Tags: 10th amendment, commerce clause, constitution, direct tax, health, health bill, health care, health insurance, health reform, healthcare, healthcare reform, interstate commerce, Medicaid, private insurance, roger hollander, t, warren richey
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(Roger’s note: it gets curiouser and curiouser. Republican state Attorneys General, who couldn’t give a damn about the Constitution and just want to make mischief for the Democrats, have inadvertently hit the nail on the head. They are questioning the government’s authority to force its citizens and residents to purchase a product, which in this instance is private health insurance, and which is universally considered to be a defective product. Talk about doing the right thing for the wrong reasons. It brings into relief this absurd strategy to reform health care in the US by creating a private monopoly instead of doing the logical thing, which is a public monopoly, which is what you find in Canada and most of Europe. And it all has to do with the private health insurance and pharmaceutical industries virtually owning the presidency and the Congress. US democracy in action. What should Obama have done? He should have from the beginning put forward a single-payer, medicare-for-all proposal, fought for it with all his eloquence and popularity, and then if it failed it would be on the Republicans and Blue Dog Democrats who would have killed it.)
Tuesday 23 March 2010
Miami – A lawsuit filed Tuesday in Florida includes 13 states and charges that the new healthcare reform law in unconstitutional. Virginia’s attorney general filed a separate lawsuit.
State attorneys general wasted no time filing legal challenges to President Obama’s healthcare reform law, swinging into action with legal filings in Florida and Virginia within minutes of the White House signing ceremony on Tuesday.
In Tallahassee, Fla., 12 attorneys general joined Florida Attorney General Bill McCollum in a 22-page complaint filed in federal court, charging that the new healthcare reform package exceeds Congress’s powers to regulate commerce, violates 10th Amendment protections of state sovereignty, and imposes an unconstitutional direct tax.
“This lawsuit should put the federal government on notice that Florida will not permit the constitutional rights of our citizens and the sovereignty of our state to be ignored or disregarded,” Attorney General McCollum said.
A Second Suit in Virginia
Virginia filed a similar lawsuit simultaneously in federal court in Richmond. That suit is slightly different in that it focuses in part on the clash between a recently enacted state law protecting the right of Virginia residents to refuse unwanted health insurance and the new federal law that imposes penalties on anyone who seeks to defy the national government’s command to purchase health insurance.
“Congress lacks the political will to fund comprehensive health care … because taxes above those already provided [in federal healthcare programs] would produce too much opposition,” the Virginia lawsuit says.
“The alternative, which was also a centerpiece of the failed Clinton administration health care proposal, is to fund universal health care in part by making healthy young adults and other rationally uninsured individuals cross-subsidize older and less healthy citizens,” the suit says.
The seven-page lawsuit presents a straightforward challenge to Congress’s decision to rely on its power to regulate interstate commerce to justify the federal mandate that every individual must have health insurance or pay a penalty.
“It has never been held that the Commerce Clause [of the Constitution] … can be used to require citizens to buy goods and services,” the suit says. “To depart from that history to permit the national government to require the purchase of goods and services would deprive the Commerce Clause of any effective limits.”
Aiming for the US Supreme Court
At a press conference in Florida, McCollum said his lawsuit is intended to move through the courts to the US Supreme Court. “I am confident the court is going to declare the new healthcare law unconstitutional,” he said.
Democratic leaders have downplayed any potential legal problems with the healthcare reform package. Many legal analysts agree with them. Others suggest the issue is open and could produce a landmark decision if the high court decides to take it up.
In addition to Florida, participating plaintiffs in the lawsuit include attorneys general from South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington State, Idaho, and South Dakota. The suing attorneys general are Republicans except James “Buddy” Caldwell of Louisiana, who is a Democrat.
The Florida-filed lawsuit identifies two victims. It says the new law infringes the liberty of individual state residents to choose for themselves whether to have health insurance. It also says the states themselves are victims of a federal power grab by leaders in Washington.
Worries About Bigger Medicaid Rolls
The new structure of the Medicaid portion of the healthcare bill – which deals with low-income Americans – leaves Florida with an offer it can’t refuse. The state can either opt out of Medicaid and leave millions of its most vulnerable residents uninsured, or opt in and surrender its authority to set priorities and run programs to an increasingly powerful national government.
Currently, Medicaid costs account for 26 percent of Florida’s annual budget. That is $18 billion for 2.7 million Medicaid recipients.
The suit says that, under the new law, Medicaid rolls in Florida are expected to increase dramatically. The corresponding soaring costs will fall increasingly on the Florida treasury, but state officials will have less authority to set priorities.
“[Florida] employees will be conscripted and forced to administer what now is essentially a federal Medicaid program for which Florida must bear a substantial cost,” the suit says.
Estimates are that the new law will impose additional costs on Florida ranging from $149 million in 2014 to more than a $1 billion by 2019.
The lawsuit says this amounts to an unconstitutional exercise of federal power that violates principles of federalism protected in the 10th Amendment. It says the healthcare reform bill commandeers the states and their employees as agents of the federal government’s regulatory scheme, and that it does so at the state’s own cost.
Another Beef: An Unconstitutional Direct Tax
The suit also says the tax penalty for noncompliance with the individual mandate to buy health insurance “constitutes a capitation and a direct tax that is not apportioned among the states according to census data, thereby injuring the sovereign interests of [the states].”
The tax penalty is unrelated to any taxable event or activity, the suit says. “It is to be levied upon persons for their failure or refusal to do anything other than to exist and reside in the United States,” the suit says.
This doesn’t just injure individuals who have a right to make healthcare decisions without government inference, the suit says. It also injures state governments who are forced to pay for the higher number of individuals coerced into enrolling in Medicaid.
Like the Virginia lawsuit, the Florida-filed suit also argues that Congress does not have the authority under the US Constitution to compel citizens to buy health insurance or punish them if they do not. An individual’s choice not to have health insurance is not “commerce” and thus does not fall within Congress’s power to regulate interstate commerce, the suit says.
A Third Lawsuit, in Michigan
In addition to the two state lawsuits, the Thomas More Law Center in Ann Arbor, Mich., filed a lawsuit in Michigan. It is filed on behalf of four individuals in southeastern Michigan who object to being forced to purchase healthcare coverage and who object to being forced to pay for abortions, contrary to their religious beliefs.
“Our Founding Fathers envisioned a limited form of government. The purpose of our Constitution and this lawsuit is to insure that it stays that way,” said Richard Thompson, president and chief counsel of the law center, in a statement.
“Let’s face it, if Congress has the power to force individuals to purchase health insurance coverage or pay a federal penalty merely because they live in America, then it has the unconstrained power to mandate that every American family buy a General Motors vehicle to help the economy or pay a federal penalty.”
Pro-Single-Payer Physicians Call for Defeat of Senate Health Bill December 22, 2009Posted by rogerhollander in Health.
Tags: anti-abortion, congress, health, health care reform, health insurance, health reform, healthcare, healthcare reform, insurance industry, Medicaid, medicare, public option, roger hollander, senate, senate bill, single payer, uninsured
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The negatives, the group says, include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, new restrictions on abortion, the unfair taxing of high-cost health plans, and cuts of $43 billion in Medicare payments to safety-net hospitals. Moreover, at least 23 million people will remain uninsured when the plan finally takes effect, they said.
“We have concluded that the Senate bill’s passage would bring more harm than good,” the group said in a statement signed by its president, Dr. Oliver Fein, and two co-founders, Drs. David Himmelstein and Steffie Woolhandler.
Addressing the Senate in an open letter, they write: “We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.”
The full statement appears below.
To the Members of the U.S. Senate:
It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.
We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.
Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!
While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:
- The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.
- The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.
- The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.
- The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.
Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.
We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.
Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program
Is the House Health Care Bill Better than Nothing? November 9, 2009Posted by rogerhollander in Health.
Tags: conyers, health, health care, health care reform, health costs, health insurance, healthcare, healthcare reform, insurance industry, kucinich, marcia angell, Medicaid, medicare, private health insurance, public option, roger hollander, single payer
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Well, the House health reform bill — known to Republicans as the Government Takeover — finally passed after one of Congress’s longer, less enlightening debates. Two stalwarts of the single-payer movement split their votes; John Conyers voted for it; Dennis Kucinich against. Kucinich was right.
Conservative rhetoric notwithstanding, the House bill is not a “government takeover.” I wish it were. Instead, it enshrines and subsidizes the “takeover” by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn’t regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.
What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers — those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65′s will be more likely to go without insurance, even if they have to pay fines. That’s OK with the industry, since these would be among their sickest customers. (Shouldn’t age be considered a pre-existing condition?)
Insurers also won’t have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an “option” at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it’s been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.
If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?
First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers — government and employers — will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.
But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It’s a shell game in which money is moved from one part of our fragmented system to another.
Here is my program for real reform:
Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it’s a better program, because it ensures that everyone has access to a uniform package of benefits.
Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.
Recommendation #3: Medicare should monitor doctors’ practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.
Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.
Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.
Is the House bill better than nothing? I don’t think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.
Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She stepped down as Editor-in-Chief of the New England Journal of Medicine on June 30, 2000.
Tags: bruce dixon, california nurses, co-payments, corporate media, Dennis Kucinich, health, health care, health care reform, health costs, health insurance, health insurance industry, healthcare, healthcare reform, kucinich amendment, lyndon johnson medicare, massachusetts health care, Medicaid, medical costs, medicare, national health, obama health plan, obama plan, private insurance, public option, roger hollander, single payer, uninsured
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The health care debate inside and outside the matrix
by Bruce Dixon
Like just about everything else, your take on the national health care debate depends on whether you’re inside or outside the matrix.
Within the bubble of fake reality blown by corporate media and bipartisan political establishment, the health care news is that theObama Plan is at last making its way through Congress. It’s being fought by greedy private insurance companies, by chambers of commerce, by Republican and some Democratic lawmakers.
Under the Obama plan, we’re told, employers will have to insure their employees or pay into a fund that does it for them. Individuals will be required under penalty of law to buy private insurance policies and for those that can’t afford it or prefer not to use a private insurer there will be something called a “public option.” This “public option, the story goes, is bitterly fought by the bad guys because it will make private insurers accountable by competing with them, forcing them to lower their costs. Both the president’s backers and opponents agree that the whole thing will be fantastically expensive, and the president proposes to fund it with cuts in existing programs like Medicaid which pay for the care of the poorest Americans and a tax on those making more than $300,000, later raised to $1 million a year.
The “public option” has that magic word “public” in it, and that’s reassuring to progressives and to most of the American people. Taxing the rich is a popular idea too. So if you rely on corporate media, the administration, or some of the so-called progressive blogs to identify the players and keep the score, it seems a pretty clear case of President Obama on the side of the angels, battling the greedy insurance companies, Republicans and blue dog Democrats to bring us universal, affordable health care.
That whole picture has about as much reality as the ones the same corporate media and most of the same politicians drew for us about Iraq, 9-11, weapons of mass destruction and some people over there who wanted us to free them. Iraq and the White House were and remain actual places, and there really is a problem called health care. But the places, problems and solutions are very different from the bubble of fake reality blown around them.
What sustains this fake reality is the diligent suppression from public space of any viewpoints, observations or proposals to Obama’s left. As long as the illusion that nobody has a better idea, that the only choice we have is Obama’s way or the Republicans’ way can be maintained, the crooked game can go on.
But bubbles are delicate things. Keeping this one intact requires so many vital topics to be avoided, so many inquiring eyes to be averted, so many fruitful conversations to be squelched that it’s hard to see how the president, the bipartisan establishment and the corporate media can pull it all off.
The real Obama Plan: doesn’t cover the uninsured till 2013, if then.
The first clue that something is deeply wrong with the Obama health care proposal is its timeline. According to a copyrighted July 21 AP story by Ricardo Alfonso-Zaldivar,
“President Lyndon Johnson signed the Medicare law on July 30, 1965, and 11 months later seniors were receiving coverage. But if President Barack Obama gets to sign a health care overhaul this fall, the uninsured won’t be covered until 2013 – after the next presidential election.
“In fact, a timeline of the 1,000-page health care bill crafted by House Democrats shows it would take the better part of a decade – from 2010-2018 – to get all the components of the far-reaching proposal up and running.”
According to a peer reviewed 2009 study in the American Journal of Medicine, 62% of the nation’s 727,167 non-business bankruptcies were triggered by unpayable medical bills in 2007. Most of these had health insurance when they fell ill or were injured, but with loopholes, exclusions, high deductibles and co-payments, or were simply dropped when they got sick. In 2008 that figure was 66% of 934,000 personal bankruptcies and in 2009 it could approach 70% of 1.1 million bankruptcies. And 18,000 Americans die each year because medical care is unaffordable or unavailable. Waiting till 2013 means millions of families will be financially ruined and tens of thousands will die unnecessarily.
If the Johnson administration with no computers back in the sixties could implement Medicare for 45 million seniors in under a year, why does it take three and a half years in the 21st century to cover some, but not all, of America’s fifty million uninsured? And why does the Obama Plan make us wait till after the next presidential election? Politicians usually do popular things and run for election on the resulting wave of approval. Delaying what ought to be the good news of universal and affordable health care for all Americans till two elections down the road is a strong indication that they know the good news really ain’t all that good. And it’s not.
Inside the matrix of TV, the corporate media and on much of the internet, discussion of the Obama plan’s timeline, the human cost of another three years delay, and the comparison with Medicare’s 11 month rollout back in the days before computers are almost impossible to find. We can only wonder why.
The Obama plan is about health insurance, not health care.
As BAR has been reporting since January 2007, the Obama plan is not a health care plan at all, it is a health insurance plan. Based largely upon the failed model in place in Massachusetts since 2006, the Obama plan will require employers to provide coverage or pay a special tax. Everybody not covered by an employer will be required to purchase insurance under penalty of law, in much the same manner as you’re currently required to buy car insurance.
“In my state,” testified Dr. Steffie Woolhandler of the Harvard Medical School last month before Congress, “beating your wife, communicating a terrorist threat and being uninsured all carry $1,000 fines.”
As in Massachusetts, the health insurance plans people are forced to buy will cost a lot and won’t cover much. In a July 20 National Journal article Dr. David Himmelstein says,
“Nearly every day that he is in the clinic, Himmelstein says, he sees a patient who has problems paying for care “despite this reform.’ Some of them had free care before the 2006 law took effect but are now expected to handle co-payments. If you’re not poor enough to get a subsidy, say you’re making $30,000 a year, you’re required to buy a policy that costs about $5,000 a year for the premium and has a $2,000 deductible before it pays for anything. For substantial numbers of people, it’s effectively not coverage,’ Himmelstein said. The policy he described is about the cheapest Massachusetts plan available, according to the Physicians for a National Health Program report, which Himmelstein co-wrote.”
A family of four making under $24,000 a year in Massachusetts gets its insurance premium free, but is still expected to cough up deductibles and co-payments and live with loopholes and exclusions that often deny care to those who need it. And in both the Massachusetts and Obama plans, funds to pay those premiums come out of the budgets of programs like Medicaid that already pay for care for the poorest Ameicans.
The Obama plan’s “public option” is a bait-and-switch scam
A July 21 pnhp.org article titled “Bait and Switch: How the Public Option Was Sold” outlines how the public option is neither public, nor an option.
“Public option” refers to a proposal… that Congress create an enormous “Medicare-like” program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today…
“Hacker (its author) claimed the program, which he called “Medicare Plus” in 2001 and “Health Care for America Plan” in 2007, would enjoy the advantages that make Medicare so efficient – large size, low provider payment rates and low overhead…
“Hacker predicted that his proposed public program would so closely resemble Medicare that it would be able to set its premiums far below those of other insurance companies and enroll at least half the non-elderly population.”
The White House is committed to twisting arms in the both houses of Congress and reconciling the two versions of Democratic bills to emerge from the House and Senate. What emerges will be the Obama plan. According to the Congressional Budget Office, the Senate version of the Democrats’ pending health care legislation leaves 33 million uninsured and omits the public option altogether. The House version includes a “public option” estimated to cover only 10-12 million people, a number far too small for it to create price pressure on private insurance companies, while leaving 16 or 17 million uninsured. Instead of setting prices for health care, it will be forced to pay whatever tthe private insurers already pay, and perhaps more.
As private insurers use their marketing muscle to recruit younger, healthier people who’ll pay for but not use their benefits, the public option will be a dumping ground for the customers they don’t want… the middle-aged, the poor, those with pre-existing conditions. And of course the Obama plan’s “public option’ will be managed by contractors from the private insurance industry.
Private insurers spend a third of every health care dollar on non-health related things like bonuses, denial machinery, advertising, lobbying and bad investments. Medicare spends 2 or 3% on administrative overhead. Bush’s “enhanced Medicare” administered by private insurance contractors, spends about 11% on overhead. That’s about what we should expect from the Obama public option. So much for change.
So far, discipline is holding. Nobody in corporate media, the administration, or among Democrats in Washington has gotten round to telling us that the public option has been eviscerated. But its powerful appeal and the awesome power of the word “public” are offered by Obama supporters as the central reasons to shut up, clap harder, and get behind the president on this.
Taxing the rich, paying for health care. How the Obama Plan stacks up against single payer.
Along with being funded by cuts in Medicaid, the Obama plan is supposed to be funded by taxing those who make $300,000 or more per year. That’s not a bad thing. The wealthy don’t pay nearly enough taxes. But the US already spends more on health care than anyplace else on the planet while leaving a greater portion of its population uninsured than anybody.
The Obama plan will not contain costs. It will subsidize the insurance vampires well into the next decade. On the other hand, single payer would eliminate the private insurance industry altogether. In many advanced industrial countries, most of the practices private insurers follow here, such as cherry picking healthy patients while dumping and denying sick ones, are illegal. Why can we do that?
Single payer, according to a study by the California Nurses Association would eliminate 550,000 jobs in private insurance while creating 3.2 million new ones in actual health care. It would be responsible for $100 billion in wages annually and a source of immense tax revenues for local governments.
So is the Obama plan really better than nothing?
The Obama plan seems calculated to buy time for private insurers, to end the health care discussion for a decade or more without solving the health care problem, do so in a way that discredits the very idea of everybody in- nobody out health care. It will leave tens of millions uninsured, a hundred million or more underinsured, and the same parasitic private interests in charge of the American health care system that run it now.
The Obama plan as it now stands requires us to let another 18,000 die for each of the next three years and allow more than a million additional families to be bankrupted by medical expenses before we can judge whether or not the plan is working. It’s easy to imagine Obama partisans telling us in mid 2013 that it’s still too early to be sure.
The Kucinich amendment, which allows the few states wealthy enough to try it the liberty to fashion their own single payer regimes is intended to attract progressives and single payer votes in Congress without breaking the bubble. By itself, it should not be a reason to support this bill.. The wealthiest state in the union is probably California, and it’s handing out IOUs instead of salaries this month. It’s hard to see what would be lost if this health care bill went down in flames, and we started over again next year.
Can he get away with it?
Maybe. Maybe not. If the corporate media and the president can keep discussion of the devilish details to a minimum, if they can silence, co-opt and intimidate the forces to Obama’s left — if they can keep most of the public inside their bubble of fake reality, Barack Obama may achieve his goal of thwarting the reform that most of the American people want — an everybody in, nobody out single payer health care system on the model of Canada or Australia, or Medicare for All. It won’t be close, it won’t be easy, and with nothing to be gained, progressives shouldn’t make it any easier.
Since the president’s success depends mostly on keeping people silent and in the dark, he will probably be unable to mobilize the 13 million phone numbers and email addresses collected during the recent presidential campaign, and now held by OFA, his campaign arm. If an organizing call went out to them, too many would try to read the bill and discuss the options, and such a discussion could easily get out of hand. When OFA called house meetings on health care last December, the most frequently advanced question was why we couldn’t or shouldn’t get a single payer health care system.
Single payer isn’t dead yet. It’s very much alive among Barack Obama’s own supporters. To succeed, he has to bury it alive, to keep them in the bubble, in the dark and quiet, or clapping so loudly they cannot hear themselves or each other think. It’s not over.
© 2009 Black Agenda Report
Tags: big pharma, canada helath, canadian health care, canadian healthcare, clintons, health, health care, health care costs, health care reform, health costs, health insurance, health insurance industry, healthcare, healthcare costs, healthcare reform, Medicaid, medicare, paul rogat loeb, pharmaceutical industry, private health insurance, rick scott, Robert Reich, roger hollander, singel-payer, single payer, tommy douglas
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Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion’s sting, but the scorpion reassures him that he’d do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. “It’s just who I am,” the scorpion replies.
I fear we’re about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another missing element parallels our current challenge-appeasement of the insurance companies as the plan’s centerpiece, and the inevitability that these same interests will betray us again.
The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies’ approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.
Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.
Even if single payer isn’t politically achievable yet, there’s no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we’ve been so conditioned that we can’t quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn’t enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.
Instead, because we’ve accepted the premise that the private insurance companies have to be included, we’re now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can’t achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns, “buy off legislators and officials as they’ve been doing for years.”
But why assume that the insurance companies are our friends? Why appease them at all? It’s not as if they’ve played a helpful role in our current system. Rather, they’ve gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they’ve made promises to cut costs, their promises are only that (like the scorpion’s), and they’re already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the “Swift Boat” attacks on John Kerry). We need to challenge the insurance companies, not appease them. There’s no evidence that suggests they’re constructive players, or are likely to do anything except defend their own parochial interest.
The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don’t want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.
Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.
Paul Rogat Loeb is the author of The Impossible Will Take a Little While: A Citizen’s Guide to Hope in a Time of Fear, named the #3 political book of 2004 by the History Channel and the American Book Association. His previous books include Soul of a Citizen: Living With Conviction in a Cynical Time. See www.paulloeb.org To receive his articles directly email email@example.com with the subject line: subscribe paulloeb-articles.