by BAR managing editor Bruce A. Dixon
It's half past December, and the White House is hell-bent on passing its version of “health insurance reform” out of Congress before the holiday recess. It's not universal. It's not even about delivering health care, it's about bailing out health insurance companies. The legislation will force millions of Americans to buy skimpy private insurance, often with hundreds of dollars a month of their own money under penalty of law. Billions more in government subsidies will be added to the giveaway to help purchase health insurance policies for the bottom half or more of the insurance market.
Universal Health Care? We Keep the Candy, But You Can Have the Wrapper. No. Wait. Give Us the Wrapper Too.
By BAR managing editor Bruce A. Dixon
"The version of 'health insurance reform' in play now has no relation to the promises candidate Obama made all during his long campaign for the White House."
Like the Obama campaign itself, the public option was never more than a brand. It was a container designed to fit our hopes and dreams just well enough and just long enough to close the deal, an empty wrapper, with little or no candy inside. Our so-called “progressives” in Congress knew all along it was a fraud, but they played along. When "progressive” Democrats were drawing lines in the sand and “fighting for the public option” all spring and summer and fall, they told us it was this humungous public entity that would be open to hundreds of millions, to anybody wanting an alternative to private insurance, and that it would compete with and force the price of private insurance downward. Howard Dean said we should think of the public option as Medicare, only for everybody.
This kind of “public option” was a transparent hoax, as the wonderful blog of PNHP, Physicians for a National Health Plan pointed out last spring. A great candy wrapper.
When the House bill finally passed, and when the outlines of the Senate bill began to emerge, the same progressive congresspeople and commentators told us the public option they had lost was such an itty bitty thing that it didn't matter much, and anyhow they were going to expand Medicare, so wasn't that a “public option,” only better? Of course their version of expanding Medicare was not free medical care with dignity. It would allow only those with very low incomes, no other insurance and no other choices to “buy into” a means-tested, ghettoized version of Medicare. Essentially, since they had cheapened their own brand, the “public option,” beyond redemption they sought to confuse it in the public mind with Medicare, which had more credibility.
"It would allow only those with very low incomes, no other insurance and no other choices to 'buy into' a means-tested, ghettoized version of Medicare."
Extending Medicare would be a great idea. But it's not Medicare if you have to buy into it, or if you are only qualified by your income being low enough. Adding that group to the Medicare pool, a group that tends to be sicker and poorer, would unbalance and destabilize Medicare, while leaving the healthiest and best and most profitable people to the private insurers. Furthermore, as Dr. Steffie Woolhandler of PNHP points out, this is a place where incrementalism makes it harder to get results, not easier. Disrupting the Medicare and private markets to admit people 55 and over this year, 50 and under five years or some time later, are all separate disruptions. It would be cheaper and easier to do it once. But Medicare, absent the Bush-era partial privatizations, really IS single payer, and therefore was never on the table. That would be too much like real candy, when our betters never intended to serve us more than the wrapper. The brand.
The House version of “health insurance reform” would not insure anyone currently uninsured till 2013, conveniently after the next presidential election. The Senate version waits till 2014, while Medicare, enacted in the 1960s, was up and running for millions in less than one year after passage. If the “public option” and the president's entire health insurance reform was ever anything more than an insubstantial candy wrapper, why would he make us wait that long to open it?
But the Republicans could play with brands and images just as adroitly as Democrats. Since the public option was in fact an insubstantial stand-in for single payer, Republicans played it as though it were full-fledged single payer, or even real socialized medicine. If only. Drug companies and health insurers dealt from both sides of the table, backing Obama's plan in Congress at the same time they backed Republican attacks on it as a socialist seizure of the health care industry.
The version of “health insurance reform” in play now has no relation to the promises candidate Obama made all during his long campaign for the White House, which he began in 2003 still declaring himself an advocate of single payer. Forcing Americans to buy private insurance, Congressman Dennis Kucinich pointed out, is simply a massive upward transfer of wealth to the insurance and pharmaceutical companies, just as the financial bailouts were a massive upward transfer of wealth to speculators and the financial sector.
"Forcing Americans to buy private insurance is simply a massive upward transfer of wealth to the insurance and pharmaceutical companies."
In the last two weeks we have seen a handful of right wing senators including Connecticut's Joe Lieberman snatch even the candy wrapper away. No public option, no phony Medicare buy-in, no nothing. Progressives are wringing their hands, gnashing their teeth and awaiting the final legislation from the office of Harry Reid and the floor of the Senate. Rahm Emanuel, the White House point man, last week directed Reid to go along with what whatever Joe Lieberman wants, just to get a bill, any health insurance bill the president can take credit for out of the Senate.
Our own best guess is that the reconciliation process will be the chance for progressives to urge the prez to ride to the rescue and restore their candy wrapper, something they can claim is both “public” and “optional”. Obama may oblige them, or maybe not. But a candy wrapper is only a wrapper. It's not the candy.
Republicans will have a series of easy targets to rail against ---- forced health insurance payments continuing to bankrupt people, lazy and undeserving blacks, and browns and poor whose health insurance is paid for by their hard-working salt-of-the-earth neighbors, and so on. The empty wrapper works fine for them. Private insurance companies will be written into the law and the system in a systemic way that will be extremely difficult to undo, and drug company profits are guaranteed. It works fine for them. The rest of us will be left with an empty wrapper at best. Or maybe with nothing at all.
The wise and savvy, as David Sirota tells us, will claim that presidents and mayors can never keep their promises and should not be expected to, that only the rubes imagine such a thing is possible. But this flies in the face of justice and democracy. For democracy to work, we all have to be rubes. We all have to believe better is possible and work for it.
There is still a broad-based coalition of single payer activists around the country, many of whom you can contact at www.mobilizeforhealthcare.org. After the bait and switch is over, they'll still be around. Get in touch, don't give up, and see what you can do.
Bruce A. Dixon is managing editor at BAR and based in Atlanta. Email him at bruce.dixon(at)blackagendareport.com.
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