In Matt Taibbi’s article in Rolling Stone, “Sick and Wrong,” Taibbi points out that the current health insurance system in the US not only leaves 47,000,000 Americans uninsured, but also
forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it's a miserable failure:….profits [are] sapped by millions of customers who enter the system only when they're sick with incurably expensive illnesses.
Alas, Taibbi also sees all sorts of problems with the probable versions of health insurance reform. First, he doesn't see how any combination of the five different Congressional drafts of health care reform will lower cost, which a single-payer system might actually have accomplished:
There are currently more than 1,300 private insurers in this country….. Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for [it].
Single-payer would probably create its own types of wasteful administration, but it’s hard to say how much. Nonetheless, single-payer is a system with many advantageous, and the current way health insurance is structured in the US is almost certainly unsustainable.
Another problem Taibbi sees with health insurance reform is the
so-called "individual mandate"…currently included in four of the five [health care reform] bills before Congress. The most likely version to survive into the final measure resembles the system in Massachusetts…[which] imposed tax penalties on citizens who did not buy insurance.
But it includes a catch:
If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the [also proposed] insurance "exchange," [a subsidized marketplace of more affordable plans to choose from]. In other words, you must take the insurance offered to you at work. And that might have made sense if…employers actually had to offer good care. But in the Senate version [of health care reform] passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care…. Which means… "If you have coverage you like, you can keep it," says Sen. [Bernie] Sanders. "But if you have coverage you don't like, you gotta keep it."
Taibbi offers this summation:
[H]ere's what ended up happening with health care. First, they gave away single-payer before a single gavel had fallen, apparently as a bargaining chip to the very insurers mostly responsible for creating the crisis in the first place. Then they watered down the public option so as to make it almost meaningless, while simultaneously beefing up the individual mandate, which would force millions of people now uninsured to buy a product that is no longer certain to be either cheaper or more likely to prevent them from going bankrupt. The bill won't make drugs cheaper, and it might make paperwork for doctors even more unwieldy and complex than it is now.
Taibbi blames this situation on a lack of leadership from The White House, a tendency among Democratic members of Congress to sound progressive but negotiate and vote largely to preserve the status quo, and the influence—largely through lobbyists—of pharmaceutical and health care companies’ efforts to scuttle reform. However, ends his list of shame and blame with November 2008's Obama true believers, specifically, the absence of
the same electorate that poured its heart out last year for the Hallmark-card story line of the Obama campaign…. The handful of legislators — the Weiners, Kuciniches, Wydens and Sanderses — who are fighting for real [health care reform] should be doing so with armies at their back. Instead, all the noise is being made on the other side. Not so stupid after all — they, at least, understand that politics is a fight that does not end with the wearing of a T-shirt in November.
I think Taibbi is right to criticize the more starry-eyed demographic of 2008's Obama-voters, whose victory, it should be pointed out, depended on the relatively more conservative--sometimes much more conservative--legions of independent voters fed-up with eight years of GOP scandal, politics of personal destruction, and incompetence, deciding to give the young, mixed-race Senator from Illinois a chance to address some pretty big national problems. It's among these voters, who also tend to be older, that Obama and the idea of health care reform lost the most support, and for the same reason that the true believers were missing in action--and who may remain so: White House miscalculation. The President was too much hands-off, the message and organizing machine idled, as if somehow health care reform would take care of itself, as if Obama's personal style--the very bedrock of the successful campaign for the presidency--somehow wouldn't be needed or--more likely it was decided: should be very, very carefully rationed, as if the right-wing media machine would be quiet, as if things like racial politics just wouldn't enter into it. Too much was perhaps taken for granted.
Now, in the days following the President's address to a Joint Session of Congress during which President Obama was interrupted and literally called a liar by a right-wing member of not only the House of Representatives, but of the newly radicalized, no longer apolitical, and more overtly quasi-racist Sons of Confederate Veterans (SCV), [1] it is clear that leading public opponents of the President will continue to resort to extreme measures and intellectual dishonesty, and that racism may simmer underneaththe debate's surface. We will see a continued scramble by the White House to save some semblance of health care reform. The White Hosue may be successful; Congress might even come up with something a few Republicans can vote for. But, if Taibbi is right, the White House and Congress will, in this round at least, be successful in saving something that shouldn't have been the goal in the first-place: something less than a new single-payer system that is free or of nominal cost at the point of care--such as is the case in Canada and the United Kingdom, or, at the very least, a highly regulated and standardized network of interconnected private health care insurance institutions--such as is the case in Switzerland. Either way, the totally for-profit and completely fee-for-service obsessed system we have now, just isn't going to cut it anymore.
Many progressives will agree with Taibbi and when they look at 2009's reform measures, whatever they may be, see anything less than a reform to a single-payer system to be no real reform at all. Many moderates may end up feeling otherwise, and will very likely declare that whatever health care reform passes in 2009, it will be a proverbial "good start." Many conservatives will dislike whatever is likely to pass. They will probably find themselves unable or unwilling to voice support for even specific aspects of the reform they may agree with, because they will be too insignificant to note in light of the overall reform plan's violations of ideologies opposing spending or involvement by the government in any realm--except the industrial-military complex, of course.
I suspect 2009's reform measures will e enormously expensive. Too expensive to tolerate very long without enacting long overdue cuts in our nation's defense spending, too expensive to tolerate without more cost and efficiency measures. But, at least some quality policies will probably have been established, such as a prohibition on denying or dropping coverage by insurance providers when an applicant or customer has or develops a medical condition. Ironically perhaps, conservatives will ignore a basic principle of the economy of scale, and continue to resist something like a national database of medical records or standards imposed on all providers, without exception, that unify medical record-keeping systems, because most modern-day Republicans will see in such an efficiency measure the specter of "Big Brother," or will see it as government "telling businesses how they have to run themselves;" never mind that it would generate the greatest possible type of cost-saving that's now understood to be possible in the entire health care debate. Or is it that, to today's Congress in general, saving money isn't that important after all, not when it might result in some short-term discombobulation among insurance company's leaders and administrators, who, after all, directly and indirectly help fund a lot of political campaigns--and not just those of conservatives.
Personally, I feel that the failure to move decisively towards standardized electronic systems of medical record keeping is a colossal missed opportunity, quite frankly just as bad for the health care system's long-term future as a lack of a public option might be for the health care system's short-term future. It's not just a failed opportunity to save hundreds of billions of dollars in administrative costs--thus helping make health care more affordable for everyone involved--but a failure to leave unaddressed well-known deficiencies in maintaining patient's medical histories and in sharing information between a patient's various doctors and specialists.... deficiencies that can actually have fatal consequences.
As is always the case, history will pass judgment on these matters, but, as history is by definition, pass judgments well after the fact, in this case, only after America's citizenry has been slogging through health care reform for who knows how much longer, and finding itself who knows where?
(Photo by Public Citizen)
