Health Care Reform: The Ideal vs. the Real

Between the idea
And the reality
Between the motion
And the Act
Falls the Shadow
--T.S. Elliot

A hot topic of debate among progressives regarding health care reform is whether the current Senate bill is worth keeping or should be jettisoned and the whole process started over. What a final Senate bill will look like is anybody’s guess, but it seems pretty certain as of this writing that a public option or an earlier Medicare buy-in at age 55 will not be in it. For some on the left this is a deal killer as has been trumpeted by Howard Dean, Keith Olbermann, insurance CEO whistleblower Wendell Potter, popular blogger Markos and other notables with bully bullhorns. Scrap the damn thing and start all over they say. I disagree, though I surely share their outrage and condemnation of Republican obstructionists, insurance company Senate vassals who eviscerated the House bill and the two Democratic Senate weasels who’ve held the bill’s passage hostage, Nelson and Lieberman. I’ll explain my position momentarily.

A cursory review

Obama ran on a health care reform platform that he insisted had to accomplish three fundamental provisions: insuring most or all of the 45 million now uninsured; reducing the ever-increasing runaway costs of health care; and doing away with private insurance companies being able to refuse coverage because of pre-existing conditions, and arbitrary policy cancellations when people get sick. Much to the dismay of progressives he did not advocate a single payer system or a universal health care system as such provided by all the other industrial and advanced nations of the world. But in order to get progressive backing in the House a plan for single payer was concocted, clumsily titled a public option that would compete with private insurance companies and ostensibly lower premium costs. And now that that third pillar of the Obama reform construct has been dismantled what is there to control rising costs? The answer is, nothing. Obama says insurance must be mandatory so a big chunk of the projected $900 billion cost of the reforms bill will be government subsidies to those unable to pay for the cost of private insurance. What a holy mess!

A primer for botching a bill

The attempt to reform the health care system, so desperately needed in this country now for decades, has been so botched, mishandled and ineptly contrived by the Democrats, and yes, by the President, it’s a wonder the thing is still breathing. It was obvious at the outset that Republicans were going to fight it every step of the way no matter how it was designed, what it contained or didn’t, so any thoughts of bipartisan cooperation were a fantasy. Charging Congress to write the thing was stupefying in extremis. Then relinquishing the progressive drive for a popularly supported single payer system before the bargaining and negotiating even began was a bone-headed decision of astounding proportion, even if it had amounted to no more than a chip in the bartering. Can these Obama chosen political operatives really be the sharpest blades in the pack? Any school kid knows you don’t back off before the fight’s even begun. Head-smacking astounding!

And why were deadlines set to get this or that done according to some schedule? That timetable got shot down in the fall. Health care reform has been discussed and debated for 60 years. Why all of a sudden does some plan have to be signed and sealed by the New Year? Where is that written? Why not make Congress wrestle with it until it’s to the President’s satisfaction? Why put arbitrary time frames on oneself? And if the writing was on the wall that he couldn’t get the 60 votes without giving away the store then screw that and use reconciliation as a club or at least the threat of it. Is the Democratic leadership that stupid or weak-kneed not to know how to or have the guts to play the game?

The deal goes down

In answer to that I have a hunch and it goes like this. Shortly after Obama rode into town on his reforming-health-care horse he met with the insurance honchos. This actually happened, remember? Sort of like Cheney’s secret pow-wow with the energy barons except the Dickster was in league with them, working for and with them in screwing America petro-style. But Obama was playing the good sheriff – gonna clean up the town and show them insurance varmints what fer.

So Marshall Barack meets with the bad guys, let’s them know he’s serious about reforming some of their most egregious shenanigans – denying care and dropping coverage – and the townsfolk, AKA the American public are with him. Even the insurance mafia knows most everyone hates their guts. Obama lets them know that he knows that in their unbridled drive for greater profits and fatter CEO rewards they’re breaking the bank, sending millions into bankruptcy, and effectively condemning 40-50 thousand Americans who can’t afford insurance to death every year. And one way or another he’s going to put a stop to it.

Obama know that what these miscreants fear most is competition; not for profit, government operated competition. He doesn’t even have to say single payer or a Medicare-like system; it’s understood. So they cut a deal and it goes like this: Insurance dudes clean up their act – cover everyone, keep it portable, make it somewhat affordable and discontinue its drop-dead policy – and in return, Obama won’t shove a real competitive system down their greedy gullets. Remember, Obama never drew a line in the sand over the public option. He just paid it a little rhetorical lip service, something he thought was a good idea or some such pablum, but not a mandate.

In addition, Obama promised insurance greed-heads gobs of new customers bankrolled by government bucks, so in the long run they stood to gain by playing ball with him. And in return they wouldn’t put up too much of a fight, i.e., bury him with TV commercials as they did the Clintons.

So they agreed because the reform writing was on the wall anyway as they’d fucked over the American public for so long revolt was in the air. And so the deal went down.

Of course the insurance geeks knew they had enough bought and paid for shills in Congress, most importantly their spineless sock-puppets in the Senate, to carry water for them when it came to squawking opposition in the public forum, so they wouldn’t even have to dirty their hands or reach far into their pockets to put up a fight. They had their elected lackeys and the more moronic fringe in the public to do that. And besides and most important of all to remember is even if a reform bill got passed it would have no real competition agency in it.

The real and the ideal

So back to what I said at the outset of this diatribe: that I disagree with Dean, Olbermann et al., who say drop the current bill and start over. I take this position for two reasons: Starting all over again won’t lead to any new outcome because the deal went down a long time ago, and the bill, whatever its final iteration won’t have what progressives and most of us want – real competition. The second reason is this: The Senate bill will extend coverage to more than 30 million now hanging in health care limbo, of which 45,000 die every year. That’s a lot of grief and suffering for too many of our fellow countrymen/women. In addition the bill will have addressed the most abusive practices of the insurance industry, and as pointed out in a recent article by Ruth Marcus for Truthdig.org, it will prevent insurers from refusing to cover individuals with pre-existing conditions, or to charge them more because of poorer health, or cancel their policies once they get sick. “People who lose their jobs, or their insurance, would have a place to turn for coverage through the new insurance exchanges. For the first time, childless adults living in poverty would be guaranteed health care through Medicaid.”

So that’s the deal. Is it a win-win? Hardly, but it’s not a total loss either. Obama is a realist – read his Nobel acceptance speech for proof positive. American politics is the real world; it may stink, but that’s the way it is. If you don’t like it then work to change the system. And that doesn’t mean voting in more Democrats or Republicans at election time. They ARE the system and they’re not about to change it. It means working to change a system run by and for large corporate interests and the military complex that feeds off war and American imperial motivation. It means changing a system where health care is not considered a human right and is managed by companies for profit. It means changing an election system that’s not based on financing from special interests. It means a whole host of things as we claw our way toward a more intelligent evolution.

But for now, see the reality of things as they are, and hope that a health care reform bill gets passed that will at the least right some of the present wrongs.

Editors note: Yesterday, Saturday December 19, Senate majority leader Harry Reid announced he had the 60 votes needed to pass the Senate health care bill, and that the final vote would take place in the coming week. If the Senate bill gets passed it will move back to the House for further negotiations.

An Open Letter to Barack Obama

Dear Mr. President,

These are hard times for many maybe even most of our fellow countrymen/women. I know that you’re aware of it and I believe that you care about them, but we all need reminders, especially when we’re inundated with other serious, vital concerns.

Any reasonable person knows that you, and by extension the rest of us, inherited a helluva mess comparable in scope and difficulty only to a few other times in our nation’s history: our bloody birth as a country, our Civil War and the fight of our lives, WWII. The presidents who presided at those times also faced unprecedented perils, entrenched political obstacles, and challenges so great they came to define us as the country we are today; good and bad.

You inherited, by choice of course, a deluge of Herculean problems no person, well almost no one, would want to take on: two on-going wars and a Middle East in turmoil; two very dangerous nuclear hot-spots that must be addressed; an economy so destroyed and disabled it harkened to the Great Depression of the 30s; a global climate change crisis that will affect millions, probably billions of lives, and perhaps the life of the planet itself to sustain many of its species, and those are just a few of the top choices from column A. As said it’s a mystery as to why anyone would walk willingly into this fire, but for better or worse you were of the small number that volunteered.

This letter is not to serve as a report card or to praise or condemn how you’ve handled things. I have my opinions on those matters, but it’s not the thrust of what I want to say here.

What I want to bring your attention back to is that your, our, country is hurting. Think a Katrina-like situation that has struck practically every state in the union. This country is drowning in a sea of unemployment, lost homes, healthcare cost bankruptcies, credit interest bankruptcies and legal usury that has so stunned the once burgeoning middle class as to threaten its very existence. What was once the pride of our economic machine is and has been dwindling since the supply-side, free market, deregulation banner waving gurus came on the scene. And because of the Wall Street and banking industry notorious misdeeds the threat to our middle class economic stability is exacerbated and could prove fatal.

This country is hurting, Mr. President, and it’s fearful, angry and confused. Yes it was of paramount importance to immediately address the deadly virus that threatened our and a good part of the world’s economies. It was questionable as to how to go about it, but decisions by your predecessor and you were made, and it seems at least for now that the fiscal patient is out of the ICU and in the recovery room, albeit on life support.

But it’s not enough to stabilize the banks and certain giant investment corporations, because as a result of their failures and immoral activities tens of millions of people are suffering or face imminent economic demise. People are fearful and angry and rightly so. This dire situation has to be addressed and it has to happen now.

Healthcare reform is very important and healthcare must be made affordable for everyone, but even passing a strong bill with a Medicare-like option is not going to put people back to work, and it’s not going to stop home foreclosures. Only jobs and programs that create huge numbers of jobs will alleviate the enormous suffering and get this country back on safe economic ground.

You were left to deal with two wars and you say that one of them is a necessity. Maybe yes, maybe no, but the reality is neither country, Iraq or Afghanistan or for that matter any country in the Middle East poses an imminent threat to this nation’s security. Every dollar spent fighting the war in Afghanistan or maintaining a large troop presence in Iraq is money not spent toward putting people to work. Every dollar spent pursuing so-called U.S. interests in the Middle East is money not going into education. Have you seen the conditions in our schools, Mr. President? Are you aware that district hospitals in rural areas are closing apace because of lack of funding? Are the hundreds of billions being spent on U.S. foreign interests more important than the educations of the nation’s children or the medical centers that serve tens of thousands throughout the country?

There are great, pressing problems before us Mr. President, but I maintain that, except for addressing the healthcare crisis, nothing is more important than turning our energies and resources toward getting vast numbers of people employed, and once that’s done government can start to address a minimum wage that reflects reality and whereby people will be able to afford healthcare, higher education for their kids and decent housing.

The wars can wait. As far as I’m concerned they’re a monstrous waste of money and lives, but that’s only as the writer sees it. But the people without jobs, the people who can’t afford healthcare or to help their kids advance through good schools and higher education, these people can’t wait. First things first, sir.

Turn the economy around by getting people back to work. You don’t offer a hungry person rhetoric or rationales for a better healthcare system – as important as that is it’s not food. Food first. Your nation needs jobs first and help not losing their homes. Put the resources, i.e., money, there. Feed those needs first, Mr. Obama, and the rest will fall into place.

Will Shonbrun, Sonoma, CA