Sunday, August 16, 2009

An unhealthy diet

Updated The idea of health care for all is dead. Even the more modest goal of something that might reasonably be called health care reform is toast - fresh, warm toast slathered with butter and strawberry jam and laid on the table of the health insurance industry, already groaning under the weight of goodies and greed.

Okay, not quite. The funeral of health care for all, complete with eulogies about how its death actually proves it's in robust health along with how up is down, black is white, and failure is success, hasn't actually been performed and the toast hasn't actually come out of the toaster. But close enough:
A North Dakota Democratic senator who is at the center of the effort to find a health care compromise in the Senate told Fox News’ Chris Wallace that there are not enough votes to pass a public option for health insurance, and the long struggle by Democratic congressional leaders and President Barack Obama “is just a wasted effort.”

“The fact of the matter is there are not the votes in the United States Senate for the public option, there never have been, so to continue to chase that rabbit is just a wasted effort,” Senator Kent Conrad (D-ND) said on Fox News Sunday.
That could be regarded as just huffing and puffing to boost his own ideas and enhance his own importance in the debate, except for the fact that the White House is practicing playing "Taps."
The public health care options is not “essential,” and consumer choice, market competition and reform of private health insurance regulations should be the focus of the health care debate, Heath and Human Services Secretary Kathleen Sebelius told CNN’s John King Sunday.
The same day, Robert Gibbs said on Face the Nation that "the bottom line for this for the president is, what we have to have is choice and competition in the insurance market." As The Hill put it, Gibbs "stopped far short of earlier calls insisting on a public plan."

And on Saturday, Obama himself called a public option "just one sliver" of the issue.

In other words, the so-called "public option," the minimum requirement for making the proposals moving through Congress worth passing, the only thing generally discussed that could possibly provide an effective option for the uninsured (and even at that would leave several million still uninsured) and be a counterweight to the economic power of the insurance industry, is on its last legs and the way we know that is that the White House is trying to find a graceful way out of supporting it, a way to let it die without being labeled as having lost a political battle.

(Sidebar: Marc Ambinder reports in The Atlantic that White House officials are objecting to the understanding that the administration is backing away from the public option: He described one unnamed offical as saying the WH "did not intend to change its messaging" and cited Linda Douglass, director of health reform communications for the administration, as saying that Obama still wants a public option in the final bill. However, Douglass also said the administration believes it is not the most important element of the plan and the fact remains Obama called it "one sliver" of reform. While this doesn't directly contradict the careful White House language of the past few weeks, it remains true that that very language was a shift from pronouncements early on and having it said three times in two days by people speaking for the administration nailed it down. The message becomes "we'd like to have a public option, but we're not going to fight for it - if it's there, it's there; if it's not, it's not." Nothing there changes my judgment about the Obama crowd's intentions.)

So it's not a public option that's important, it's "competition and choice."

"Competition," indeed. Just what the hell sort of "competition" are you imagining? Where is the competition if no one outside the health insurance industry is offering an insurance plan? What, we're going to make them compete with each other like some national version of some deal? With all the desperate searching for cost-cutting by employers, if getting insurers to lower (or even contain) costs in competing with each other for business was going to work, don't you think it would already be happening instead of seeing premiums continue to rise at twice the rate of inflation?

"Choice," indeed. What sort of "choice" are you envisioning? Being more able to choose just which inadequate, budget-busting plan is going to get to tell you "that's not covered?"

Oh, now wait a minute, because there, we know the answer: The Next Big Thing, it appears, is to be "co-ops" - of what form and how organized depending on the particular speaker assuming they even give such details, which they generally don't. Lacking such non-existent details, such "co-ops" do not even rise to the level of a proposal, much less a program. Instead, they're a slogan. A bumper sticker. A feel-good tonic that implies much but actually promises little or nothing.

As a result, it's pretend-reformer Conrad's preferred option. Right-wing flake Sen. Richard Shelby says it's "something we should look at." The White House is on board, too, as Sebelius clearly indicated on Sunday.

There's only one little problem: They don't work.

In 2002, The Commonwealth Fund did a study of the actual experiences of such health insurance "purchasing cooperatives" around the country and found that while there were some successes, "success" apparently being defined as continued operations rather than fulfilling promises of lower costs, there were also "notable failures." Ultimately, the study concluded that
[t]he principal advantage that current co-ops offer to small employers is not lower premiums but the opportunity for individual employees to select different health plans from the variety the co-op offers.
In other words, as noted,
[c]o-ops offer choice, but not lower costs. This fact was recently illustrated by the nation's largest health insurance co-op, Puget Sound Health, announcing a 13% rate increase for 2010, a larger increase than several of the major private insurers in the state.
(Interestingly, Puget Sound Health was the example Kent Conrad pointed to as a successful insurance co-op.)

What's more, the Fund found, co-ops could hypothetically offer better prices, but that depends on reaching “critical mass,” a size big enough to have the market clout necessary - and that "is difficult." It's a Catch-22: Getting a sufficient number of decent health plans to participate requires having a big enough market share to draw them - but getting that market share requires having enough of a variety of decent plans to offer. And as noted,
[h]ow likely do you think it is good private insurers will offer good plans to any federal co-op scheme they already want to kill?
The Commonwealth Fund study also found, very significantly (and with my emphasis added),
[e]ven if co-ops could offer lower premiums, they could not substantially reduce the number of uninsured because the premium reductions would not be big enough to induce large numbers of uninsured employers and uninsured workers to opt for coverage.
[c]o-ops are likely to become an important source of health coverage only if some significant change makes them the favored or perhaps the sole source of coverage for particular groups. This could happen, for example, ... if government offered co-ops as the source of coverage for individuals who receive certain kinds of subsidies.
Or, to put it more simply, if the government just outright bought coverage for the uninsured at market rates from the private insurance companies.

In light of all that, I guess it's not surprising that some sort of "nonprofit insurance cooperatives" is the preferred option of - wait for it - the insurance companies! Right along with the far right as embodied in the Heritage Foundation, attempting to give a patina of rationality to their corporate boot-licking.

And so again, again, again,

- even as more than half of bankruptcy filings are related to health care expenses, and 68% of those are filed by people who have health insurance - meaning that over a third of all personal bankruptcies result from health care expenses among people who already have insurance;

- even as the cost of health insurance premiums more than doubled between 1999 and 2008 while workers’ earnings stagnated;

- even as the average annual cost for family insurance coverage hit $12,700 in 2008, and is still rising;

- even as every year an estimated one million Americans go to Mexico for medical and health care because they can't afford it at home;

- even as a group that was founded to bring free health care to remote areas of the world now finds it appropriate to do the same across the USA;

- even as former CIGNA executive turned whistleblower Wendell Potter reports that insurance companies intentionally "confuse their customers and dump the sick, all so they can satisfy Wall Street investors";

still again those very same industry bloodsuckers and greedheads get to determine what constitutes "reform" via the use of lies, deceit, misdirection, front groups, and distribution of talking points to the talk radio nutzoids - and do it largely without pushback because the dopes, dimwits, and assorted mouth-breathers that make up the leadership of the Democratic Party and way, way too many of those who define what passes for progressives in this country were so goddam concerned about being "pragmatic" and "practical" that they opted to push for what they thought could pass instead of for what they wanted - and so wound up with far less than the former precisely because they took the latter off the table without even trying.

And didn't I say it? Didn't I?

Damn it all to hell. Just damn it all to hell.

Footnote: The picture at the top is via Eli at Left I on the News, who is good enough to be checked occasionally even though I think he too often lets his ideology act like blinders, narrowing his vision, instead having it act, as it should, like sunglasses, cutting through the glare.

Updated with the Marc Ambinder report.

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