Sunday, August 23, 2009

Public Option--fear vs. hope

Reading through wrap-ups of the Sunday gab shows, featuring the usual array of pontificating politicians and prognosticators, I am struck by the admission finally that they fear the "public option" because it will provide more for less than private insurers and as a result will become insurer of first resort.  That is an elaborate way of saying that the "public option" is the backdoor to a single-payer national health plan.  "Progressives," as Paul Krugman calls them, backed the Obama's convoluted plan only because it contained a "public option" they hoped would become a single-payer national plan.  Thus, Republican fears are Progressives' hopes, and therein lies a real problem.  If the Obama, who ran on hope, drops the "public option" to please reactionary Republicans, he chooses fear over hope and in a real sense betrays all he has stood for.  He betrays all those who took him at his word and chose to hope.

With the debate stripped down to essentials, the House and Senate should scuttle their unnecessarily long, complex, and needlessly obfuscatory and costly legislation and write a simple expansion of Medicare into the nation's insurer.  The Obamans will be able to articulate a clear principle--the right to health care--and offer a concrete solution that is comprehensive and comprehensible.  They will also be in a position to challenge each Republican and insurance company lie as soon as it oozes into the light.

Right!  Some days I still imagine that I live in a rational society whose leaders care enough and are intelligent and informed enough to write and pass decent legislation.  Then I wake up.  

Tuesday, August 18, 2009

An Interesting Footnote

While the Obama decides what he stands for in the healthcare debate he started, here is a curious little footnote, pulled from statistics compiled by the Tax Foundation for the 2003-2004 fiscal year. For every dollar of federal tax money received from the good people of North Dakota, the federal government spent $1.73, making it the 5th ranking national welfare state. Montana received $1.58, for 9th place. New Mexico was first at $2.00. Senators Kent Conrad from North Dakota, Max Baucus from Montana and Jeff Bingaman from New Mexico are the three Democrats in the Senate Finance Committee group negotiating healthcare reform while refusing to consider a public option. The three Republicans--Charles Grassley of Iowa, Olympia Snowe of Maine, and Mike Enzi or Wyoming--also represent states that receive more than they give. A large chunk of the money for Montana and North Dakota is in the form of agricultural and insurance subsidies. You've got to love the inconsistency--or should we say 'hypocrisy'--of the 'gang of six.'

Sunday, August 16, 2009

Health Reform: What'sTo Like

The headlines today say it all: The New York Times--Obamans ready to ditch public option in favor of insurance cooperatives, a system the Office of Technology Assessment found in the mid-1990s would save not money, and health debate fails to ignite Obama base. Ignite? The Obama has correctly identified the insurance companies as a large part of the problem, proclaimed that they are 'holding America hostage.' But rather than take the next logical step and demand a system that does not permit that, rather than go on to articulate the basic right of everyone to health care and work to see that become real, he tells people that his reform will require them to purchase health insurance from those same companies. The only sop he threw to his base was a 'public option," which diehard Obamans hoped or persuaded themselves would, as insurance companies feared, win any cost competition. Now that is probably gone.

Commenting on my last entry, Retrieverman said he believes that Obama in his "heart of hearts" supports and wants a single payer national health insurance plan but doesn't think he can get there from here. Retrieverman also points out that the anti-reform campaign has been noteworthy for its vileness. That all true. But if the Obama had listened to what people told him he couldn't do, he wouldn't be where he is today. That he seems to have forgotten how to challenge and beat the odds is sad enough; that he has done so with the stakes so high is tragic.

Saturday, August 08, 2009

Government Blues Again

That a sizable number of Americans appear to believe that government is so vile that it can't even run its own programs--Medicare and Social Security in particular--can justly be called a legacy of Reaganism, which for nearly 30 years has drummed into people the notion that government is the problem even when you are the government, but more precisely it is a legacy of rabid, kneejerk anti-Communism, which while predating the Cold War reached its full flowering under MAD's mushroom cloud.

Questions of geneology aside, this rabid outpouring of right wingnut fear and loathing over a "reform" that, like the banking reform that led to the just blown financial/real-estate bubble, favors corporate medicine, including the insurance companies, bespeaks something profoundly sad about America's educational system--that it is a monumental failure, as seriously in need of reform as healthcare but less likely to undergo it. How else is one to explain citizen comments like this one: "Keep the government out of my Medicare."

The Obama and the Democrats are as caught up in the fog as the right wingnuts, which is why reform is bogged down. Rather than articulate from the start that everyone is entitled to health from conception to grave and then figuring how to best pay for the thing--and the studies that address these questions exist. The late, lamented Office of Technology Assessment studied the issue repeatedly in the 199os, including Understanding Estimates of National Health Expenditures Under Health Reform from May 1994 (Princeton has all OTA reports on line.) In that report they concluded that despite difficulty in coming up with hard figures, economists estimated savings of various significant size were the country to move to a single-payer national health plan while purchasing pools for buying private insurance could be expected to save precious little to zero. That's right, purchasing pools of the sort that seem the darling of the conservatives.

So here is the legacy of anti-communism as filtered through Reaganism for the Obama and his fellow Democrats: Unable to discuss the right of all Americans to health, much less of developing a single-payer plan that would recognize that and solve the current crisis, they are forced to forced to defend legislation that would force Americans to purchsae insurance from companies they have repeatedly condemned as rapciaous money suckers. Unable to defend their healthcare non-reform, the Obamans and Democrats are let to argue that the right wingnuts are simply trying to destroy his presidency and so to save his Presidency, we must support whatever healthcare package he accepts. Whether the Democrats win or lose, we will all lose in this great health non-reform.

Tuesday, August 04, 2009

Open Letter to Barack Obama

I have a bunch of junk waiting to be turned into serviceable prose few will read, but rather than pursue that or try to write the President directly--he only is given to read a certain number of messages from the people a day after all--I decided to write this open letter to:

President Barack Obama--

I'll keep it short and sweet. The health care bills working their ways through Congress are overly complicated--meaning no one can understand them--expensive, give something to everyone and everything to no one exercises in special interest lobbying that are dragging your poll numbers in general and on what should be your signature initiative into the gutter. You know it, and you know the way out does not lie in negotiating even more convoluted plans doomed to failure or a compromise that will see your public option trashed. You have repeatedly stated the case for universal coverage. Now is the time to act, to tell Congress that it has labored mightily but produced bills that serve no one, that, in fact, are major leaps backward.

What I suggest is that you call on the economists who have repeatedly studied the issues and crunched the numbers, the doctors, and the people who care to stand firm with you. Then you say in your own eloquent way the following:

We need to reconceptualize the entire 'healthcare debate.' We need to go back to basics and put forward clearly that every American has the right to health, to cradle to grave medical care. That right is inviolate, yet as a nation we have failed to honor it. [Clearly, to recognize the right to healthcare is to reject the notion that individuals must be forced to buy insurance if their employers don't buy it for them.]

We intend to join the ranks of civilized nations and design a system that provides that healthcare. This system will be administered by the Federal government as an expansion of a reformed Medicare--i.e. one that serves people's needs, not the special interests of pharmaceutical companies. Rather this Medicare would operate like its legislative sponsors imagined--guanteeing that all Americans will be able to choose their own doctor, subject, of course, to their doctor's ability to see them., and that people will receive the treatment they need, as determined by their doctors, not by insurance managers who know next to nothing about medicine. In other words, if you need a doctor, you go see a doctor.

How do we pay for this. Well individuals and businesses should expect to pay an increased Medicare assessment. You will have numbers, but it is important to emphasize that the demise of private insurers will turn 30 percent to 60 percent of money currently paid to private insurers back to medical care or back to the people who paid it. That is not chump change, and it should make the bill more than manageable.

The point is that hopelessly complex bills that if enacted are bound to lead to all kinds of trickery by health insurers gaming the system and not provide either 'reform' or anything close to universal care. You must stick to the fundamental principle that healthcare is a right subsumed under 'life, liberty, and the pursuit of happiness" if nothing else, and that the government can best provide--that is unless you want to create an independent national insurer. Then send your forces out and prepare for the barrages of lies that will rain upon you.

I can imagine what your advisers will say to this plan, and all I can say is that you've listened to them and the polls too much on this one. If you had done the same when deciding to run, you wouldn't be where you are.

Best Wishes,