Oct 24 2009
Public option takes two steps forward, three backward
Notice how news coverage of health care reform no longer talks about “whether” there will be a public option, but “what kind?” How could that be? Only the loony left was interested in that, while the sober, bipartisan minds of the U.S. Congress were busy trying to strike deals for Republican votes with more “moderate” proposals.
Well, for starters, the “loony left” polled at anywhere from 55 to 80 percent when pollsters asked whether the health reform bill should contain a public option. And once the teabaggers shouted themselves out, the real majority of Americans began making themselves heard. And their concerns — losing their health care with their jobs, not being able to keep their health care unless they turned over their entire unemployment check to the insurance company, not being able to get the care they paid for over a lifetime once something actually became wrong with them — were far more real than the teabaggers’ unfocused complaints about violating the Tenth Amendment, creeping socialism, and the president’s birthplace. Not to mention their implied faith in the pirates that run the health insurance scam in the United States.
Funny story about the health insurers. A couple of weeks ago, they overplayed their hand by ginning up defective studies claiming that health care reform would raise everyone’s premiums. This kind of thing worked pretty well in 1993 (see bought-and-paid-for think-tank apparatchik Betsy McCaughey) but the faster news cycle — plus the fact that we’ve seen this game of three-card monte before — not only debunked the studies but allowed room for folks to question their motives at length. This made the studies radioactive to health reform opponents, and cleared the way for a more sober consideration of the public option.
This is not to say we’re going to get a good bill, however. Neither house of Congress appears to have a solid majority for the kind of balls-out public option that really will push the cost curve and bring the entire population under the coverage umbrella. Right now the discussion is over “triggers” and “opt-out.” One of these two useless fig leaves may be necessary to get a health reform bill through the Congress, unfortunately, but that doesn’t mean I have to like it.
“Triggers” means they’ll create a public option but hold it in abeyance until some future date when it becomes clear even to politicians with six figures’ worth of health care/health insurance/pharmaceutical money in their re-election accounts that the reform bill hasn’t made any headway. This is an exceedingly bad idea because tripping the trigger will require legislation, the story will be mostly ignored by the media because it won’t involve kids stowing away inside a weather balloon, and therefore will be easy for lobbyists to kick down the road further, with the help of still more campaign money. If there must be a trigger, here’s a good one: The public option kicks in when U.S. health care costs per capita reach double those of Canada, France, Japan, the U.K. and Germany.
Then there’s the “opt-out” proposal, under which they’ll pass a public option but states can opt out of it. This may actually be more insane than triggers; consider that if the Civil Rights Act of 1964 had an “opt-out” provision, there’d still be whites-only lunch counters in Alabama and Mississippi, and possibly Texas as well. And since there still are a fair number of Republican governors in the U.S., hardly any of whom are profiles in courage when it comes to resisting the brain-damaged entreaties of the core Republican base voter, we can expect a significant number of states to opt out of health care reform. Which will do a number on any effort to bend the cost curve or get everybody insured. Not to mention it will guarantee a permanent campaign against further health care reform, as the retrogrades band together with the moneyed health interests to get all 50 states to opt out.
Last week folks in the Democratic party finally, much belatedly, got behind the best possible description of what health care reform needs to be: Medicare For Everyone, or Medicare Part E. Can you name somebody over 65 who doesn’t have health insurance? Of course not. So why stop there? One of the important points of health reform is to insure everyone. Then there’s the need to do away with all the silly administrative games: pre-existing conditions; “experimental” treatments; the subrogation game, in which multiple insurance companies play hot potato with people’s health bills; and the ever-popular recission, in which people’s entire policies get canceled the day they show up with a condition that’s expensive to treat.
Then there’s the need to make a dent in the phenomenon of medical bills bankrupting ordinary Americans — some 60 percent of all bankruptcies are primarily caused by mounting medical expenses. Check out Sen. Al Franken evicerating an industry flack who tried to claim that medical bankruptcies would go up if the U.S. passed health insurance reform:
Folks, I remain convinced that straight-up single-payer is what the U.S. needs to get to real health care and health insurance reform. Unfortunately, we’ve allowed too many interested profit centers to grow up in this country; instead of moving toward sustainable reform, we’ve actually been moving in the opposite direction for some 30 years now. Been to a hospital lately? It used to be that everybody in the hospital worked for the hospital, and while the doctors had private practices, they were beholden to the hospitals in terms of quality care and ability to make money treating patients. Today’s hospitals are like shopping malls — practically every department of the hospital is a separate private enterprise cost center and a separate medical practice. You can go to a hospital that’s “in the network” yet be treated by doctors who are outside the network. (That happened to me personally.) Even the emergency room doctors are an external practice. And who do you think pays for the byzantine reams of paperwork that are generated by dozens of cost centers under a single hospital’s roof?
Meanwhile, the hospitals tolerate this situation because if the doctors don’t like the hospital, they can withhold services and even go into competition with the local hospital to drive it out of business by cherry-picking all the profitable treatments and surgeries in their own shiny new outpatient centers. If the doctors aren’t rich enough to undertake such a thing themselves, there are any number of medical provider chains who would be happy to underwrite such a move.
The political conservative sees nothing wrong with any of this because it’s market-based private enterprise. Unfortunately, patients do not have any ability to harness the power of the market. You don’t shop for an emergency room or the best place to have an appendectomy; you get rushed into whatever facility will take you in a reasonable amount of time. This is why EVERY advanced democracy in the world has downplayed or regulated the amount of private enterprise in the health care system. The U.S. needs to get to that point, but it’s going to take years and years of political struggle to get within a country mile of where everybody else is.
