Monday, August 31, 2009

Why we will never have universal health care, Part Two

John Avalon is not the only one slobbering out the "if only the DFHs on the left would be reasonable this would all be done in a flash!" shtick.

For example, George Stephanopoulos is out there with the bizarre claim - made on The O'Reilly Factor, let it be noted - that Ted Kennedy would have ditched the public option, a truly inane claim that is becoming conventional wisdom among the punditocracy despite it (or, equally likely because of it) being grounded in neither fact nor statement nor past practice of the man who called universal coverage "the cause of my life." You could disagree on Kennedy's goals (and many other things about him) but it takes an exceptionally high cranial density to doubt his sincerity and determination.

A more extended claim is made by Washington Post business columnist Steven Pearlstein, who also invokes Kennedy's memory in the course of insisting "there is a deal to be had here if only Democrats would be willing to take it."
And while there will be plenty of liberal Democrats who will be fuming about all the compromises forced upon them, somewhere from above will come a familiar voice with that distinctly Boston accent, whispering, "The dream will never die. Take the deal."
But in his own bizarre twist on this, Pearlstein hastens to add that this supposed "deal" will not gain support from the GOPper leadership in Congress, who are "determined to derail any health reform plan." Instead, it aims to win "broad support" from the public. That is, it's not a "deal" at all, it's a hodgepodge of notions that have caught Pearlstein's fancy and now he wants to use the pages of the Washington Post to show how clever he is.

Leave aside the inconvenient fact that the idea of a government-run health care program has consistently enjoyed such "broad support" and in fact still does enjoy such support: According to a SurveyUSA poll released August 20, a whopping 77% of those surveyed said it was "extremely important" or "quite important" that any final bill provide the "choice of both a public plan administered by the federal government and a private plan" - that is, include some version of the "strong public option." Leave that aside and take a closer look at what's in this non-existent "deal," the one deserving of such massive public endorsement. It includes individual mandates, state-level co-ops, "lower-cost, high-deductible plans," low-income subsidies, employer mandates (at 50% of the cost of insurance and exempting small businesses), a 25% tax on "extravagant" health insurance benefits, "malpractice reform," and "cost containment" for Medicare and Medicaid.

This is the "deal" that, Pearlstein assures us, would win the support not only of "wavering moderate Democrats" but also of "a sizeable number of Republicans" whose desire to be "on the right side of history" would surely outstrip their desire to be on the right side of the party leadership. He's quite touching (more likely, touched) in his faith in others' devotion to "history," but he insisted himself the idea was to win broad public support. Judge it by that standard.

Public support? This deserves public support? Is that a joke?

Rather, it's a package any insurance executive, any Big Pharma executive, could love. First, it requires every individual to have insurance - and, lacking any form of public option, that means from a private insurance company: Whether they get it directly, through the toothless co-ops which Pearlstein hides behind the word "exchanges," or through work, it's still from a private, profit-driven corporation. They have to have such insurance whether or not they can afford it and the plan commits the government to paying the cost for those who can't. Translation: A multi-billion dollar annual taxpayer handout from the federal government to the health insurance industry, partly paid for by increased taxes on workers (usually unionized ones) who managed to secure good plans. On the other hand, there is no mention of increased taxes on the rich as a means of payment and the only mention of a cost to corporations is a levy on those larger companies who find paying that levy is more profitable than paying 50% of the cost of insurance for their employees - a percentage lower than most of those employers who do offer coverage pay now.

Co-ops? I've already cited the demonstrated failures of co-ops to offer lower costs or to expand coverage; I'll just add here that state-level co-ops would be even weaker, even less able to have the economic clout needed to have an impact, than a federal-level one would.

As for those "lower-cost, high-deductible plans," we checked some of them out when we were without insurance a couple of years ago. We quickly realized that they were utterly useless to us - because while we could afford the lower premiums, we'd never get any benefit from the insurance because we couldn't afford the deductibles. They might be of use to some small number of people looking solely for catastrophic coverage - but they do not provide access to regular health care.

Next, "malpractice reform," is another right-wing dream project. The costs related to medical malpractice are a very small part of overall health care costs. In 2004, the Congressional Budget Office calculated it at less than 2% of total spending, adding that evidence for claims of additional costs related to "defensive medicine" (such as "conducting excessive procedures") is "weak or inconclusive." And in July, a study by Americans for Insurance Reform calculated the combined cost of medical malpractice premiums and claims at less than 0.7% of health care costs. "Malpractice reform" will not control or reduce costs. What it will do is protect corporations against individuals and the powerful against the weak - which is why the right-wing loves it.

(Avalon also brought up this idea: "If Obama embraced a proposal like medical-malpractice reform, performing a bit of political judo, they [i.e., the right wing] wouldn’t know what to do." Which only shows the vacuity of his thinking: Of course they would know what to do. They would celebrate their victory and look at whatever was the next item on their list. Fool.)

Which leaves "cost containment" for Medicare and Medicaid. Such containment, let it be noted well, is not to be applied to the actual cost of health care or to private insurance premiums. Oh, no, we can't do that, that would interfere with the Choice that the Free Market (pbui) provides. Only government programs are to get such attention. Government programs whose costs are driven mostly the cost of health care - so as the latter continues to rise, so do the former. What is being proposed, then, in the absence of any meaningful program of cost containment in health care, is a biennial declaration of the need to cut benefits to participants of government-run health care programs in order to "control costs" amid, you can be sure, much tut-tutting about the "failures of government programs."

So this is the "deal" that the public is supposed to embrace and that Ted Kennedy would endorse: Untold billions of dollars funneled to the insurance industry for lowest-common-denominator coverage that often enough will not provide access to regular care, paid for in part out of the pockets of unionized workers, and a program which will generate constant downward pressure on government-run programs while protecting the well-placed and the powerful and allowing costs and premiums and most importantly profits - with their associated stresses and bankruptcies among consumers - to continue to rise unabated. (To later be addressed, no doubt, by further tightening the rules for individuals trying to declare bankruptcy.)

Pearlstein had it wrong. Kennedy won't be whispering, "The dream will never die. Take the deal." He'll be whispering "The dream will never die. Go to hell."

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