes.com, May 21, 2009

That didn’t take long. Less than two weeks have passed since much of the medical-industrial complex made a big show of working with President Obama on health care reform — and the double-crossing is already well under way. Indeed, it’s now clear that even as they met with the president, pretending to be cooperative, insurers were gearing up to play the same destructive role they did the last time health reform was on the agenda.

So here’s the question: Will Mr. Obama gloss over the reality of what’s happening, and try to preserve the appearance of cooperation? Or will he honor his own pledge, made back during the campaign, to go on the offensive against special interests if they stand in the way of reform?

The story so far: on May 11 the White House called a news conference to announce that major players in health care, including the American Hospital Association and the lobbying group America’s Health Insurance Plans, had come together to support a national effort to control health care costs.

The fact sheet on the meeting, one has to say, was classic Obama in its message of post-partisanship and, um, hope. “For too long, politics and point-scoring have prevented our country from tackling this growing crisis,” it said, adding, “The American people are eager to put the old Washington ways behind them.”

But just three days later the hospital association insisted that it had not, in fact, promised what the president said it had promised — that it had made no commitment to the administration’s goal of reducing the rate at which health care costs are rising by 1.5 percentage points a year. And the head of the insurance lobby said that the idea was merely to “ramp up” savings, whatever that means.

Meanwhile, the insurance industry is busily lobbying Congress to block one crucial element of health care reform, the public option — that is, offering Americans the right to buy insurance directly from the government as well as from private insurance companies. And at least some insurers are gearing up for a major smear campaign.

On Monday, just a week after the White House photo-op, The Washington Post reported that Blue Cross Blue Shield of North Carolina was preparing to run a series of ads attacking the public option. The planning for this ad campaign must have begun quite some time ago.

The Post has the storyboards for the ads, and they read just like the infamous Harry and Louise ads that helped kill health care reform in 1993. Troubled Americans are shown being denied their choice of doctor, or forced to wait months for appointments, by faceless government bureaucrats. It’s a scary image that might make some sense if private health insurance — which these days comes primarily via HMOs — offered all of us free choice of doctors, with no wait for medical procedures. But my health plan isn’t like that. Is yours?

“We can do a lot better than a government-run health care system,” says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.

Which brings us back to Mr. Obama.

Back during the Democratic primary campaign, Mr. Obama argued that the Clintons had failed in their 1993 attempt to reform health care because they had been insufficiently inclusive. He promised instead to gather all the stakeholders, including the insurance companies, around a “big table.” And that May 11 event was, of course, intended precisely to show this big-table strategy in action.

But what if interest groups showed up at the big table, then blocked reform? Back then, Mr. Obama assured voters that he would get tough: “If those insurance companies and drug companies start trying to run ads with Harry and Louise, I’ll run my own ads as president. I’ll get on television and say ‘Harry and Louise are lying.’ ”

The question now is whether he really meant it.

The medical-industrial complex has called the president’s bluff. It polished its image by showing up at the big table and promising cooperation, then promptly went back to doing all it can to block real change. The insurers and the drug companies are, in effect, betting that Mr. Obama will be afraid to call them out on their duplicity.

It’s up to Mr. Obama to prove them wrong.

How the American Health Care System Got That Way December 15, 2008

Posted by rogerhollander in Health.
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wal-mart-health1

Activists protest Wal-Mart’s health care coverage. More and more workers are struggling with inadequate employer-based coverage. (Photo: Scott Olson / Getty Images) www.truthout.org  

  As Americans respond to President-elect Obama’s call for town hall meetings on reform of the American health care system, an understanding of how that system came to be the way it is can be crucial for figuring out how to fix it. The American health care system is unique because, for most of us, it is tied to our jobs rather than to our government. For many Americans, the system seems natural, but few know that it originated not as a well-thought-out plan to provide for Americans’ health, but as a way to circumvent a quirk in wartime wage regulations that had nothing to do with health.

    As far back as the 1920′s, a few big employers had offered health insurance plans to some of their workers. But only a few: By 1935, only about two million people were covered by private health insurance, and on the eve of World War II, there were only 48 job-based health plans in the entire country.

    The rise of unions in the 1930′s and 1940′s led to the first great expansion of health care for Americans. But ironically, it did not produce a national plan providing health care to all, like those in virtually all other developed countries. Instead, the special conditions of World War II produced the system of job-based health benefits we know today.

    In 1942, the US set up a National War Labor Board. It had the power to set a cap on all wage increases. But it let employers circumvent the cap by offering “fringe benefits” – notably, health insurance. The fringe benefits created a huge tax subsidy; they were treated as tax-deductible expenses for corporations, but not as taxable income for workers.

    The result was revolutionary. Companies and unions quickly negotiated new health insurance plans. Some were run by Blue Cross, Blue Shield and private insurance companies. Others were “Taft-Hartley funds,” run jointly by management and unions. By 1950, half of all companies with fewer than 250 workers and two-thirds of all companies with more than 250 workers offered health insurance of one kind or another. By 1965, nearly three-quarters of the population were covered by some kind of private health insurance.

    This private, job-based insurance covered millions of workers, who had never had health care insurance before. But this victory also set patterns that are responsible for many of the problems the health care system faces today.

    Because this private system was tied to employment, it did not provide health insurance for all. Millions of people outside the workforce were without coverage. Those most likely to be covered were salaried or unionized white men in northern industrial states. Two-thirds of those with incomes under $2,000 a year were not covered, nor were nearly half of nonwhites and those over 65.

    Employer-based plans tied workers to their jobs – something that benefited employers, but not workers or the economy as a whole. The quality of the coverage was spotty – some plans were excellent, others completely inadequate. Doctors accepted this revolution because it didn’t challenge their power; but, as a result, the system provided no public control over medical costs.

    This revolution had a subtle political effect as well. By giving much of the workforce health benefits, it reduced the incentive for them to pursue a system of universal care. And it gave unions a stake in the private, employer-based health care system. As one opponent of publicly financed health care put it, “the greatest bulwark” against “the socialization of medicine” was “furthering the progress already made by voluntary health insurance plans.”

    Since then, many layers have been laid on top of employer-based health care. Medicare and Medicaid provided government-funded health insurance for the elderly and impoverished. The “managed care revolution” led to the takeover of 90 percent of employer-based health care by HMOs, most of them driven by profit rather than health concerns. But most people continue to get their health care through their employer.

    Many of the problems of American health care grow out of this history. The system is so complex that even experts – let alone ordinary people trying to find care for themselves and their loved ones – are unable to fully understand it. The system spends one-third of its cost on paperwork, waste and profit over and above the cost of actually providing health care. Yet, nearly one-third of Americans are without health insurance over the course of a year. In all other developed countries, more than 85 percent of citizens have health coverage under public programs. The American health care system is full of inequalities: People who work for one company may have high quality insurance, while those who work for a similar company have none.

    All of these problems are due at least in part to an employer-based system, the original intent of which was not to provide quality health care to all, but to circumvent wartime wage regulations. As we begin to debate how to reform health care, we should keep in mind that the American health care system was not created to express American values or to meet Americans’ health care needs. And knowing that, we should not be afraid to change the system if we can come up with a better one.

    ———

     This piece is excerpted from “Doctor Wall Street: How the American Health Care System Got So Sick,” from a popular pamphlet on the history of the American health care system available for free download at http://laborstrategies.blogs.com/DoctorWallStreet.pdf

    Tim Costello, Jeremy Brecher and Brendan Smith are the co-founders of Global Labor Strategies, a resource center providing research and analysis on globalization, trade and labor issues. GLS staff have published many previous reports on a variety of labor-related issues, including Outsource This! American Workers, the Jobs Deficit, and the Fair Globalization Solution, Contingent Workers Fight For Fairness, and Fight Where You Stand!: Why Globalization Matters in Your Community and Workplace. They have also written and produced the Emmy-nominated PBS documentary Global Village or Global Pillage? GLS has offices in New York, Boston, and Montevideo, Uruguay. For more on GLS visit: www.laborstrategies.blogs.com or email smithb28@gmail.com.

 

by: Jeremy Brecher, Tim Costello and Brendan Smith, t r u t h o u t | Perspective

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