Sunday, August 16, 2009

Has the Health Care Battle Been Lost?

Comedian John Marshall put it best: Obama has dropped the "health" and "care" provisions from health care reform. "Some will be upset that we didn't get everything we wanted, or anything, even," said the spokesman. "But we've worked hard to come up with a compromise that both Republicans AND the insurance companies find acceptable, and still they hate us like we ran over their family pet."

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."


Anonymous said...

Infuriating if not at all surprising.

You make a strong case on the policy merits for walking away from this stinking pile that is the emerging "viable" plan. I will continue to follow the debate and can imagine scenarios where a clearly inadequate plan is adopted that is nonetheless much better than the SQ. But the momentum is definitely not in the desired direction.

A good case on the politics can be made for progressives to walk away as well, though I suspect very, very few will in Congress. (Though Brown, Sanders, and a few others claim they have the votes and the willingness to kill any bill that does not include a robust public option and the Progressive Coalition in the House has also taken a similar hardline; the game is not quite over).

But the politics are not good in that this stinking pile of corporate garbage (compelling people to buy insurance that won't cover them when needed, won't provide coverage for all uninsured, won't eliminate the ~25% of health expenditures that is useless paper pushing and another unknown pct. that is pointless corporate profits, etc., etc.) will come to occupy in popular consciousness a role as "this is progressive health care".

No. It's not. It's largely a corporate giveaway.

It is time to think much more strategically about achieving what we really want: single-payer.

This is starting to look less and less like Dr. Dean's 'give the coverage then improve it' stepping stone and much more like a successful PR campaign to kill real reform now and in the future.

We will see. I am very pessimistic at this point and think we need to figure out how to position the fallout from whatever happens as a consequence of corporate health care and market values and not of progressive health care.

We are losing on both the policy and politics fronts at the moment.

Anonymous said...

The above is from Detroit. I like that handle, btw.

matt said...

Detroit. We have come full circle. Two years ago, on this very blog, you told me it was condescending of me to eschew working people's faith in Democrats, because health care might make an incremental difference in the life of a single mother. Because I at least somewhat agreed with you, I attempted to engage a plurality of progressive tendencies and have been doing so ever since, as you know.

This is a lot of people's moment of truth.

What scenario, precisely, can you imagine where things are better? Does Obama win on pre-existing conditions, with a few exceptions? Does the cost of care go down a few hundred to a few thousand bucks across the board per year? I can see those as small gains, but I'm not totally sure they will even happen. Is there any lesson to be learned from this beyond: "Go with the Democrats for tiny gains, or form a genuine and united left alternative and take a leap of faith into a world of uncertainty"? It's time to start talking about the latter, I think, but I'm more interested in what everyone else thinks, and I imagine the podcast will be busy on that question tomorrow night...

But above all, I agree with you about single payer. The best possible strategy I see is a LOT of single payer memes being spread everywhere, a lot of detailed and patient conversations in public and private fora, and a national demonstration (a million people for single payer?)...

We have a lot to talk about, everybody.

Anonymous said...


I readily concede that my position continues to evolve. Only an idiot remains fixed in a view for all time. In a world that is changing, people who do not become a problem.

However, you mischaracterize the argument I made then. It was not that working people should retain blind faith in Democrats on health care regardless of any and all circumstances. It was a response to you saying that working people should look askance at any and all of their efforts. I was (implicitly) defending SCHIP at the time. That bill did make a difference in the lives of many, many, single mothers. It should not have been opposed because it was tepid and not single-payer.

And I could not (or more accurately did not) anticipate that the upwelling then occurring would be channeled into a bill that appears to be as bad as what we may get from the current process.

My argument was, more or less, that you appeared to start from the premise that nothing good can come from working with the Democrats, where I argued that this conclusion awaited the hurly burly of the sausage making. That and that you offered no alternative to the person without the means or time to engage in the revolutionary changes while their kid was dying on account of lack of care. At least that is how I remember it. Like everyone I engage in selective memory. My underlying objective was to hear you articulate to that mom why she should wait for your revolution. Still have not heard that answer.

I am pretty intelligent but no Nostradamus. Still, in the interest of moving the debate forward, I am happy to say I was wrong and you were right.

As far as where we go from here, yeah, that is the debate we need. What I am saying now is that the piece of garbage that is now (most likely) going to pass must be seen in the eyes of the public when it fails as a consequence of not going far enough to the left rather than proof that progressive health care reforms don't work. My fear is that if progressives fight too hard for what appears to be emerging is that we will own the stench even though in reality six f*ckers on the Senate Finance Committee will have written an breathtakingly effective corporate giveaway.

We need to militate against that spin directed at disenchanted folks and make sure people understand that when they are forced to by crappy insurance that does not help them, maybe get those benefits they happen to receive from their employers taxed, etc., it is because Dems chickened out in the face of GOPer and corporate pressure, not because the right was correct.

The single most helpful thing now I believe would be for Sanders, Brown, etc., and the Progressive Caucus to continue to hold the line: No robust public option, no health care bill. It is the necessary ingredient for any bill, pretty much regardless of other elements, to be effective over the long term.

Then progressives and Dems could go into 2010 arguing that it was GOPers who killed real reform. If progressives and Dems are viewed as owning a bad GOPer bill, we are all screwed. Though, to be fair, since the current bill starts with the public option, if it even survives, in 2013, they can go into 2010 touting their success and maybe fixing it later?

All I know is that we have a lot riding on the Sanders of the world not caving.

matt said...

Check your email, then. Single Payer Now! We can build a political culture around the demand.