Have We Been Had on Health Care Reform?

It's irritating to read about the latest wrangling over health care (insurance) reform in the U.S. Senate. Clearly, the process is being controlled by A) the health care industry, B) the pharmaceutical industry C) compromised whack jobs like Joe Lieberman and Ben Nelson and, even worse as it turns out, D) President Obama and Harry Reid. Who's on the side of ordinary Americans? Only those Senators who are brazen enough to dare pissing off the Dem Party's big donors by proposing real reform, cost cutting and expansion of access. Of course the Dems have any number of Senators whose positions are excellent on health care reform issues. New Mexico has two of them. But what power do they have in a caucus run by weak-kneed Harry Reid?

Old Harry allows Senate Dems to be dominated by the obstructionist demands of a handful of sell outs led by the venal Joe Lieberman. Apparently Obama and Reid are content to sit on the sidelines and allow the President's old Senate mentor to hold forth and twist the legislative process however he wants, with no threat of any punishment or blowback from the White House. Instead, Obama sends Rahm Emanuel and other White House operatives to pressure progressive Dems to cave in to the demands of industry lobbyists and their pets.

Bye Bye Public Option, Hello Crumbs?
One has to wonder at the self-destructiveness of the Dem strategy on this -- on what is viewed as our signature issue. We've watched the public option be pumped as the end all and be all of reform, without which the legislation isn't worth passing. A significant majority of Americans continue to support the public option, even if they have no idea of what it really is or how weakened and deformed it's become in the hands of corporate manipulators.

Now, as we move towards a finalized bill in the Senate, we're suddenly presented with a new end all and be all in the form of Medicare expansion. If this is a terrific idea now, why wasn't it a terrific idea during all those months when the Gang of Six was fiddling while Rome burned? We're switching horses this late in the process? I guess there must be some crumbs thrown to the masses given the triggered and weakened public option that remains, at least for now, in the mix. Suddenly a strong public option isn't necessary if we have expanded Medicare and a few other elements thrown into the mix to placate progressives? Talk about changing horses in mid-stream.

I'm all for expanding Medicare -- I think it should be expanded to allow everyone to buy in immediately -- but if it's only for those aged 55-64, how can it be an effective replacement for a robust public option? Those younger than 55 will be stuck having to buy expensive coverage from the usual for-profit suspects, with absolutely no downward pressure on premium costs. No way does that make up for the lack of a strong public plan to compete with the for-profit sharks.

Another proposal aimed at convincing people we don't need a genuine public option comes in the form of an opportunity for folks to purchase insurance through the federal employee benefit plan. That sounds appealing, but is it? Will it do anything to make health coverage affordable?

Greedy Insurers and Big Pharma Triumph
So what will we get if the Senate bill ends up as reported? Robert Reich lays out the inadequacy of the current reform proposal -- including the Medicare expansion and proposed access to the federal employee benefit plan -- in no uncertain terms:

But we still end up with a system that's based on private insurers that have no incentive whatsoever to control their costs or the costs of pharmaceutical companies and medical providers. If you think the federal employee benefit plan is an answer to this, think again. Its premiums increased nearly 9 percent this year. And if you think an expanded Medicare is the answer, you're smoking medical marijuana. The Senate bill allows an independent commission to hold back Medicare costs only if Medicare spending is rising faster than total health spending. So if health spending is soaring because private insurers have no incentive to control it, we're all out of luck. Medicare explodes as well.

A system based on private insurers won't control costs because private insurers barely compete against each other. According to data from the American Medical Association, only a handful of insurers dominate most states. In 9 states, 2 insurance companies control 85 percent or more of the market. In Arkansas, home to Senator Blanche Lincoln, who doesn't dare cross Big Insurance, the Blue Cross plan controls almost 70 percent of the market; most of the rest is United Healthcare. These data, by the way, are from 2005 and 2006. Since then, private insurers have been consolidating like mad across the country. At this rate by 2014, when the new health bill kicks in and 30 million more Americans buy health insurance, Big Insurance will be really Big.

From the start, opponents of the public option have wanted to portray it as big government preying upon the market, and private insurers as the embodiment of the market. But it's just the reverse. Private insurers are exempt from competition. As a result, they are becoming ever more powerful. And it's not just their economic power that's worrying. It's also their political power, as we've learned over the last ten months. Economic and political power is a potent combination. Without some mechanism forcing private insurers to compete, we're going to end up with a national health care system that's controlled by a handful of very large corporations accountable neither to American voters nor to the market.

Meanwhile, we get word that Reid inserted a loophole in the Senate bill that allows insurers to maintain the authority to impose dollar limits on coverage -- one of the horrors that health insurance reform was supposed to stop.

As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not “unreasonable.” The bill does not define what level of limits would be allowable, delegating that task to administration officials.

If that's not bad enough, we also have Obama and Reid fighting against a useful tool for bringing down pharmaceutical costs -- allowing the importation of prescription drugs from Canada and Europe:

Despite all the talk about “bending the cost curve,” President Obama and Harry Reid have declared all-out war on cost control. They are in the process of doing everything they can to kill Byron Dorgan’s bipartisan drug re-importation amendment. They have delayed the vote on his amendment for days (effectively filibustering their own bill), had Lautenberg create an 11th hour poison pill amendment to gut Dorgan’s amendment (which has a safety trigger–see, this is how triggers are used in Washington to kill good ideas), and may try to bring final cloture on the bill to stop a vote from ever taking place on the amendment.

... What is sickening is that Obama campaigned on this rather small, common sense cost controlling idea. Yet Obama traded away drug re-importation to PhRMA in a sweetheart deal. He also traded away direct drug price negotiation in the same deal. Obama and Reid have clearly taken the side of protecting corporate profits instead of bringing down health care costs for regular Americans.

Scrap It and Use Reconciliation?
Given all this, is the Senate bill worth supporting? I know that Obama has publicly said that, at this point, he wants a bill, any bill, to secure a political victory. The question is, will the current legislation make things better or worse? After all the complicated negotiations, does anyone really know?

I'd love to hear what Senator Jeff Bingaman and Senator Tom Udall have to say about the latest permutation of the Senate bill and why it merits passage. I'm starting to believe it might be better to abandon a bill shaped by some of the worst actors active in the process and stifled by the Senate's obstructionist 60-vote requirement. We could easily get many good reforms passed piecemeal, via the reconciliation process, which requires only a simple majority for success. How low can we let the Lieberman-Nelson-lobbyist contingent go and still have a bill that has any chance of significantly improving the provision of health care to all our citizens?

The crux of the matter is whether Obama would prefer passage of a bill that meets the demands of the crazy-corrupt Senators just so he can declare a victory -- or if he's willing to do what's right and push through real reforms in the Senate using reconciliation. Given his past reluctance to rock the "moderate" boat, I'm afraid Obama will put politics before people. I hate to say it.