Thursday, December 17, 2009

The President as an Innocent Bystander On Health Care Reform

After months and months of closed-door negotiations among themselves, Senate Democrats are about to pass a nauseating health care reform bill that does little or nothing to contain costs and the greed of the insurance companies and their political allies. We are told that the bill is imperfect, but that its opponents should still vote for it because “it will save lives.” That is certainly a worthy goal, but one that can be achieved without pickpocketing the American people's already thinning wallets.

Gov. Dean is right when he says that the reconciliation route must be entertained to outflank health care reform opponents, the thieving and immoral senators, like Joe “Douche Evilman” Lieberman, Blanche Lincoln, Ben Nelson, Max Baucus, Tom Carper, Kent Conrad, and Mary Landrieu, who are putting their political future and their sponsors' interests ahead of the American people's. Use reconciliation—says Gov. Dean—not as Sen. Landrieu says “to create a new government bureaucracy, but to expand an existing one: Medicare. The Senate had the right idea when it considered letting people 55-65 buy into Medicare. It should go even further: it should let anyone choose to buy into Medicare, regardless of age. As Gov. Dean tried in vain to explain to Sen. Landrieu during yesterday's Hardball with Chris Matthews, the Senate is about to force 300 million Americans (through the insertion of an individual mandate) to buy a product they might not want, or openly despise, and depriving them of real choice by taking a way a government-administered health care option.

There are other ways of reforming health care, of course. Medicare for all or a public option are not the only ways to ensure that people have guaranteed, affordable access to health care. Other countries have shown us the way. You can keep a private insurance-based system in place and provide efficient, reasonably cheap care to your people, but you have to support it with fierce regulation, for example by denying insurance companies the right to make a profit on basic health care services. In other words, they must operate as a non-profit for basic care. Switzerland and, I believe, the Netherlands, already do that. Other countries, like Japan, have decided that the way to go is to set the rates providers can charge patients, thus limiting the profit potential of providers. And yet, there are over 6,000 insurance companies in Japan, so the argument that negotiating rates or setting strict market rules is an insurance company killer is in fact just a meme, advanced by reform opponents here in the U.S.

But what about the argument that any reform that saves lives is worth passing, regardless of its pitiful shortcomings, made by many liberals such as Paul Krugman, Ezra Klein, Josh Marshall, etc, not to mention the White House? That may be true, but that is also precisely why Democrats should go the reconciliation route. Use reconciliation to do what it is supposed to do: save money and achieve budget neutrality. Then come up with an insurance regulation bill, one that bans exclusions for pre-existing conditions, or that prevents insurance companies from charging sick people three or four times the going rate. Prohibit insurance companies from dropping people's coverage at their whim. Mandate a medical loss ratio of at least 85% (preferably less: casinos make tons of money on the slots by keeping 2% of what gamblers bet), meaning that the industry must spend 85 cents of every dollar it takes in. And remove the monopoly exemption that, under the misused McCarran-Ferguson act, allows insurers to act as an organized crime cartel at the expense of American patients. Then, on the pharma front, allow drug re-importation so that Americans, like citizens of other countries, can reap the rewards of government negotiated rates for drugs. The key is competition, and the Senate bill (and, to a lesser degree, the House bill as well) contain no provisions in support of competition. It was not long ago that the President told us health care reform should include some mechanism to keep insurance companies honest. The current bill has none.

Going back to the “saving lives” argument: Use reconciliation to expand Medicare, and let a “regulation” bill take care of saving lives. The advantage is that only 51 votes are needed to pass reconciliation, making the passage of a Medicare for all bill a very achievable goal, without having to worry about reform-killing maneuvers by the likes of the despicable Liebermans, Landrieus, etc. Then let politically suicidal Republicans or Democrats rise in opposition of a life-saving, insurance regulation bill ahead of the mid-term election cycle, and—should they choose to call the all-in bet—enjoy the ensuing carnage.

None of this had to be difficult, had the White House decided to exert its power and influence on fence-sitting, obstructionist Democrats. But that great disappointment of a president we now have has decided to act like an innocent bystander, rather than as the leader we though we had elected in Nov. 2008. On health care reform, as on Afghanistan and on too many other important matters, he has spoken out of both sides of his mouth leading us to doubt his true motives for not offering leadership where leadership was needed.

We can apply to President Obama the same yardstick that Vice-president Biden reminded us we should apply to Sen. Lieberman's opposition of reform: question not the man's motives, but his judgment. By that measure, President Obama does not come out of this legislative effort as the squeaky clean paladin of the American people's best interest he purported to be during the campaign.

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