Zero Public Option + One Mandate = Disaster

Not long ago, the most prominent supporters of the public option were
touting it as essential for healthcare reform. Now, suddenly, it's
incidental.

In fact, many who were lauding a public option as the key to a
better healthcare future are now condemning just about anyone who
insists that the absence of a public option makes the current bill
unworthy of support.

Consider this statement: "If I were a senator, I would not vote for
the current healthcare bill. Any measure that expands private insurers'
monopoly over healthcare and transfers millions of taxpayer dollars to
private corporations is not real healthcare reform."

That statement is as true today as it was when Howard Dean, former
chairman of the Democratic National Committee, made it three months ago
in a Washington Post op-ed. But now, a concerted political blitz is
depicting anyone who takes such a position as a menace to "real
healthcare reform."

After devoting vast amounts of time, money, energy and political
capital to banging the drum for the public option as absolutely vital
during 2009 and through this winter, countless liberal organizations and
prominent Democrats in Congress have made a short-order shift.

You are now to understand that the public option isn't essential --
it's expendable. And all of the sudden, people who assert that a public
option is a minimal requirement for meaningful healthcare reform are no
longer principled -- they're pernicious.

This dynamic goes way beyond the routine malleability of political
positions. While the whips crack on Capitol Hill, what we're seeing is a
stampede of herd doublethink.

*****

I continue to believe that guaranteed healthcare -- a.k.a.
single-payer or enhanced Medicare for all -- is the only way to solve
this country's enormous healthcare crisis. But early last year, before
the public option shrank and shrank some more and then disappeared under
the bus of the Obama administration, it appeared to possibly be a
significant step forward.

But the White House, even while claiming to want a public option,
was cutting deals with the pharmaceutical and hospital industries while
ditching the public option. For those who doubt that the administration
engaged in double-dealing to such an extent, I recommend the March 16
article by Huffington Post writer Miles Mogulescu, "NY Times Reporter
Confirms Obama Made Deal to Kill Public Option."

A postscript from Mogulescu voices a broader outlook. I'll quote a
couple of paragraphs here:

"Whenever I write blogs which are critical of Obama and
Congressional Democrats for making corporatist deals, I get numerous
comments from people who believe they are progressive but say they will
never vote for Obama or Democrats again, that they will stay home at the
next election, or that they will vote for small third parties who have
no chance of winning. It's not my intent to encourage those views. Do
people making these comments really think bringing Republicans back to
power would make things better? . . .

"Progressives need to have a sophisticated and nuanced relationship
with elected Democrats. After the 2008 elections, too many progressive
organizations demobilized believing their job was simply to take orders
from the White House to support Obama's agenda, whatever it was. That
was a mistake. It's equally a mistake for progressives to overreact in
the opposite direction and think they can abandon electoral politics and
do nothing to prevent the Republicans from regaining power. What's
needed is a powerful grassroots progressive movement to force elected
officials to do the right thing more often and to counter-balance the
power of big money in politics. The periods of progressive change in
American politics, like the Progressive Era, The New Deal, and the Great
Society, have come when strong progressive movements have forced elites
and elected officials to enact somewhat progressive legislation."

The dynamic now in full force on Capitol Hill was aptly described
by Dean in his Post op-ed midway through December: "In Washington, when
major bills near final passage, an inside-the-Beltway mentality takes
hold. Any bill becomes a victory. Clear thinking is thrown out the
window for political calculus. In the heat of battle, decisions are
being made that set an irreversible course for how future health reform
is done. The result is legislation that has been crafted to get votes,
not to reform healthcare."

A week after Dean's article, the Senate approved the healthcare
bill that is now on track to be "deemed" by the House -- with the avid
support of Dean and numerous other public-option enthusiasts, and also
for that matter with the support of Rep. John Conyers and many other
single-payer enthusiasts (including, as of Wednesday, Rep. Dennis
Kucinich).

The quality of the Senate healthcare legislation hasn't improved in
the three months since Dean condemned it. What has gone over the top is
the cacophony of voices and pressures to tout doublethink as virtuous
pragmatism.

*****

But there are big problems with skipping lightly past the absence
of a public option in the current bill. And none is bigger than the
reality of the individual mandate in the legislation.

It's remarkable and sadly revealing that boosters of the bill have
scarcely mentioned -- much less publicly come to terms with -- the dire
implications of a nearly enacted law that requires people to have health
insurance and offers no option other than further enriching the private
insurance industry.

Last year, when the subject came up, progressive supporters of the
White House's general approach were quick to offer assurances that a
public option would mitigate the unpleasant aspects of mandated
coverage. After all, the story went, people could select a nonprofit
government-run entity for insurance coverage rather than being forced to
choose between corporate insurance policies.

But now, if the pending bill becomes law, people will be forced to
choose between corporate insurance policies.

Meanwhile, all the hype about how 30 million more Americans "will
be covered" fails to deal with the quality and cost of their purported
coverage, much less how much real access to healthcare will actually
result.

For many, the available coverage would be bottom-of-the-barrel
quality -- and even then, given thin personal finances, would cause
added strains to pay for premiums. In the absence of public-option
health insurance run for purposes other than maximizing profits, the
built-in unfairness of an individual mandate becomes magnified.

What's more, the very concept of healthcare as a human right will
be fundamentally undermined by placing the health-insurance burden on
individuals. Many who receive government subsidies will routinely
struggle to make ends meet, while making do with shoddy health plans as
part of a new configuration of healthcare apartheid. And, inevitably,
the extent of government subsidies will be vulnerable to attacks from
politicians eager to cut "entitlements."

On a political level, the mandate provision is a massive gift to
the Republican Party, all set to keep on giving to the right wing for
many years. With a highly intrusive requirement that personal funds and
government subsidies be paid to private corporations, the law would
further empower right-wing populists who want to pose as foes of
government "elites" bent on enriching Wall Street.

With this turn of the "healthcare reform" screw, the Democratic
Party will be cast -- with strong evidence -- as a powerful tool of
corporate America. But the Democrats on Capitol Hill and the
organizations eagerly whipping for passage are determined to celebrate
the enactment of something called "healthcare reform."

*****

"When I use a word," Humpty Dumpty said, "it means just what I
choose it to mean -- neither more nor less."

"The question is," Alice replied, "whether you can make words mean
so many different things."

"The question is," Humpty Dumpty responded, "which is to be master
-- that's all."

Many well-informed and insightful people are now hoping that the
current healthcare bill will become law and then lead to something
better. But few backers want to dwell on its requirement that everyone
get health coverage from the private insurance industry -- a stunning,
deeply structural transfer of humongous power and wealth that would
greatly boost the leverage of an already autocratic corporate state.