By BAR managing editor Bruce A. Dixon
Candidate Barack Obama told us to judge his first term by whether he delivers quality affordable health care for all Americans, including nearly fifty million uninsured. So why does his proposal not cover the uninsured till 2013, after the next presidential election when Medicare took only 11 months to cover its first 40million seniors? Why are corporate media pretending that no opinions exist to Obama's left? And why has the public option part of the Obama health care plan shrunk from covering 130 million to only 10 million, with 16 million left uninsured altogether?
Is the Obama Health Care Plan Really Better Than Nothing?
By BAR managing editor Bruce A. Dixon
The health care debate inside and outside the matrix
Like just about everything else, your take on the national health care debate depends on whether you're inside or outside the matrix.
Within the bubble of fake reality blown by corporate media and bipartisan political establishment, the health care news is that the Obama Plan is at last making its way through Congress. It's being fought by greedy private insurance companies, by chambers of commerce, by Republican and some Democratic lawmakers.
Under the Obama plan, we're told, employers will have to insure their employees or pay into a fund that does it for them. Individuals will be required under penalty of law to buy private insurance policies and for those that can't afford it or prefer not to use a private insurer there will be something called a “public option.” This “public option, the story goes, is bitterly fought by the bad guys because it will make private insurers accountable by competing with them, forcing them to lower their costs. Both the president's backers and opponents agree that the whole thing will be fantastically expensive, and the president proposes to fund it with cuts in existing programs like Medicaid which pay for the care of the poorest Americans and a tax on those making more than $300,000, later raised to $1 million a year.
The “public option” has that magic word “public” in it, and that's reassuring to progressives and to most of the American people. Taxing the rich is a popular idea too. So if you rely on corporate media, the administration, or some of the so-called progressive blogs to identify the players and keep the score, it seems a pretty clear case of President Obama on the side of the angels, battling the greedy insurance companies, Republicans and blue dog Democrats to bring us universal, affordable health care.
That whole picture has about as much reality as the ones the same corporate media and most of the same politicians drew for us about Iraq, 9-11, weapons of mass destruction and some people over there who wanted us to free them. Iraq and the White House were and remain actual places, and there really is a problem called health care. But the places, problems and solutions are very different from the bubble of fake reality blown around them.
What sustains this fake reality is the diligent suppression from public space of any viewpoints, observations or proposals to Obama's left. As long as the illusion that nobody has a better idea, that the only choice we have is Obama's way or the Republicans' way can be maintained, the crooked game can go on.
But bubbles are delicate things. Keeping this one intact requires so many vital topics to be avoided, so many inquiring eyes to be averted, so many fruitful conversations to be squelched that it's hard to see how the president, the bipartisan establishment and the corporate media can pull it all off.
The real Obama Plan: doesn't cover the uninsured till 2013, if then.
The first clue that something is deeply wrong with the Obama health care proposal is its timeline. According to a copyrighted July 21 AP story by Ricardo Alfonso-Zaldivar,
“President Lyndon Johnson signed the Medicare law on July 30, 1965, and 11 months later seniors were receiving coverage. But if President Barack Obama gets to sign a health care overhaul this fall, the uninsured won't be covered until 2013 — after the next presidential election.
“In fact, a timeline of the 1,000-page health care bill crafted by House Democrats shows it would take the better part of a decade — from 2010-2018 — to get all the components of the far-reaching proposal up and running.”
According to a peer reviewed 2009 study in the American Journal of Medicine, 62% of the nation's 727,167 non-business bankruptcies were triggered by unpayable medical bills in 2007. Most of these had health insurance when they fell ill or were injured, but with loopholes, exclusions, high deductibles and co-payments, or were simply dropped when they got sick. In 2008 that figure was 66% of 934,000 personal bankruptcies and in 2009 it could approach 70% of 1.1 million bankruptcies. And 18,000 Americans die each year because medical care is unaffordable or unavailable. Waiting till 2013 means millions of families will be financially ruined and tens of thousands will die unnecessarily.
If the Johnson administration with no computers back in the sixties could implement Medicare for 45 million seniors in under a year, why does it take three and a half years in the 21st century to cover some, but not all, of America's fifty million uninsured? And why does the Obama Plan make us wait till after the next presidential election? Politicians usually do popular things and run for election on the resulting wave of approval. Delaying what ought to be the good news of universal and affordable health care for all Americans till two elections down the road is a strong indication that they know the good news really ain't all that good. And it's not.
Inside the matrix of TV, the corporate media and on much of the internet, discussion of the Obama plan's timeline, the human cost of another three years delay, and the comparison with Medicare’s 11 month rollout back in the days before computers are almost impossible to find. We can only wonder why.
The Obama plan is about health insurance, not health care.
As BAR has been reporting since January 2007, the Obama plan is not a health care plan at all, it is a health insurance plan. Based largely upon the failed model in place in Massachusetts since 2006, the Obama plan will require employers to provide coverage or pay a special tax. Everybody not covered by an employer will be required to purchase insurance under penalty of law, in much the same manner as you're currently required to buy car insurance.
“In my state,” testified Dr. Steffie Woolhandler of the Harvard Medical School last month before Congress, “beating your wife, communicating a terrorist threat and being uninsured all carry $1,000 fines.”
As in Massachusetts, the health insurance plans people are forced to buy will cost a lot and won't cover much. In a July 20 National Journal article Dr. David Himmelstein says,
“Nearly every day that he is in the clinic, Himmelstein says, he sees a patient who has problems paying for care "despite this reform.' Some of them had free care before the 2006 law took effect but are now expected to handle co-payments. If you're not poor enough to get a subsidy, say you're making $30,000 a year, you're required to buy a policy that costs about $5,000 a year for the premium and has a $2,000 deductible before it pays for anything. For substantial numbers of people, it's effectively not coverage,' Himmelstein said. The policy he described is about the cheapest Massachusetts plan available, according to the Physicians for a National Health Program report, which Himmelstein co-wrote.”
A family of four making under $24,000 a year in Massachusetts gets its insurance premium free, but is still expected to cough up deductibles and co-payments and live with loopholes and exclusions that often deny care to those who need it. And in both the Massachusetts and Obama plans, funds to pay those premiums come out of the budgets of programs like Medicaid that already pay for care for the poorest Ameicans.
The Obama plan's “public option” is a bait-and-switch scam
A July 21 pnhp.org article titled “Bait and Switch: How the Public Option Was Sold” outlines how the public option is neither public, nor an option.
“Public option” refers to a proposal... that Congress create an enormous “Medicare-like” program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today...
“Hacker (its author) claimed the program, which he called “Medicare Plus” in 2001 and “Health Care for America Plan” in 2007, would enjoy the advantages that make Medicare so efficient – large size, low provider payment rates and low overhead...
“Hacker predicted that his proposed public program would so closely resemble Medicare that it would be able to set its premiums far below those of other insurance companies and enroll at least half the non-elderly population.”
The White House is committed to twisting arms in the both houses of Congress and reconciling the two versions of Democratic bills to emerge from the House and Senate. What emerges will be the Obama plan. According to the Congressional Budget Office, the Senate version of the Democrats' pending health care legislation leaves 33 million uninsured and omits the public option altogether. The House version includes a “public option” estimated to cover only 10-12 million people, a number far too small for it to create price pressure on private insurance companies, while leaving 16 or 17 million uninsured. Instead of setting prices for health care, it will be forced to pay whatever tthe private insurers already pay, and perhaps more.
As private insurers use their marketing muscle to recruit younger, healthier people who'll pay for but not use their benefits, the public option will be a dumping ground for the customers they don't want... the middle-aged, the poor, those with pre-existing conditions. And of course the Obama plan's “public option' will be managed by contractors from the private insurance industry.
Private insurers spend a third of every health care dollar on non-health related things like bonuses, denial machinery, advertising, lobbying and bad investments. Medicare spends 2 or 3% on administrative overhead. Bush's “enhanced Medicare” administered by private insurance contractors, spends about 11% on overhead. That's about what we should expect from the Obama public option. So much for change.
So far, discipline is holding. Nobody in corporate media, the administration, or among Democrats in Washington has gotten round to telling us that the public option has been eviscerated. But its powerful appeal and the awesome power of the word “public” are offered by Obama supporters as the central reasons to shut up, clap harder, and get behind the president on this.
Taxing the rich, paying for health care. How the Obama Plan stacks up against single payer.
Along with being funded by cuts in Medicaid, the Obama plan is supposed to be funded by taxing those who make $300,000 or more per year. That's not a bad thing. The wealthy don't pay nearly enough taxes. But the US already spends more on health care than anyplace else on the planet while leaving a greater portion of its population uninsured than anybody.
The Obama plan will not contain costs. It will subsidize the insurance vampires well into the next decade. On the other hand, single payer would eliminate the private insurance industry altogether. In many advanced industrial countries, most of the practices private insurers follow here, such as cherry picking healthy patients while dumping and denying sick ones, are illegal. Why can we do that?
Single payer, according to a study by the California Nurses Association would eliminate 550,000 jobs in private insurance while creating 3.2 million new ones in actual health care. It would be responsible for $100 billion in wages annually and a source of immense tax revenues for local governments.
So is the Obama plan really better than nothing?
The Obama plan seems calculated to buy time for private insurers, to end the health care discussion for a decade or more without solving the health care problem, do so in a way that discredits the very idea of everybody in- nobody out health care. It will leave tens of millions uninsured, a hundred million or more underinsured, and the same parasitic private interests in charge of the American health care system that run it now.
The Obama plan as it now stands requires us to let another 18,000 die for each of the next three years and allow more than a million additional families to be bankrupted by medical expenses before we can judge whether or not the plan is working. It's easy to imagine Obama partisans telling us in mid 2013 that it's still too early to be sure.
The Kucinich amendment, which allows the few states wealthy enough to try it the liberty to fashion their own single payer regimes is intended to attract progressives and single payer votes in Congress without breaking the bubble. By itself, it should not be a reason to support this bill.. The wealthiest state in the union is probably California, and it's handing out IOUs instead of salaries this month. It's hard to see what would be lost if this health care bill went down in flames, and we started over again next year.
Can he get away with it?
Maybe. Maybe not. If the corporate media and the president can keep discussion of the devilish details to a minimum, if they can silence, co-opt and intimidate the forces to Obama's left --- if they can keep most of the public inside their bubble of fake reality, Barack Obama may achieve his goal of thwarting the reform that most of the American people want --- an everybody in, nobody out single payer health care system on the model of Canada or Australia, or Medicare for All. It won't be close, it won't be easy, and with nothing to be gained, progressives shouldn't make it any easier.
Since the president's success depends mostly on keeping people silent and in the dark, he will probably be unable to mobilize the 13 million phone numbers and email addresses collected during the recent presidential campaign, and now held by OFA, his campaign arm. If an organizing call went out to them, too many would try to read the bill and discuss the options, and such a discussion could easily get out of hand. When OFA called house meetings on health care last December, the most frequently advanced question was why we couldn't or shouldn't get a single payer health care system.
Single payer isn't dead yet. It's very much alive among Barack Obama's own supporters. To succeed, he has to bury it alive, to keep them in the bubble, in the dark and quiet, or clapping so loudly they cannot hear themselves or each other think. It's not over.
Bruce Dixon is managing editor at BAR, and can be reached at firstname.lastname@example.org