I Read the News Today, Oh Boy.....

I must confess that I’ve been out of the loop. Until just now I missed the latest flurry of legislative activity surrounding the most recent efforts of President Obama and the Democratic Party leadership to move forward with a House reconciliation bill that would allow the previously passed the Senate health care reform package to become law. Unfortunately, despite over three weeks of a virtual news blackout, clearly nothing has changed. The previously passed Senate bill and the last-minute legalistic tinkering being undertaken by the House will do nothing to provide the people of the United States with any meaningful protection from predatory insurance practices, employer health insurance abuses, exorbitantly priced pharmaceuticals, and the very real ongoing risk of adding bankruptcy to the stress and misfortune of serious illness.

Max Baucus's early and vigorous exclusion of meaningful reform proposals like single payer have stuck.

The Senate bill which was really written by Liz Fowler, the former VP for public policy and external affairs for Wellpoint, the nation’s largest for-profit insurance company, is in reality a windfall for the health insurers through direct Federal subsidies and lack of regulatory oversight. In addition to not being held accountable for flogging a fatally flawed product and shamelessly profiteering on the backs of the sick and unfortunate, now the power of the State through the IRS will be employed to compel more people than ever to participate in the insurance industry’s extortion. Rather than providing health insurance itself (or heavily regulating it a la Germany), the Government is compelling it's citizens to buy an intrinsically flawed, market-based product. Rather than building a safer ship or even installing better navigation equipment or improving watch procedures, the Senate bill packs even more passengers onto the Titanic. This ship of fools, too, will come to grief and seal the fate of even more potential victims of the US healthcare system than the estimated 45,000 excess annual deaths already caused by lack of health insurance. The only really good news is that this travesty of “reform” won’t even take effect until 2014. But it’s highly unlikely that this 4 year hiatus will allow for the replacement of this legislation with something like single-payer which could actually save the government $400 billion a year or improve the dismal health outcomes so often found in the US. No, even if the bill passes, I fear the Democratic “leadership” will declare “mission accomplished” (maybe they could stage it on a cruise ship instead of an aircraft carrier) and we’ll be saddled with yet another crazy quilt “system” that reinforces the rest of the developed world’s accurate impression that US healthcare is immoral, corrupt inhumane and just plain bizarre.

Perhaps saddest is the sense of resignation that has resulted in the capitulation of even some of the most passionate advocates of meaningful reform like single-payer. I’m referring specifically to the disappointing announcement by Dennis Kucinich that he would vote for this bill in an effort to get something, anything, passed. I really don’t fault him since he has had no support whatsoever from the Democratic Party. The complete failure of leadership on the part of Barack Obama, Harry Reid, and Nancy Pelosi is simply breathtaking -- and in my most cynical moments I think is simply indicative of the crying need for campaign finance reform and reclaiming our democracy from the power of corporate lobbyists and influence.

I have contemplated trying to enumerate all the problems with the latest legislative effort but it’s clear to me that I will never be able to write anything nearly as comprehensive and succinct as the comparison below that appeared in Jane Hamsher’s blog FireDogLake: http://fdlaction.firedoglake.com/ Ms. Hamsher is perhaps the one political writer I know of who best articulates the compelling case for rejecting the current “reform” legislation.

Here amidst all the propaganda, disinformation, misunderstanding, and willful lies is the naked truth about the woeful inadequacy of the proposed “reforms”. (Thanks again, Jane Hamsher!)

Myth	Truth
1. This is a universal health care bill.	The bill is neither universal health care nor universal health insurance. Per the CBO: Total uninsured in 2019 with no bill: 54 million Total uninsured in 2019 with Senate bill: 24 million (44%)
2. Insurance companies hate this bill	This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009. The original Senate Finance Committee bill was authored by a former Wellpoint VP. Since Congress released the first of its health care bills on October 30, 2009, health care stocks have risen 28.35%.
3. The bill will significantly bring down insurance premiums for most Americans.	The bill will not bring down premiums significantly, and certainly not the $2,500/year that the President promised. Annual premiums in 2016, status quo / with bill: Small group market, single: $7,800 / $7,800 Small group market, family: $19,300 / $19,200 Large Group market, single: $7,400 / $7,300 Large group market, family: $21,100 / $21,300 Individual market, single: $5,500 / $5,800* Individual market, family: $13,100 / $15,200*
4. The bill will make health care affordable for middle class Americans.	The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can’t afford to use. A family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible.
5. This plan is similar to the Massachusetts plan, which makes health care affordable.	Many Massachusetts residents forgo health care because they can’t afford it. A 2009 study by the state of Massachusetts found that: 21% of residents forgo medical treatment because they can’t afford it, including 12% of children 18% have health insurance but can’t afford to use it
6. This bill provide health care to 31 million people who are currently uninsured.	This bill will mandate that millions of people who are currently uninsured must purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties. Some will be assisted with government subsidies.
7. You can keep the insurance you have if you like it.	The excise tax will result in employers switching to plans with higher co-pays and fewer covered services. Older, less healthy employees with employer-based health care will be forced to pay much more in out-of-pocket expenses than they do now.
8. The “excise tax” will encourage employers to reduce the scope of health care benefits, and they will pass the savings on to employees in the form of higher wages.	There is insufficient evidence that employers pass savings from reduced benefits on to employees.
9. This bill employs nearly every cost control idea available to bring down costs.	This bill does not bring down costs and leaves out nearly every key cost control measure, including: Public Option ($25-$110 billion) Medicare buy-in Drug reimportation ($19 billion) Medicare drug price negotiation ($300 billion) Shorter pathway to generic biologics ($71 billion)
10. The bill will require big companies like WalMart to provide insurance for their employees	The bill was written so that most WalMart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage
11. The bill “bends the cost curve” on health care.	The bill ignored proven ways to cut health care costs and still leaves 24 million people uninsured, all while slightly raising total annual costs by $234 million in 2019. “Bends the cost curve” is a misleading and trivial claim, as the US would still spend far more for care than other advanced countries. In 2009, health care costs were 17.3% of GDP. Annual cost of health care in 2019, status quo: $4,670.6 billion (20.8% of GDP) Annual cost of health care in 2019, Senate bill: $4,693.5 billion (20.9% of GDP)
12. The bill will provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition.	Access to the “high risk pool” is limited and the pool is underfunded. It will cover few people, and will run out of money in 2011 or 2012 Only those who have been uninsured for more than six months will qualify for the high risk pool. Only 0.7% of those without insurance now will get coverage, and the CMS report estimates it will run out of funding by 2011 or 2012.
13. The bill prohibits dropping people in individual plans from coverage when they get sick.	The bill does not empower a regulatory body to keep people from being dropped when they’re sick. There are already many states that have laws on the books prohibiting people from being dropped when they’re sick, but without an enforcement mechanism, there is little to hold the insurance companies in check.
14. The bill ensures consumers have access to an effective internal and external appeals process to challenge new insurance plan decisions.	The “internal appeals process” is in the hands of the insurance companies themselves, and the “external” one is up to each state. Ensuring that consumers have access to “internal appeals” simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an “external appeals process,” as there is neither funding nor a regulatory mechanism for enforcement at the federal level.
15. This bill will stop insurance companies from hiking rates 30%-40% per year.	This bill does not limit insurance company rate hikes. Private insurers continue to be exempt from anti-trust laws, and are free to raise rates without fear of competition in many areas of the country.
16. When the bill passes, people will begin receiving benefits under this bill immediately	Most provisions in this bill, such as an end to the ban on pre-existing conditions for adults, do not take effect until 2014. Six months from the date of passage, children could not be excluded from coverage due to pre-existing conditions, though insurance companies could charge more to cover them. Children would also be allowed to stay on their parents’ plans until age 26. There will be an elimination of lifetime coverage limits, a high risk pool for those who have been uninsured for more than 6 months, and community health centers will start receiving money.
17. The bill creates a pathway for single payer.	Bernie Sanders’ provision in the Senate bill does not start until 2017, and does not cover the Department of Labor, so no, it doesn’t create a pathway for single payer. Obama told Dennis Kucinich that the Ohio Representative’s amendment is similar to Bernie Sanders’ provision in the Senate bill, and creates a pathway to single payer. Since the waiver does not start until 2017, and does not cover the Department of Labor, it is nearly impossible to see how it gets around the ERISA laws that stand in the way of any practical state single payer system.
18 The bill will end medical bankruptcy and provide all Americans with peace of mind.	Most people with medical bankruptcies already have insurance, and out-of-pocket expenses will continue to be a burden on the middle class. In 2009, 1.5 million Americans declared bankruptcy Of those, 62% were medically related Three-quarters of those had health insurance The Obama bill leaves 24 million without insurance The maximum yearly out-of-pocket limit for a family will be $11,900 (PDF) on top of premiums A family with serious medical problems that last for a few years could easily be financially crushed by medical costs

*Cost of premiums goes up somewhat due to subsidies and mandates of better coverage. CBO assumes that cost of individual policies goes down 7-10%, and that people will buy more generous policies.

Documentation:

1. March 11, Letter from Doug Elmendorf to Harry Reid (PDF)

1. The AHIP Plan in Context, Igor Volsky; The Max Baucus WellPoint/Liz Fowler Plan, Marcy Wheeler
2. CBO Score, 11-30-2009
3. “Affordable” Health Care, Marcy Wheeler
4. Gruber Doesn’t Reveal That 21% of Massachusetts Residents Can’t Afford Health Care, Marcy Wheeler; Massachusetts Survey (PDF)
5. Health Care on the Road to Neo-Feudalism, Marcy Wheeler
6. CMS: Excise Tax on Insurance Will Make Your Insurane Coverage Worse and Cause Almost No Reduction in NHE, Jon Walker
7. Employer Health Costs Do Not Drive Wage Trends, Lawrence Mishel
8. CBO Estimates Show Public Plan With Higher Savings Rate, Congress Daily; Drug Importation Amendment Likely This Week, Politico; Medicare Part D IAF; A Monopoloy on Biologics Will Drain Health Care Resources, Lancet Student
9. MaxTax Is a Plan to Use Our Taxes to Reward Wal-Mart for Keeping Its Workers in Poverty, Marcy Wheeler

1. Estimated Financial Effects of the “Patient Protection and Affordable Care Act of 2009,” as Proposed by the Senate Majority Leader on November 18, 2009, CMS (PDF)
2. ibid
3. ibid
4. ibid
5. Health insurance companies hang onto their antitrust exemption, Protect Consumer Justice.org

1. What passage of health care reform would mean for the average American, DC Examiner
2. How to get a State Single Payer Opt-Out as Part of Reconciliation, Jon Walker

1. Medical bills prompt more than 60 percent of U.S. bankruptcies, CNN.com; The Patient Protection and Affordable Care Act Section‐by‐Section Analysis (PDF)

So, if you still think the proposed legislation is better than nothing, you’ll still have four years to wait to see how bad it really will be. In the interim, an additional 180,000 people will die for lack of health insurance; the insurance industry will continue to raise premiums unchecked; big Pharma will continue to gouge consumers and systematically lobby to deprive them of any meaningful collective bargaining arrangements to reduce costs; personal bankruptcies -- often among the insured -- will continue to accelerate; and globally, US healthcare will become even more synonymous with institutionalized human rights abuse through market-based denial of health care. In fact, it will probably be far more than just four more years of this wretched status quo. Through this colossal failure of leadership we may have squandered our very best chance to implement reform for a long time to come. That is, of course, unless we manage to elect a new generation of political vertebrates who will do the right thing. Got hope?

I really regret that I am so comprehensively pessimistic, but I see nothing in this health reform process to convince me that our politicians have anyone’s best interests at heart other than their own. If this were not the case we would see something more meaningful. As hard as it is to say this, I think I understand the anger, frustration and mistrust of the rank and file Tea Baggers.(But far less so their leaders.) Unfortunately, they simply don’t realize the depth of their ignorance and the degree to which they been manipulated by and played into the hands of the very political forces they profess to reject. As I said in a previous post, the solution is ethical, responsive government -- of the We-The-People sort-- that reflects the values and compassion of our communities that really do care for one another. That is really the only way we can join the ranks of all the other developed countries who employ democratic processes to carry out this most vital of democratic functions.

Next, we’ll see how things are set up in New Zealand, with a dose of reality based on a busy week in the trenches in Darfield on the South Island. Not surprisingly, it’s not perfect and there have been a few surprises, but ultimately everyone gets cared for without bankrupting individuals or the government.We'll see how they do it.