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 40 million 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?
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.