It appears that those who were hoping for genuine reform: universal coverage, substantially lower costs, and a symbolic victory for egalitarianism over corporate greed, will get none of those things. After a week that included Rahm Emmanuel taking a giant dump on the Democratic left, Obama cutting a deal promising not to allow Medicare to negotiate for lower drug prices, and Kathleen Sebelius giving the green light on insurance cooperatives rather than a public insurance option, it's difficult to see what the Obama administration hasn't bargained away, or what good news there could possibly be for the tens of millions of Americans who are an injury or sickness away from complete economic ruin, and in some cases, death.
The administration could not have signalled their willingness to jettison the public option any more clearly. Obama said it in Grand Junction, Colorado, his right wing Democratic friends said it soon after he did, and then, this morning, Kathleen Sebelius said a public option “is not an essential element" of reform.
In place of the public option? Non-profit cooperatives. What are they? The Nation's Katha Pollitt "poked around online for fifteen minutes and discovered that they're untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them—but I didn't discover what they actually are." "Cooperatives" have varying definitions, but these insurance co-ops would be "credit unions" to the "banks" of big insurance companies. Of course, a "credit union" approach to banking is a tiny bit more consumer-friendly, and maybe even a tad more reasonably priced, but the existence of credit unions doesn't stop global economic disasters, and insurance cooperatives won't solve the crisis of the uninsured. We are also reasonably certain the co-ops won't be effective (read "competitive," Selebius's favorite word) without raising taxes.
One important reason we should be suspicious of the insurance cooperative option is that Chuck Grassley likes it. Moreover, listen to why he likes it, as he asks his Senate colleagues to "go along with the cooperative movement as we've known it for 150 years in America..." Presumably that's 150 years of cooperatives failing to solve universal coverage, and presumably that century-and-a-half includes the past 50 years of corporate insurance hegemony. I'm not sure Grassley would support any proposal to fund the cooperatives in a significant way; Lord knows the rest of the GOP doesn't. Perhaps he simply proposes to pass legislation mandating that the President mention the presence of already existing cooperatives in his next State of the Union Address...give 'em a little free advertising.
According to Slate, a cooperative would have to be national to be competitive, but that would take some kind of federal gesture the GOP minority wouldn't tolerate (and hence Obama won't push for it). On the subject of funding, Slate's Chris Beam suggests,
in order to be competitive, a co-op would have to offer competitive rates to attract patients. Here co-ops run into a chicken-and-egg problem: They can't get good prices until they have a critical mass of patients, but they can't attract those patients without low prices. A new cooperative would thus need an initial financial boost—probably between $3 billion and $10 billion—to help it reach out to patients and providers alike, plus other start-up costs.
Nor will non-profit co-ops satisfy the most vocal and, apparently powerful, Republicans, who will inevitably charge that they are "government-run health care in drag." George Harris at Kansas City Star's Midwest Voices blog agrees with this assessment, reporting that some Republicans have already voiced opposition to it, though he wasn't specific about which Republicans. But for that matter, why would centrist Democrats work any harder for a non-profit option than a public option? And if Obama caved in this easily to the minority GOP and conservative Democrats, what makes anyone think he won't cave in the complaints about government-subsidized co-ops?
Miles Mogulescu speculates that, much like a watered-down public option, co-ops will be too weak to genuinely compete with insurance companies. Mogulescu, who asks whether Obama is a "Back-Room Blue Dog on Health Care" gets it half right. When it comes to relatively safe culture war issues, Obama, unlike the Clintons, can hang with the left, and do so credibly; I predict the President will eventually push harder on Gay rights and DADT, neither of which will offend the sensibilities of his corporate benefactors.
Health care is different in the same way that the bailouts were different, although the former has caused more pseudo-populist backlash than the latter. Obama, like the Clintons, like every other Democrat to the right of Kucinich (and one only wonders where Dennis's threshold is because he never needs to worry about it being tested within his party), can be a Keynesian only to a point, must accept the fundamentals of free markets, and must periodically prostrate himself before the corporate altar on questions of redistribution. Mogulescu's observant article also points out that Rahm Emmanuel told progressive Democrats they were "fucking stupid" for criticizing right wing Democrats who were gutting the public option. Although some progressives may prefer masochism in their private lives, I hope they'll walk away from an abusive relationship in their political lives, 'cause if we needed another reminder of the need to build an independent progressive coalition, this is it. I'd rather be called "reformist" by a bunch of doctrinaire Marxists and Anarchists than have the Democratic Party's Chief Asshole call me stupid. At least the radicals will be fighting for my interests and the interests of my family.
By now, dear reader, it should not surprise you that doubts are even beginning to emerge about the one aspect of reform upon which we'd thought we'd achieved universal consensus: pre-existing conditions. This is also what the administration gets for their compromising gesture of marginalizing single payer so early in the game; many of us predicted that the tactic wouldn't get anywhere. Smelling blood, now even hack Republicans like Orin Hatch are joining Palin and Limbaugh in framing universal health care as darkly totalitarian.
Katha Pollitt wonders:
Whatever happened to, um, health? Wasn't that a big part of the original case for reform? The 46 million uninsured, the 20,000 people who die every year for lack of medical care, the studies showing that people without insurance get worse care than those with it, even after car crashes? Where are all those people with infuriating stories of being denied essential care by insurance company bureaucrats, and those who thought they were covered when they weren't, and those who were hit with huge bills because of fine print in their contracts? What about the people who can't quit their jobs because they need the insurance? The people who struggle and sacrifice to pay enormous premiums? The people who cut their pills in half to save money, or who can't afford them at all? And what about doctors? My internist and gynecologist no longer even take private insurance because of the endless hassles and frustrations. Why don't we hear more about how fed up doctors are with the status quo?
Katha, I wish this debacle could be reduced to whose stories we heard, and whose promises were broken. But what "we" hear is irrelevant if it isn't what the kleptocrats want us to hear. Those calling health care Obama's "Waterloo" might consider extending the metaphor to reformist Democratic politics in general. I'd say more, but Rahm Emmanuel might call me "fucking stupid."