The great health care swindle

WHEN IT comes to the crisis in health care the adage “The more things change, the more they stay the same” couldn’t be more true. The politicians’ names may change, but the two parties don’t deviate much from the same timeworn script. The Republicans are making hysterical and ludicrous pronouncements of a “government takeover” of the health care system and President Barack Obama and the Democrats offer false promises to “keep the insurers honest,” or as House Speaker Nancy Pelosi declared, “The glory days are coming to an end for the health insurance industry.” How can that be when the private insurers had most of the seats at the table, shaped the legislation into what was acceptable and what was not, and are spending $1.4 million dollars a day lobbying members of Congress? Would these wealthy corporations willingly agree to end their “glory days” of astronomical profit making?

The health care debate gripping Washington happens about every twenty years. Two things have coalesced to force the government to attempt reform once again: the economic depression and record numbers of uninsured (50 million and counting). Unemployment is the major factor contributing to the steep rise in the number of uninsured, because for most American workers health coverage is linked to a job.

In one comment to NBC reporter Chuck Todd, President Obama revealed how deeply the priorities of the private health insurance industry are embedded in his legislation. In the interview with Todd, Obama explained:

I want to cover everybody—now, the truth is that unless you have a—what’s called a single-payer system in which everybody’s automatically covered, then you’re probably not going to reach every single individual because there’s always going to be somebody out there who thinks they’re indestructible and doesn’t want to get health care, doesn’t bother getting health care and then, unfortunately, when they get hit by a bus, end up in the emergency room and the rest of us have to pay for it. But that’s not the overwhelming majority of Americans. The overwhelming majority of Americans want health care but millions can’t afford it. So the plan has been—that I’ve put forward and that what we’re seeing in Congress would cover, the estimates are at least 97 percent to 98 percent of Americans. There might still be people left out there who, even though there’s an individual mandate, even though they are required to purchase health care, might not get it or, despite a lot of subsidies are still in such dire straits that it’s still hard for them to afford it, and we may end up giving them some sort of hardship exemption.

One might reasonably ask that if a single-payer system would cover 100 percent of Americans, why not enact Rep. John Conyers single-payer bill H.R. 676. Answer: because that legislation eliminates the role of the private insurance industry, which makes obscenely high profits.

Obama’s comment represents a wholesale acceptance of the “talking points” the lobbying group for the health insurance industry, America’s Health Insurance Plans (AHIP), are promoting. The notion that people “don’t want” or “don’t bother” to purchase insurance, get injured and then “we” end up paying is straight from the crooked mouth of Karen Ignagni, the CEO of AHIP. Always blame the victims of the system. Or as the corporate media does, blame doctors for ordering too many tests, prescribing brand name drugs, not rationing care, and providing too much “expensive” end-of-life care. Nowhere in Obama’s comments does he acknowledge the obscene greed and wealth of the health care CEO’s and stockholders, the real source of crisis. From 2000 to 2007, health insurance profits grew from $2.4 billion to $12.9 billion. Under Obama’s plan, Ronald A. Williams, CEO of Aetna, will continue to make $18,608,778 a year.

Representative Peter Welch, a Democrat from Vermont, admitted in an article in the New York Times, that “under the agreement, private insurers are coming off unscathed.… They do quite well—too well, frankly.”

The insurance industry wants a legal requirement that millions of people buy private coverage and punishment for those who don’t. The Congressional Budget Office (CBO) estimates that people who disobey the mandate and don’t purchase insurance would pay $29 billion in penalties over ten years. Moreover, the House legislation allocates billions of dollars to subsidize those who can’t afford insurance premiums—an outright transfer of money to the insurance industry. But where the money will come from is still being hotly debated. The “Blue Dog” Democrats oppose taxing the rich to fund and expand coverage, but are entertaining the idea of taxing workers’ health benefits.

There was one moment of honesty in the debate over funding health care reforms that are expected to cost more than $1 trillion over ten years. Douglas Elmendorf from the CBO said of the proposed House legislation: “We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.” In other words, the legislation cannot do what Obama said it must do; contain costs.

The so-called public option made it into the House legislation by a vote of 35 to 24. It’s touted as the antidote to private insurers’ greed—the way to “keep them honest.” Boosters claim that it will infuse competition into the system and bring down costs. It will do nothing of the sort. In a thoroughly researched article on the public option titled “Bait and Switch,” author Kip Sullivan shows how it can’t control costs and still leaves millions uninsured. He explained, “Any proposal that leaves in place a multiple-payer system—even a multiple-payer system with a large-government run program in the middle of it—is going to save very little money.”

Sullivan notes that the public option was originally sold as something similar to Medicare that could cover 130 million people and which, like Medicare, would cost considerably less than private insurance. Now the public option has been whittled down to a plan to cover at most 10 million. Moreover, as the CBO notes, the plan “would pay providers of health care at rates comparable to privately negotiated rates—and thus was not projected to have premiums lower than those charged by private insurance plans.”

As long as the private insurance industry is in the mix, affordable health care coverage for everyone is an impossibility because the system is based on the avoidance of sick people and denial of care—to ensure profits. It is the central logic of privatized health care in a capitalist economy.

Congress faces the same conundrum every time they address health care. In order to keep profit-making at the core of the system, which is the cause of the crisis, heavily lobbied lawmakers create legislation that is deliberately complex, confusing, full of contradictions, and offers only incremental change at best. The Obama bill is more than 1,000 (impenetrable) pages long. The legislation promises only to “rein in” the most outrageous insurance industry practices of medical underwriting and make coverage affordable, but how will they “rein in” insurers, and who decides what is affordable? The leading cause of bankruptcy is the inability to pay medical bills and the majority of those who declared bankruptcy had insurance when they got sick.

Unfortunately, the “glory days” of the health insurance industry are not over. It will take a much bigger social movement to pry health care from the greedy fingers of the private health care industry.


Issue #76

March 2011

Revolt in the Middle East: Another world is possible

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