As
transcribed:
The system doesn’t work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation.
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.
Over the course of this summer, those two failed systems have collided in a spectacular crossroads moment in American history. We have an urgent national emergency on the one hand, and on the other, a comfortable majority of ostensibly simpatico Democrats, who were elected by an angry population, in large part, specifically to reform health care. When they all sat down in Washington to tackle the problem, it amounted to a referendum on whether or not we actually have a functioning government.
It’s a situation that one would have thought to be sobering enough to snap Congress into real action for once. Instead they did the exact opposite, doubling down on the same-old, same-old and laboring day and night in the halls of the Capitol to deliver us a tour de force of old thinking and legislative trickery, as if that’s what we really wanted. Almost every one of the main players –from House Speaker Nancy Pelosi to Blue Dog turncoat Max Baucus—found some unforeseeable, unique-to-them way to fuck this thing up. Even Ted Kennedy, for whom successful health care reform was to be the great vindicating achievement of his career, and Barack Obama, whose entire presidency will likely be judged by this bill, managed to come up small when the lights came on.
The game in health care reform has mostly come down to whether or not the final bill that is hammered out from the work of these five committees will contain a public option--- i.e. , an option for citizens to buy in to a government-run health care plan. Because the plan wouldn’t have any profit motive—and wouldn’t have to waste money on executive bonuses and corporate marketing—it would automatically cost less than private insurance. Once such a public plan is on the market, it would also drive down prices offered by for-profit insurers--- a move essential to offset the added cost of covering millions of uninsured Americans. Without a public option, any effort at health care reform will be as meaningful as a manicure for a gunshot victim. “The public option is the main thing on the table,” says Michael Behan, an aide to Sen. Bernie Sanders of Vermont. “It’s really coming down to that.”
The House versions all contain a public option, as does the HELP committee’s version in the Senate. So whether or not there will be a public option in the end will likely come down to Baucus, one of the biggest whores for insurance-company money in the history of the United States. The early indications are that there is no public option in the Baucus version; the chairman hinted he favors the creation of nonprofit insurance cooperatives, a lame-ass alternative that even a total hack like Sen. Chuck Schumer has called “a fig leaf.” Even worse, Baucus has set things up so that the final Senate bill will be drawn up by six senators from his committee: a gang of three Republicans (Chuck Grassley of Iowa, Olympia Snowe of Maine, Mike Enzi of Wyoming) and three Democrats (Baucus, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico) known by the weirdly Maoist sobriquet “Group of Six.” The setup senselessly submarines the committee’s Democratic majority, effectively preventing members who advocate a public option, like Jay Rockefeller of West Virginia and Robert Menendez of New Jersey, from seriously influencing the bill. Getting movement on a public option—or any other meaningful reform—will now require the support of one of the three Republicans in the group: Grassley, (who has received $ 2, 034,000 from the health sector), Snowe ($ 756,000) or Enzi ($ 627,000).
This is what the prospects for real health care reform come down to – whether one of three Republicans from tiny states with no major urban populations decides, out of the goodness of his or her cash-fattened heart, to forsake forever any contributions from the health-insurance industry (and, probably, aid for their re-election efforts from the Republican National Committee.)
But just to hedge its bets even further and ensure that no real reforms pass, Congress has made sure to cover itself, sabotaging the bill long before it even got to Baucus’ committee. To do this, they used a five-step system of subtle feints and legislative tricks to gut the measure until there was nothing left.
And the five steps are:
STEP ONE: AIM LOW
STEP TWO: GUT THE PUBLIC OPTION
STEP THREE: PACK IT WITH LOOPHOLES
STEP FOUR: PROVIDE NO LEADERSHIP
STEP FIVE: BLOW THE MATH
Heading into the health care debate, there was only ever one genuinely dangerous idea out there, and that was a single payer system. Used by every single developed country outside the United States (with the partial exceptions of Holland and Switzerland, which offer limited and highly regulated private- insurance options), single payer allows doctors and hospitals to bill and be reimbursed by a single government entity. In America, the system would eliminate private insurance, while allowing doctors to continue operating privately.
In the real world, nothing except a single payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up process: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $ 350 billion a year could be saved on paperwork alone if the U. S. went to a single-payer system--- more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.
Everyone knows this, including the president. Last spring, when he met with Rep. Lynn Woolsey, the co-chair of the Congressional Progressive Caucus, Obama openly said so. “He said if he were starting from scratch, he would have a single-payer system,” says Woolsey. “But he thought it wasn’t possible, because it would disrupt the health care industry.”
Huh? This isn’t a small point: The president and the Democrats decided not to press for the only plan that makes sense for everyone, in order to preserve an industry that is not only cruel and stupid and dysfunctional, but through its rank inefficiency has necessitated the very reforms now being debated. Even though the Democrats enjoy a political monopoly and could have started from a very strong bargaining position, they chose instead to concede at least half the battle before it even began.
Many of the health care advisers in Obama’s inner circle, meanwhile, are industry hacks—people like Nancy-Ann DeParle, the president’s health care czar, who has served on the boards of for-profit companies like Medco Health Solutions and Triad hospitals. DeParle is so unthreatening to the status quo that Karen Ignagni, the insurance industry’s leading lobbyist-gorgon, praised her ”extensive experience” and “long track record.”
Behind closed doors, Obama also moved to cut a deal with the drug industry. “It’s a dirty deal,” says Russell Mokhiber, one of the protesters whom Baucus had arrested. “The administration told them ‘Single-payer is off the table. In exchange, we want you on board.’” In August the Pharmaceutical Research and Manufacturers of America announced that the industry would contribute an estimated $ 150 million to campaign for Obamacare.
The situation was made worse as the flagging economy ate away at Obama’s political capital. Polls showed the percentage of “highly engaged” Democrats plummeting, while the percentage of “highly enraged” Republicans--- inspired by idiotic scare stories from Rush Limbaugh and Sarah Palin about socialized medicine and euthanasia—rose rapidly.
For a while, the public option looked like it had a real chance at passing. In the House, both the ways and means committee and the labor committee passed draft bills that contained a genuine public option. But then conservative opponents of the plan, the so-called Blue Dog Democrats, mounted their counterattack. A powerful bloc composed primarily of drawling southerners in ill-fitting suits, the Blue Dogs--- a gang of puffed-up political mulattos hired by the DNC to pass as almost-Republicans in red state battlegrounds--- present themselves as a quasi-religious order, worshipping at the sacred altar of “fiscal responsibility” and “deficit reduction.” On July 9, in a harmless-sounding letter to Pelosi, 40 Blue Dogs expressed concern that doctors in the public option “must be fairly reimbursed at negotiated rates, and their participation must be voluntary.” Paying doctors using Medicare’s below-market rates,” they added, “would seriously weaken the financial stability of our local hospitals.”
The letter was an amazing end run around the political problem posed by the public option --- i.e., its unassailable status as a more efficient and cheaper health care alternative. The Blue Dogs were demanding that the very thing that makes the public option work --- curbing costs to taxpayers by reimbursing doctors at Medicare rates plus five percent ---- be scrapped. Instead, the Blue Dogs wanted compensation rates for doctors to be jacked up, on the government’s tab. The very Democrats who make a point of boasting about their unwavering commitment to fiscal conservatism, were lobbying, in essence, for a big fat piece of government pork for doctors. “Cost should be the number one concern to the Blue Dogs,” grouses Rep. Woolsey. “That’s why they’re Blue Dogs.”
In the end, the Blue Dogs won. When the House commerce committee passed its bill, the public option no longer paid Medicare-plus-five-percent. Instead, it required the government to negotiate rates with providers, ensuring that costs would be dramatically higher. According to one Democratic aide, the concession would bump the price of the public option by $ 1,800 a year for the average family of four.
In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, “about the same as what we have now,” as one Senate aide puts it. This was the worst of both worlds, the kind of take-the-fork-in-the-road nonsolution that has been the peculiar specialty of Democrats ever since Bill Clinton invented a new way to smoke weed. The party could now sell voters on the idea that it was offering a “public option” without technically lying, while at the same time reassuring health care providers that the public option it was passing would not imperil the industry’s market share.
Even more revolting, when Pelosi was asked on July 31st if she worried that progressives in the House would yank their support of the bill because of the sellout to conservatives, she literally laughed out loud. “Are the progressives going to take down universal, quality, affordable health care for all Americans?” she said, chuckling heartily to reporters. “I don’t think so.”
The laugh said everything about what the mainstream Democratic Party is all about. It finds the notion that it has to pay anything more than lip service to its professed values funny. “It’s a joke,” complains one Democratic aide. “This is all a game to these people--- and they’re good at it.”
Given that five different committees are weighing five different and often competing paths to reform, it’s not surprising that all sorts of bizarre crap winds up buried in their bills, stuff no one could possibly have expected to be in there. The most glaring example, passed by Ted Kennedy’s HELP committee, would allow the makers of complex drugs known as “biologics” to keep their formulas from being copied by rivals for 12 years--- twice as long as the protection for ordinary pharmaceuticals. The notion that an effort ostensibly aimed at curbing health care costs would grant the pharmaceutical industry lucrative new protections against generic drugs is even weirder when you consider that earlier proposals, including one supported by Obama, would have protected brand-name drugs for only seven years.
Another favor to the industry buried in the bills involves the use of choice. From the outset, Democrats have been careful to make sure that a revamped system would not in any way force citizens to give up their existing health care plans. As Obama told the American Medical Association in June, “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”
That sounds great, particularly with the new set of standards for employer-provided insurance outlined in the House version of reform. Under the bill--- known as HR 3200--- employers must provide “essential benefits” to workers or face a stiff penalty. “Essential benefits” includes elements often missing in the fly-by-night plans offered by big employers: drug benefits, outpatient care, hospitalization, mental health, the works. If your employer does not offer acceptable coverage, you then have the right to go into one of the state-run insurance “exchanges,” where you can select from a number of insurance plans, including the public option.
There’s a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance “exchange.” In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their shitty plans protected by a grandfather clause.
Which means….
“If you have coverage you like, you can keep it,” says Sen. Sanders. “But if you have coverage you don’t like, you gotta keep it.”
This grandfather clause has potentially wide-ranging consequences. One of the biggest health care problems we have in this country is the technique used by large employers--- Walmart is the most notorious example--- of offering dogshit, bare-bones health insurance that forces employees to take on steep co-pays and other massive charges. Low-wage workers currently offered these plans often reject them and join Medicaid, effectively shifting the health care burden for Walmart employees on to the taxpayer. If the HELP committee’s grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart’s crap employer plan and taking the comparatively awesome insurance offered via Medicaid will now be rebuffed by the state and forced to take the Walmart dogshit offering.
In a legislative sense, the bad ideas are already in the barn, and the solutions are fenced off in the fields, hoping to get in.
One of the reasons for this chaos was the bizarre decision by the administration to provide absolutely no real oversight of the reform effort. From the start, Obama acted like a man still running for president, not someone already sitting in the White House, armed with 60 seats in the Senate. He spoke in generalities, offering as “guiding principles” the kind of I’m-for-puppies-and-sunshine platitudes we got used to on the campaign trail--- investment in prevention and wellness, affordable health care for all, guaranteed choice of doctor. At no time has he come out and said what he wants Congress to do, in concrete terms. Even in June, when congressional leaders desperate for guidance met with chief of staff (and former legislative change-squelcher) Rahm Emanuel, they got no signal at all about what the White House wanted. On the question of a public option, Emanuel was agonizingly noncommittal, reportedly telling Senate Democrats that the president was still “open to alternatives.”
On the same day Emanuel was passing the buck to senators, Obama was telling reporters that it’s “still too early” to have a “strong opinion” on a public option. This was startling news indeed: Eight months after being elected president of the United States is too early to have an opinion on an issue that Obama himself made a central plank of his campaign? The president conceded only that a “public option makes sense.”
This White House makes a serial vacillator like Bill Clinton look like Patton crossing the Rhine. Veterans from the Clinton White House, in fact, jumped on Obama. “The president may have overlearned the lesson of the Clinton health care plan fiasco, which was: Don’t deliver a package to the Hill, let the Hill take ownership,” said Robert Reich, who served a labor secretary under Clinton. There were now so many competing ideas about how to pay for the plan and what kind of mandates to include that even after the five bills are completed, Congress will not be much closer to reform than it was at the beginning. “The president has got to go in there and give it coherence,” Reich concluded.
But Reich’s comment assumes that Obama wants to give the bill coherence. In many ways, the lily-livered method Obama chose to push health care into being is a crystal-clear example of how the Democratic Party likes to act--- showering a real problem with a blizzard of ineffectual decisions and verbose nonsense, then stepping aside at the last minute to reveal the true plan that all along was being forged off-camera in the furnace of moneyed interests and insider inertia. While the White House publicly eschewed any concrete “guiding principles,” the People Who Mattered, it appeared, had already long ago settled on theirs. Those principles seem to have been: no single-payer system, no meaningful public option, no meaningful employer mandates and a very meaningful mandate for individual consumers. In other words, the only major reform with teeth would be the one forcing everyone to buy some form of private insurance, no matter how crappy, or suffer a tax penalty. If the public option is the sine qua non for progressives, then the “individual mandate” is the counterpart must-have requirement for the insurance industry.
The so-called “individual mandate” is currently included in four of the five bills before Congress. The most likely version to survive into the final measure resembles the system in Massachusetts designed by Mormon glambot Mitt Romney, who imposed tax penalties on citizens who did not buy insurance. Several of Romney’s former advisers are involved in the writing of Obamacare, including a key aide to Ted Kennedy who was instrumental in designing the HELP committee legislation. The federal version of the Massachusetts plan would slap the uninsured with a hefty tax penalty--- making the HELP committee clause barring people from opting out of their employer-provided plan that much more outrageous.
If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that is already proved not to work. “The IRS and the government will force people to buy a defective product,” says Woolhandler. “We know it’s defective because three-quarters of all people who file for bankruptcy because of medical reasons have insurance when they get sick--- and they’re bankrupted anyway.”
“Without a real public option to drive down costs, the federal support to make sure everyone gets coverage is going to get very expensive very fast,” says Behan, the aide to Sen. Sanders.
Here’s the other thing. By blowing off single-payer and cutting the heart out of the public option, the Obama administration robbed itself of its biggest argument--- that health care reform is going to save a lot of money. That has left the Democrats vulnerable to charges that the plan is going to blow a mile-wide hole in the budget, one we’ll be paying debt service on through the year 3000. It also left them scrambling to find other ways to pay for the plan, making it almost inevitable that they would step in political shit with seniors everywhere by trying surreptitiously to whittle down Medicare. As a result, the Democrats have become so oversensitive to charges of fiscal irresponsibility that they’re taking their frustrations out on people who don’t deserve it. Witness Nancy Pelosi’s bizarre freakout over the Congressional Budget Office. When the CBO questioned Obama’s projected cost savings, Pelosi blasted them for “always giving you the worst-case scenario” --- which, of course, is exactly what the budget office is supposed to do. When you start asking your accountant to look on the bright side, you know you’re not dealing from a position of strength.
And it’s virtually guaranteed to sour the public on reform efforts for years to come.
And to Republicans, Blue Dogs and all others on the take, it is mission accomplished.
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