Wayne O’Leary

Hollow Reform

Let me get this straight. According to the White House, the main roadblock to decent health-care reform, the one party responsible for spoiling the pudding, for fouling the nest, is not the insurance cartel, not Big Pharma, not the hospital lobby, not the AMA, not Joe (“the Weasel”) Lieberman (I-Conn.), not Harry (“Hapless”) Reid (D-Nev.), not Rahm (“Let’s Make a Deal”) Emanuel (D-White House), not Max (“Donations Accepted”) Baucus (D-Mont.), not Ben Nelson (D-Neb.) or Blanche Lincoln (D-Ark.) or Mary Landrieu (D-La.) or Olympia Snowe (R-Maine), or even the lock-step, knee-jerk GOP. No, the culprit is ... (Wait for it) Howard Dean! Yes, Dr. Dean is the one, the only spoilsport potentially preventing a happy Democratic ending for President Obama.

In fact, the president is so detached he apparently doesn’t know what’s in his own signature initiative, which was long ago contracted out to congressional lobbyists. Dr. Dean, on the other hand, has been on the health-care case for years — as Vermont governor, as presidential contender, as student of the issue and author of a book about it. And in rejecting the Democrats’ explicit sellout, he knows whereof he speaks. Moreover, he’s earned the right to expound on the subject, certainly more so than Barack Obama and his amen chorus of party compromisers.

The Dean critique — that what’s left of health reform is barely worth passing into law — accurately sums up where things stand. Majority members of Congress are either cynically in thrall to the insurance industry and other medical “stakeholders,” or delusional to the point of believing their own exaggerated rhetoric about what’s being accomplished; they simply can’t or won’t enact the kind of reform that’s truly needed.

The Obama administration is no better. Its spokespersons insist the emerging plan will insure everyone — or practically everyone. In reality, the government is insuring no one; it’s forcing the heretofore uninsured to insure themselves. They will do this by involuntarily entering an “exchange” to choose among largely indistinguishable private health policies they may or may not be able to afford, depending on their income levels and subsidy eligibility.

There will not, it appears certain, be anything called a public option, nor any possibility that the uninsured, or anyone else, might buy into Medicare, nor any chance individual states can opt for a state single-payer plan. This means the 20 to 30 percent cut in premiums readily available through a public, nonprofit program open to all and partnered with Medicare — a figure confirmed by both the conservative Lewin Group and the liberal Commonwealth Fund — is by the board. Furthermore, the estimated 160 million who now have increasingly expensive, employer-based private coverage will be stuck with it; they can’t enter any health exchange, and without a competitive public option, there’s no reason why they’d want to anyway. As a result, most Americans will see little positive change; skyrocketing premiums and deductibles will continue to work their financial devastation unimpeded.

Hopes that a public option would provide interim competition for private insurers and eventually evolve into a broad public-insurance system (the Edwards idea) have been dashed for now. The Wall Street-dominated for-profit system that exists has been locked into place — news of this development sent health-insurance stocks soaring in December — and no corresponding effort has been made to exert downward pressure on its pricing policies through rate regulation. It seems inevitable that at some juncture businesses, as well as individuals, won’t be able to meet the ever-rising insurance tab, and the whole sorry edifice will reach a tipping point.

In the meantime, so-called reform will be an effort at modest insurance, as opposed to health reform: the compensated elimination of the most morally egregious industry practices (e.g. requiring companies to insure those with “pre-existing conditions,” but offsetting that proviso by imposing few limits on what they can charge) combined with the ultimatum that the uninsured cover themselves in order to help deficit hawks “bend the curve” of national health-care costs.

The Obama health plan, with an individual self-insure mandate, not an entitlement, as its central feature, is remarkably similar, philosophically, to the Clinton tough-love welfare reform that ended guaranteed federal support and put the onus on individual recipients. Both programs contribute to America’s outlier status when it comes to social policy. In contrast to most Western nations, which place the responsibility for health care and poverty reduction with their national governments, the US has chosen to place it with the affected portions of its population. Under “reform,” health care will be neither a right nor a privilege, but a self-financed requirement. Get yourself insured; it’s the law!

Another similarity of Obama health reform to Clinton welfare reform is that, in both cases, liberal politicians have promised to improve the more onerous aspects of their handiwork in the future. Promises are cheap, however; we’re still waiting for Clintonian welfare reform to be “fixed” after 13 years. As far as health reform is concerned, this is it for the near-term future. Congressional majorities such as the Democrats now enjoy rarely come along, and the current changes will not even debut until 2013 and will not be fully phased in until 2019. This will allow the administration to more easily meet its self-imposed 10-year spending limit of $900 billion for implementation, but it will also allow years more of insurance-industry exploitation, systemic chaos, and continued suffering. In addition, the spending ceiling means less in the way of needed individual subsidies, which, in any case, are actually transfer payments from the taxpayers to the insurers.

In truth, genuine health-care reform, not to be confused with the pending legislation of the same name, will be some time in coming. Like victory in the Cold War, achieving it will necessitate a long twilight struggle. Regrettably, the parameters for what’s presently being called reform were limited from the outset to whatever wouldn’t unduly upset or anger the insurance and pharmaceutical industries, so nothing’s been fundamentally altered. The political battle to divorce health care from the profit system, to enact the government-run, single-payer program we should have gotten in 2009, begins the day after President Obama signs the existing flawed legislation into law — or, depending on how you look at it, applies lipstick to the pig.

Wayne O’Leary is a writer in Orono, Maine.

From The Progressive Populist, Febuary 1, 2010