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Friday, December 11, 2009

Have We Been Had on Health Care Reform?

Universal-health-care-cartoon

It's irritating to read about the latest wrangling over health care (insurance) reform in the U.S. Senate. Clearly, the process is being controlled by A) the health care industry, B) the pharmaceutical industry C) compromised whack jobs like Joe Lieberman and Ben Nelson and, even worse as it turns out, D) President Obama and Harry Reid. Who's on the side of ordinary Americans? Only those Senators who are brazen enough to dare pissing off the Dem Party's big donors by proposing real reform, cost cutting and expansion of access. Of course the Dems have any number of Senators whose positions are excellent on health care reform issues. New Mexico has two of them. But what power do they have in a caucus run by weak-kneed Harry Reid?

Old Harry allows Senate Dems to be dominated by the obstructionist demands of a handful of sell outs led by the venal Joe Lieberman. Apparently Obama and Reid are content to sit on the sidelines and allow the President's old Senate mentor to hold forth and twist the legislative process however he wants, with no threat of any punishment or blowback from the White House. Instead, Obama sends Rahm Emanuel and other White House operatives to pressure progressive Dems to cave in to the demands of industry lobbyists and their pets.

Bye Bye Public Option, Hello Crumbs?
One has to wonder at the self-destructiveness of the Dem strategy on this -- on what is viewed as our signature issue. We've watched the public option be pumped as the end all and be all of reform, without which the legislation isn't worth passing. A significant majority of Americans continue to support the public option, even if they have no idea of what it really is or how weakened and deformed it's become in the hands of corporate manipulators.

Now, as we move towards a finalized bill in the Senate, we're suddenly presented with a new end all and be all in the form of Medicare expansion. If this is a terrific idea now, why wasn't it a terrific idea during all those months when the Gang of Six was fiddling while Rome burned? We're switching horses this late in the process? I guess there must be some crumbs thrown to the masses given the triggered and weakened public option that remains, at least for now, in the mix. Suddenly a strong public option isn't necessary if we have expanded Medicare and a few other elements thrown into the mix to placate progressives? Talk about changing horses in mid-stream.

I'm all for expanding Medicare -- I think it should be expanded to allow everyone to buy in immediately -- but if it's only for those aged 55-64, how can it be an effective replacement for a robust public option? Those younger than 55 will be stuck having to buy expensive coverage from the usual for-profit suspects, with absolutely no downward pressure on premium costs. No way does that make up for the lack of a strong public plan to compete with the for-profit sharks.

Another proposal aimed at convincing people we don't need a genuine public option comes in the form of an opportunity for folks to purchase insurance through the federal employee benefit plan. That sounds appealing, but is it? Will it do anything to make health coverage affordable?

Greedy Insurers and Big Pharma Triumph
So what will we get if the Senate bill ends up as reported? Robert Reich lays out the inadequacy of the current reform proposal -- including the Medicare expansion and proposed access to the federal employee benefit plan -- in no uncertain terms:

Coverage

But we still end up with a system that's based on private insurers that have no incentive whatsoever to control their costs or the costs of pharmaceutical companies and medical providers. If you think the federal employee benefit plan is an answer to this, think again. Its premiums increased nearly 9 percent this year. And if you think an expanded Medicare is the answer, you're smoking medical marijuana. The Senate bill allows an independent commission to hold back Medicare costs only if Medicare spending is rising faster than total health spending. So if health spending is soaring because private insurers have no incentive to control it, we're all out of luck. Medicare explodes as well.

A system based on private insurers won't control costs because private insurers barely compete against each other. According to data from the American Medical Association, only a handful of insurers dominate most states. In 9 states, 2 insurance companies control 85 percent or more of the market. In Arkansas, home to Senator Blanche Lincoln, who doesn't dare cross Big Insurance, the Blue Cross plan controls almost 70 percent of the market; most of the rest is United Healthcare. These data, by the way, are from 2005 and 2006. Since then, private insurers have been consolidating like mad across the country. At this rate by 2014, when the new health bill kicks in and 30 million more Americans buy health insurance, Big Insurance will be really Big.

From the start, opponents of the public option have wanted to portray it as big government preying upon the market, and private insurers as the embodiment of the market. But it's just the reverse. Private insurers are exempt from competition. As a result, they are becoming ever more powerful. And it's not just their economic power that's worrying. It's also their political power, as we've learned over the last ten months. Economic and political power is a potent combination. Without some mechanism forcing private insurers to compete, we're going to end up with a national health care system that's controlled by a handful of very large corporations accountable neither to American voters nor to the market.

Meanwhile, we get word that Reid inserted a loophole in the Senate bill that allows insurers to maintain the authority to impose dollar limits on coverage -- one of the horrors that health insurance reform was supposed to stop.

As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not “unreasonable.” The bill does not define what level of limits would be allowable, delegating that task to administration officials.

If that's not bad enough, we also have Obama and Reid fighting against a useful tool for bringing down pharmaceutical costs -- allowing the importation of prescription drugs from Canada and Europe:

Despite all the talk about “bending the cost curve,” President Obama and Harry Reid have declared all-out war on cost control. They are in the process of doing everything they can to kill Byron Dorgan’s bipartisan drug re-importation amendment. They have delayed the vote on his amendment for days (effectively filibustering their own bill), had Lautenberg create an 11th hour poison pill amendment to gut Dorgan’s amendment (which has a safety trigger–see, this is how triggers are used in Washington to kill good ideas), and may try to bring final cloture on the bill to stop a vote from ever taking place on the amendment.

... What is sickening is that Obama campaigned on this rather small, common sense cost controlling idea. Yet Obama traded away drug re-importation to PhRMA in a sweetheart deal. He also traded away direct drug price negotiation in the same deal. Obama and Reid have clearly taken the side of protecting corporate profits instead of bringing down health care costs for regular Americans.

Scrap It and Use Reconciliation?
Given all this, is the Senate bill worth supporting? I know that Obama has publicly said that, at this point, he wants a bill, any bill, to secure a political victory. The question is, will the current legislation make things better or worse? After all the complicated negotiations, does anyone really know?

I'd love to hear what Senator Jeff Bingaman and Senator Tom Udall have to say about the latest permutation of the Senate bill and why it merits passage. I'm starting to believe it might be better to abandon a bill shaped by some of the worst actors active in the process and stifled by the Senate's obstructionist 60-vote requirement. We could easily get many good reforms passed piecemeal, via the reconciliation process, which requires only a simple majority for success. How low can we let the Lieberman-Nelson-lobbyist contingent go and still have a bill that has any chance of significantly improving the provision of health care to all our citizens?

The crux of the matter is whether Obama would prefer passage of a bill that meets the demands of the crazy-corrupt Senators just so he can declare a victory -- or if he's willing to do what's right and push through real reforms in the Senate using reconciliation. Given his past reluctance to rock the "moderate" boat, I'm afraid Obama will put politics before people. I hate to say it.

December 11, 2009 at 12:04 PM in Corporatism, Healthcare, Obama Health Care Reform | Permalink

Comments

This has gotten out of control. What the hell is left of value in this bill? The American people are being dissed.

Posted by: Chris | Dec 11, 2009 1:40:46 PM

I've been trying to convince you of that for months Barb.

Posted by: William Nie | Dec 11, 2009 2:45:02 PM

We need to act, not just talk. We started this whole debate asking to reform healthcare and many people argued where the reform should focus. I suggest that the reform should be in how we finance our healthcare. Removing health insurance companies from the driver's seat in deciding who gets coverage and how much things cost is what will make the most significant cost reduction for us and our problems require significant changes.

We asked for Single-Payer and they told us that it was off of the table.

We asked for a robust public option and they told us that it is just not politically feasable.

They then started talking about a weak public option and now they are saying that we will just have to give up on that fantasy.

I think that we should go back to single-payer. We never took it off of the table and it is the only system that will make a real reduction in how much we spend on our healthcare from now on.

Please join me in working for the only thing that will reduce our cost of healthcare.

SINGLE PAYER NOW!

Terry Riley
www.whatifyouknew-nm.com

Posted by: Terry Riley | Dec 11, 2009 3:32:38 PM

You won't get your public option because most of the U.S. does not want it. Liberals in Congress know they are about to get booted in 2010 and are not about to seal their fate with a socialistic move the citizens oppose. We don't really care if you pass healthcare through reconciliation, because we will remove it in 2010 through the same budget process. We are organizing, and we will demonstrate that we can protest and organize from grass roots in a way liberals have never seen. We are prepared for a fight, and a revolution if needs be.

Posted by: djamminh | Dec 11, 2009 11:50:56 PM

@djamminh, don't you have a tea party to go to? Perhaps you don't get this, but your organization represents less than 10% of the population. The only reason anyone has ever heard of it is because the rest of us are amused to hear the stupid things you say publicly. Keep up the good work. You are destroying the GOP piece by piece.

Posted by: William Nie | Dec 12, 2009 8:21:35 AM

Apparently the Office of Personnel Management, where the federal employees' plans are created/monitored, is overseen under JoeLie's Homeland Security Committee.

Nice touch, que no?

I am sick of this whole thing. Harry Reid is a loser, and he will lose his seat in NV because they are so over him there.

Nelson, Landrieu, Lieberman and Lincoln need to be driven out too.

That the whole country is beholden for health care to these insurance company whores is a tragedy.

And Obama, what can I say? Disappointment. A lump of coal for you, Mister.

Posted by: bg | Dec 12, 2009 8:38:21 AM

It is funny to read this guy dj above...he is for his own bad healthcare...and championing it. Actually the american people do want a public option...
bg what a hoot the program gets run thru the joe dhs....he should be stripped of that position.
Obama is not leading.
Today I say to all my NM reps. vote NO for this POS.

Posted by: mary ellen | Dec 12, 2009 9:07:41 AM

I hope the Dorgan-Snow amendment passes. It allows "re-importation" of drugs. I watched the whole debate on CSpan. It is one of the few amendments that is bi-partisan. There are 3 basic points.

1. We hear time and again that this is a global economy. Americans buy goods and even food from foreign countries so why not drugs? Isn't restricting citizens to "domestic" medications taking away our freedom?

2. The foremost argument against allowing "re-importation" of drugs is that it isn't safe. Well, it turns out that there are no standards for inspection or quality control for our "domestic" medications. Since nearly all our medications are manufactured in other countries anyway, consuming "domestic" medications is no safer. The Dorgan-Snow amendment would require inspection standards and drug "pedigrees" tracking medications from manufacturer to local pharmacy regardless of origin. As it stands, we do not inspect drugs or know where they have been with who knows doing what with the pills.

3. Americans pay the highest prices for the same medications than any other people in the world. We pay up to 10X or more for our drugs for no other reason than than big Pharma is being allowed to fleece us. This is immoral and can't continue. "Re-importation" allows for more market competition for medications making pricing fair for American citizens.

Our corporatist President has come down on the wrong side of this issue and is advocating on behalf of Big Pharma against the interests of the American people.

Posted by: qofdisks | Dec 12, 2009 11:12:05 AM

The Dorgan-Snow amendment is the very one Obama and his pals are trying to stop by making sure there's no vote on it. They know it would win and that would be bad for Obama's secret deal with Big PhRMA. Remember when we thought Obama would be on our side? Think again.

Posted by: barb | Dec 12, 2009 2:14:55 PM

What do you expect when we only have 2 major parties calling the shots?

If other parties were allowed to fully participate in the process we would have the kind of voter leverage that would force the candidates and parties to stand up for and implement the ideas they campaigned on instead of this insane bait and switch fiasco most engage in every 4 years.

Posted by: Michal | Dec 13, 2009 11:00:57 AM

All I've ever seen from a third party is the worst candidate getting in because of splitting the vote and letting someone like Gary Johnson win. It would be better if third party people would get involved in the party and run for office as Democrats.

Posted by: Old Dem | Dec 13, 2009 12:14:26 PM

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