X is better than W[hat]

Without repeating myself, I'll call attention to the comment on my last blog from Retrieverman on the Massachusetts special senatorial election.  He's right--people are pissed at the banks; they're pissed that there are no jobs or that their job is gone next week or that people are walking away from mortgages and houses with impunity or that "too-good-to-be-true" offers from big banks to lower the interest rate on their mortgage are more of a hassle than they are worth; and they're pissed because their guts tell them that Obamacare is a fiasco wrapped in a monumental giveaway to insurance companies.  They are right.  They know that no matter how you justify it, insurance that costs them more than $5,000 a year for a family of 4 and then covers only 60 percent of costs, which the Senate bill deems affordable, is not advantageous to them.   It's amazing really, Rahm Emanuel has been so busy working to get anything passed in order to ensure the Obamacare is not Bubbacare that he has made something far worse. Now all the Obamans can do is whine that the cost of inaction on healthcare will be their ruination.  Then so be it.  

The Obamans decided at the start what they could not do--expand Medicare to cover everyone.  Indeed, they never wanted or intended to do that.  Nonetheless, many people bought the spiel called "hope," and sent the Obama to Washington.  What the Obamans didn't take into a account but the Republicans sensed intuitively--and doubtless through polling--is that it is far better to keep people hopeless and despairing, than to first raise and then dash their hopes and expectations.

Health Care X Massachusetts

The political classes most heard have declared that yesterday's election of Scott Brown to fill out the departed Edward M. Kennedy's seat in the Senate is, among other things, a repudiation of the health care bill now slouching toward denouement that would not pertain to Massachusetts in any event.   That means as nearly as I can tell that the good citizens of a state founded by religious intolerants fleeing religious persecution have voted into office a man who voted for a health care bill in Massachusetts authored by Republicans that served as a template for the Congressional bills that same senator-elect has sworn he will vote against once he assumes his seat, even though it will not affect his own state. Right.  No one will ever accuse these Republicans of consistency or intellectual integrity.

Brown's election is significant only because it cuts the Democratic majority to 59 votes, meaning they can no longer vote in a block to kill Republican filibusters. Given the sorts of vile deals the Democrats stuck to gain and hold those 60 votes, I'm not sure that losing that majority was such a bad deal.  Any time you pass a bill that satisfies no one, that doesn't meet its primary objective and that is inherently punitive, simply because you've convinced yourself that anything is better than what is, you have major problems, including ignorance.

Yet that's exactly what the Democrats were.  Now they might have to revert to a better strategy, which is to develop a simple, clean efficient bill that expands Medicare over time to include everyone and includes necessary tort and compensation reform and sufficient funding, much of it gained by taxation of the wealthy, especially the bonus babies of finance.  The Republicans, including Brown, who have declared themselves friends and defenders of Medicare, would then have to put up or shut up.    In either case, the Democrats would have something to run on that was  easy to understand.  The key for the Democrats and this means the Communicator in Chief would be to cast the expansion in a positive light--not hard.  It would shore up Medicare; it would provide health care for all without rationing or limits; it would remove a major source of stress, financial distress and early death from Americans; it would guarantee a fundamental human right.

Taking this step would take political courage of a sort not manifest in the Obama Administration, which seems intent on riding its slouching beast of a bill into the dustbin of history.

Say It Ain't So!

New York Times columnist and economics Nobel laureate  Paul Krugman, who once was insistent on the need for a "public option" in any health reform bill, on Friday, December 18, 2009,  urged passage of a health bill everyone knows is a giveaway to the insurance and pharmaceutical industries, on the grounds that it will be easier to fix this 2,000-page hoax than start from scratch.  Krugman cited Social Security as a program that started with gaps and flaws and has been steadily improved since then.  But his comparison is wrong.  Social Security's counterpart in health is Medicare.  The expansion of Medicare to cover everyone would be the equivalent of closing gaps and loopholes in Social Security.  The Senate health 'deformation' more closely resembles a Social Security privatization scheme that would require people to put a certain percentage of their income in 401 Ks or some other mutual fund or private investment vehicle controlled by one of a small number of companies devoted to managing "pension" accounts.  Once it's in place, it will be nearly impossible to change.  This bill is garbage produced because Congress can't, as a lifeguard at a local pool says, manage to provide healthcare for all Americans.  That's really sad, he says.  Indeed.  I hope Obama is being cynical when he calls this bill, which meets none of his goals, a great achievemen.  It insures 30 million out of 47 million and climbing uninsured.  It does nothing to curb insurance policy increases; rather it rewards insurance and drug companies with massive infusions of government funds in the forms of subsidies.  It turns a fundamental human right--access to healthcare--into a legal mandate that everyone purchase insurance from a rapacious company. It cuts Medicare benefits.  Iit curbs the right of women to control their own bodies.

At this point, were I a Republican, I would simply step back and let the Democrats have the Senate deformation, since it will guarantee Republican victories and resounding Democratic defeats for at least another generation , no matter whom they run.

Were I a Democrat, I would scrap the House and Senate bills and introduce an expansion of Medicare.

Senator Bernie Sanders, Vermont's erstwhile democratic socialist, told the New York Times's Sheryl Gay Stolberg, when describing his own struggle over the Senate health 'deformation,' that he was certain the "insurance companies and the drug companies will be laughing all the way to the bank the day after this is passed."  It is hard to see how that can be called reform.

[revised to get out most of the gremlins, 12/30/2009.]

Health Care Obamanation

-With the Senate's virtual abandonment of any "public option," even one of the most anemic sort, and its deep-sixing of the plan to allow people 55 to 64 to buy into Medicare if no private plans are available, healthcare reform has turned into a hoax disguised as fiasco with Joseph Lieberman, the putative independent from Connecticut  presiding and gobbling up all the attention he can get for being the paid lackey of the insurance industry.  He's ego tripping; he should be ejected from the Democratic caucus and ignored.  But the sad truth is that the Democrats, for the past 60 years a party of political cowardice, has now become a party of political cowards, although just what they fear, short of exposure of their own perfidy is hard to imagine. Note that I have called them "political" cowards, not personal cowards, since I'm sure many of them are quite brave physically.  But here they are preparing to pass a healthcare reform bill that no one in the public, except a few experts, perhaps, understands or supports because it does not include the one item a majority has consistently endorsed--some kind of  "robust" public option or the option to buy early into Medicare.

 To pander to and please Lieberman is to pass a bill only insurance companies and their paid representatives can love, but that exactly where these bills taking us.  The Democrats are so eager to claim a victory that they will pass a bill that will make things far worse for patients and institutions that serve the poor.

Afghanistan

My plan for Afghanistan is direct and to the point.

Call in Taliban leaders and tell them they can have their rocks under two conditions:
1. Produce Osama bin Laden's head on a pike.
2. We will airlift from Afghanistan all women and children and non-corrupt males who choose not to live under Taliban brutality.

After that, they are welcome to each other.

RIP Public Option

The public option in the bill the House of Representatives passed is a joke that might cover a fraction of the people in need; the one in the bill before the Senate is worse.  So why cling to them as if they will, as Obama keeps saying, level the playing field on insurance costs?  It's far better I'm thinking now--if the Congress can't even muster the courage for a vote on expanding Medicare--to dump the public option.  In its place, Congress should, as it is doing, mandate minimum coverage--access to the doctors of your choice, no penalty for pre-existing conditions or age or any other thing under the sun, no limitations on what is covered, implementation within one year--and it should forbid insurance companies from profiting from those policies.  The rule should be, if you want to write any other kind of high-end coverage, you must also offer the basic coverage. That high end coverage can only cover frills, like private hospital rooms; it cannot offer different levels of actual medical care.  Doctors cannot choose  to take only the high end policies.  If they take any insurance, they must take all insurance.  Simpler than what's on the table now.

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.