Health Insurance Reform: How your precious bodily fluids got sapped

Anyone who takes health insurance reform seriously recognizes that universal government-funded health care is the only way to eliminate the abuses of the health insurance industry and control costs to the point that per capita spending on health care in the US falls more or less into line with other developed countries rather than running 50%-100% higher.

Call it single-payer, call it Medicare For All, whatever; it’s what will work in this country because it’s the most straightforward, most familiar, least complicated and most easily understood system. Barack Obama is on record supporting it; only before we get there, he said, “we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

But when it began to look as though those things were going to happen, candidate Obama backed way off, saying that while he still supported a single-payer plan in theory—“If I were designing a system from scratch, I would probably go ahead with a single-payer system”—in practice, he now supported massively subsidizing the health insurance industry, although he didn’t put it quite like that, because “a lot of people work for insurance companies, a lot of people work for HMOs … let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”

The devolution of Obama’s fondness for single-payer isn’t surprising; it wasn’t so much foreshadowed as trumpeted. He announced in advance his intention to include the health insurance and pharmaceutical industries in the crafting of his insurance reform legislation—which has now nonsensically become “health reform”—and to exclude single-payer advocates. It’s one of the few campaign promises he has fought hard to keep.

Now we’re at a point where the president has resorted to classic doublespeak. In a mass email sent out last week by Organizing for America, the Obama campaign machine, the organization’s director, Mitch Stewart, says that “[t]he President does not believe we can address a problem this big incrementally,” while Obama said last week that the subject had been completely explored and now was the time to act.

We began our push to reform health insurance last March, in this room, with doctors and nurses who know the system best. And so it’s fitting to be joined by all of you as we bring this journey to a close.

Last Thursday, I spent seven hours at a summit where Democrats and Republicans engaged in a public and very substantive discussion about health care. This meeting capped off a debate that began with a similar summit nearly one year ago. And since then, every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said — (laughter) — and just about everybody has said it. (Laughter.) So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and America’s businesses.

[...]Now, some also believe that we should, instead of doing what I’m proposing [tinkering around the edges of this challenge], pursue a piecemeal approach to health insurance reform, where we tinker around the edges of this challenge for the next few years.

The (Laughter) is from the White House transcript. Haha! Of course every idea has not been on the table; although the president mentioned that “some” support a “government-run health care system”, in fact the concept of universal government-funded health care was never given a hearing. House Speaker Nancy Pelosi promised single-payer advocates in Congress the opportunity to bring existing single-payer legislation to the floor for debate (she graciously allocated 20 minutes), but the big moment never arrived.

So what we have at this moment is the mischaracterization and off-hand dismissal of an approach the president once supported but now says, without explanation, is “neither practical nor realistic” in the US, and the transformation of a proposal he once described as incremental to a much weaker version of the same proposal that he now offers as more or less the final resting place of health insurance reform. And even that probably won’t pass without further buggering, if at all. RIP.

Throughout the whole process, single-payer advocates have gotten the Bill O’Reilly approach from most supporters of the various incarnations of the “public option”—whether robust or microscopic or born without a brain—and the “pass anything” approach. “Shut up! Shut up!” We are alleged to have undermined the president and his allies in Congress by failing to support whatever they’re up to at any given moment, when in fact the president and his allies in Congress have repeatedly engaged in a dramatic reenactment of the famous Peanuts scenes in which Lucy pulls the football away from Charlie Brown and he winds up flat on his back. And just like Charlie, supporters of that amorphous plan keep coming back for more. Or more accurately, coming back for less. And less.

The single-payer program can be explained in a sentence. “Everyone gets a comprehensive Medicare plan with no copays and no deductibles, and if there’s anything you want that isn’t covered you can buy supplemental private insurance for it, and it saves big, big money.” The details take a bit longer, but the proposal is about 2000 pages shorter than what’s circulating now, and it’s a whole hell of a lot easier to understand.

The current mishmash proposal takes a little longer to explain. “There’s some good stuff here and there in this bill but mostly it shovels about $50 billion a year in new revenue to health insurance and pharmaceutical firms, including a bucket of taxpayer money, by forcing millions of people to buy private insurance that will either strain their budgets or require government subsidies; it’s being paid for in part by taxes on the best employer-subsidized insurance plans, thereby providing incentives for employers to either scale back their plans or shift more of the cost to their employees; and it still leaves an estimated 10 million people uninsured.”

Let’s review. Obama plan: hideously complicated, doesn’t cover everybody, forces people to buy private insurance, further entrenches insurance companies, saves less, if any, money. Single-payer: Breathtakingly simple, covers everyone, saves very much money, breaks the insurance company stranglehold on health care delivery. But Americans are presumed to be so opposed to the simple solution that it’s not even worth explaining, let alone supporting.

And oh, yes: fixing the gaps in Medicare coverage and expanding it to cover everyone is a budget issue, which means it could be enacted through reconciliation. 51 votes in the Senate …