Health Reform Deformed: Is the Best Option Being Ignored?:

Call me a pre-existing condition. Until seven years ago when I was diagnosed with Parkinson's disease, I was the kind of physically fit, healthy person insurance companies love to enroll. Overnight I became someone to shun, damaged goods certain to need extra medical care and thus to erode a company's profits. I am currently covered under my wife's employer-provided insurance--these days that means that the employee picks up much to all of the extra cost of dependents, unless they have a better plan ass part of their employment agreement. Should my wife's coverage end for any reason, I am unlikely to find an affordable policy.

Given that reality and my belief that whatever its final shape, health care reform, if enacted, is going to affect us all, I have followed the current debate intently--my wife would say obsessively. I have done so with a growing sense of dismay, as it becomes clearer with each additional page that this reform will, as written to date, dump me and people like me into the backwash of Medicaid or some messy, expensive, buying combine.

Thus, I use “debate” advisedly because it is delusional for our elected officials to say they are seriously discussing health-care reform when the simplest, most practical and most comprehensive solution--a single-payer plan that provides all Americans with cradle to grave coverage--is not on the table. A bill expanding Medicare to cover all Americans has languished in a House committee years and was not even brought out for consideration this year.

Physicians for a National Health Plan, an advocacy group, estimates that a single-payer would save $350 billion a year that now goes to administrative costs of insurance companies and health-care providers. Such a plan would relieve people from worry over whether they can afford treatment. It would free employers from the continually rising cost of providing insurance for their employees, and it would give employees now working for insurance in jobs they dislike the opportunity to try something else. But we do not engage in that discussion.

Instead, what we see and hear of single payer in the media or from our fearful leaders are lame excuses: it will never fly, it is not possible in America, it is socialistic, the transition would prove too disruptive, Americans won't stand for it, with a reminder of the town hall incivilities of August.

The best the House could offer was a watered down public option, along with expansion of Medicaid, evisceration of Medicare, and a resounding declaration that women have no right to control their own bodies. The bill that Senate Majority leader Harry Reid, the worst majority leader in my memory, offers up a "public option" that never had guts in the first place. It would allow states to "opt out," which sounds more than vaguely like granting them the power to secede from the Union or decide not to abide by any civil rights legislation. The completely untested logic behind the public option is that a government run insurance program would compete with private insurers to hold prices down and, one hopes, quality up.

The aim of both House and proposed Senate bills is to create purchasing cooperatives that would provide small businesses and uninsured people an opportunity to purchase coverage at “affordable prices” whatever those are. No one could be denied insurance, and the government would help families buy plans. We are told that this approach would bring fiscal sanity to skyrocketing insurance rates.

That is hard to see in light of the fact that reform as it is shaping up would not meet Obama's fundamental goal of insuring the uninsured. Millions would remain uncovered, including illegal immigrants, who nonetheless would as a matter of law and medical ethics have to be covered should they appear at a hospital.

 A month ago private insurers said that unless everyone who is uninsured is forced to purchase insurance from them or pay hefty fines, they will have to raise premiums considerably. These are the same insurance companies that stand to collect tens of billions of dollars in new policy premiums should reform pass without a public option--or with an opt-out. As I read the Senate bill it would be possible for a big company in an opt-out state to pay a relatively modest fine, compared with what coverage would cost them, and dump all their employees into the combine or buying cooperative, where they would  have to buy private insurance.

The insurance industry has long declared that it would be unable to compete against a federal insurance provider in a truly free market. Because people would flock to the more economical “public option,” Private insurers argue that because consumers, given a choice, would flock to a publc option, it is little more than a stalking horse for the dread single payer. So be it, true believers in capitalism claim the market is never wrong, so they should embrace its decision the opportunity to let it decide.

Instead, the insurance industry wants to design the field, write the rules, and choose the referees. The Obama Administration meanwhile long ago negotiated away to no one in particular all its advantages.

As I have followed the debate, I have also talked to people about health care. A common incomprehension and an unexpected consensus have emerged from my conversations with trades people, mechanics, lawyers, doctors, architects, academics, business owners, shopkeepers, morning lap swimmers at the public pool, local politicians, and other writers of various ethnic, religious and political persuasions.

They find incomprehensible the convoluted, complicated bills currently or soon to be before them. That is largely because they accept that access to medical care is a fundamental right, as President Barack Obama seemed to recognize in his September 9 speech to Congress, and they agree that the government should guarantee that right through a universal, single player insurance plan, achieved, for example, through expansion of Medicare.

My informal survey participants find especially troublesome the way members of Congress and, with caveats, President Obama have managed to transform society's moral obligation to provide health care for all into a legal mandate that everyone buy health insurance or pay a fine. Absent a robust public option that means from one of the private insurers President Obama and his allies in Congress have spent months vilifying as rapacious and irresponsible.

No wonder people are alienated and disgusted. A Jamaican ironworker, who had come to install a wrought iron gate at the top of our stairs a month ago (October 31, 2009, posting), captured the attitude of most people I know when he looked at me and said, “Americans are crazy” because of our inability simply to provide health care for all.

Not long after, my internist, a rock-solid Republican, declared he would not vote for a Republican again because the party had offered not alternatives. Then, he said, "I beginning to thing that maybe there shouldn't be profit in healthcare."

I couldn't disagree. Some services like police and fire protection and health insurance are meant to protect and enhance all our lives, not to produce profits for a few and heartache for many. If that be socialism, then Call me Socialistic.

A Modest Proposal

Were I a Republican strategist I would recommend to my delusional colleagues the following: Before the House and Senate take up their epic health measures, introduce a simple bill calling for the expansion of Medicare to include all Americans by the year 2020--cradle to grave coverage.  This measure would seem to violate core Republican principles, but when it works, they can claim that the profit principle should never have applied to such a fundamental right and in any case, Medicare is simply the insurer.  In any event, the success of this simple reform would make everyone forget the what we'll call the ideological diversion.  In that sense, this bill would be the Congressional Republican equivalent of Nixon, the great Red Baiter, opening relations with China.
  
The Republicans benefit in all regards: If the plan works, they take credit.  It it fails, they blame the Democrats.  If the Democrats don't allow a vote on this measure or vote it down, the Republicans can trash them as unimaginative obstructionists to true reform. 


More important, if the measure were to pass, we would all benefit.  But I am not a Republican strategist.

The Gate

We commissioned a simple gate from a local ironworker from one of the Caribbean islands--IW, I'll call him-- to go at the top of the stairs and prevent the intrepid kelpie Katie, now lame with spondylosis, from charging  down to intercept some threat, real or imagined, like the Fed-Ex man, and taking a misstep into oblivion.  

IW is not anomalous in Miami--used here in the common sense for both the city and the county.  He's a craftsman who does much of his work off the books--for cash whenever possible.  Who can blame them?

We are devolving into a Third World city.  I know the word is in disrepute, but here it fits.  The city is one of the costliest in the world and one of the richest, according to City Mayors.  But increasingly here, you're rich or poor serving the rich or middle to upper middle class doing the same.


I'd like to make the gate a metaphor for all that's fucked up in the world, but I can't.  If you open the door into a house of bedlam, you get bedlam.  If you open a door out of a house of bedlam, you get insanity loose in the world.  The gate works in terms of the opening inward and outward, but it fails because unlike a door, which provides a solid barrier between those worlds, or states, if you will, the gate is permeable, allowing much of the lunacy to cross back and forth.  The solid door keeps everything out; the gate discriminates by design.


The 1990-page healthcare reform act of the House of Representatives is the same way--neither one thing nor the other, impressive for its size; lilliputian in its execution.


There, i've done it, anyway, which at the end of the day is all one can say of healthcare reform.  .  It promises a lot.  It might make some changes. but in the ned, the world's it dividies and uites are no long our own.  

Peace

The Norwegian Nobel Committee says that it awarded the 2009 Nobel Peace Prize to the singularity that is Barack Obama because of his work the past nine months to reach out to the rest of the world and emphasize diplomacy and international cooperation over unilateral declarations of war.  But one can't help but think that the Norwegians, whose mythological heritage is not given to a hopeful end game--i.e., the bad guys win--have opted for "hope" that he will fulfill his promise to make the world a safer place.  It is the promise of Obama that has long been his strong suit.  It is his inability to deliver on that promise--or to deliver decisively programs and policies that make a difference, or at least match in ambition his soaring rhetoric--that increasingly is dragging his presidency toward mediocrity.  We can only hope that this Prize will strengthen and embolden him.

"The" Demotion

When Barack Obama began his improbable campaign to become president of the United States, I began referring to him as "the Obama."  He was sui generis, a singularity, a figure unique in American politics, and when against all odds, the Obama became the first African American, and one of the few intellectuals, to be elected president, he sealed the case.  His oratorical powers were superb.  He seemed to have the temperament for the monumental tasks confronting him.  I was even willing to grant that we weren't going to get much in terms of sound progressive policies, although each time I thought the moderate Democrat in him would win out, he proved me wrong--a moderate Democrat in 2009 is politically on a par with the 1968 vintage Richard Nixon--think about it.   Then came healthcare, and his abject surrender of a "public option" for health insurance, coupled with his embrace of the notion that people must be made to purchase private health insurance, a proposition antithetical to the notion that access to decent healthcare is a fundamental right. What makes this surrender so cowardly are the polls, like the one the New York Times reports on today, showing that close to two-thirds of the American people support a public option. He's got the people behind him; all he has to do is rally them.

Diehard Obamans will claim that he continues to support a "public option," but there is scant proof of that.  He has basically left the House of Representatives out to dry by declaring that although he personally would prefer a "public option," its absence will not trigger an automatic veto.  Obama's equivocation on this one issue, which, denials to the contrary, is essential to any successful health industry reform--and then only if it involves true coverage, say through expansion of Medicare--has confused the public precisely because it is so illogical.  Whether  Obama really wants to beef up the private insurance industry or for all his high rhetoric does not understand healthcare or is willing to settle for anything so he can claim success, I can't say.  I can say his wavering has earned him "the" demotion. He will not easily reclaim it.


There are times in the world's history when leaders emerge to meet a pressing need.  The time is now; the need is present and pressing;t the leader is awol.  We can only hope he returns.

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The Story Line

The most interesting and disturbing thing about the "Baucus healthcare reform" proposals is the way the main stream media has closed ranks on the story line that it is the bill with best chance of advancing.  That the Baucus mark is the only one, apparently, without a public option should give them pause but does not for two reasons: 1. The Obamans have for weeks been signalling that the vaunted 'public option' was a ruse, a stalking horse to keep progressives at the table until they couldn't easily leave; and 2. The Obamans long ago declared that nothing would disrupt their drive for and ability to claim success in reform, even if they must redefine the universe in order to do so.  The Obamans and press toe the line, building each story around the same checklist--cost containment, efficiency, no exclusion for pre-existing conditions, individual mandates, electronic medical records, and so on.  In that way, the public option becomes just one of what Obama calls ideas or ways to get to the end of "universal coverage," a term that must henceforth be used advisedly.  The cost to the federal government is weighed.  Lost is any assessment of what it means to individuals beyond elaborate and frightening costs that government subsidies are to help meet.  Not included is any serious investigation of these insurance coops, which appear to be largely imaginative extensions from a small scale to one never tried before and thus are more experimental, more of a grafting of an alien life form onto the American healthcare system than would be expansion of Medicare to cover everyone. Why, for example, does it make any sense to subsidize people to purchase overpriced private insurance policies when it would be cheaper to have them buy directly into Medicare--employers would pay, as well?  Oh, but that would be "new" taxes!

As result, the Baucus bill is deemed to have the best chance of passage because it has dropped all of that nonsense about government programs and embraced the insurance industry.  It is too big and too powerful to fight, we're told, which should be all the more reason to smash it, except the world we inhabit is one is in which giant corporations are deemed too big to fail and bailed out at huge cost to the public treasure, while individuals are allowed to suffer.