By Bruce A. Dixon
Black Agenda Report
There are real fights and there are fake fights, engineered to distract attention away from the real deal. The shouting match between Obama’s Dems and the Tea party Repubs is one of those fake fights. The health care legislation passed by the Obama Democrats is incomparably worse than anything they could have passed right after the presidential election, and significantly worse than anything Democrats could have passed at midyear 2009. The president and his minions have delayed as long as possible to guarantee the worst, not the best bill for patients, and the best deal possible for Big Insurance, Big Pharma and Big Medicine.
The fifteen month running battle between Obama Democrats and tea party Republicans was never much more real than televised professional wrestling. Like the opposing wrestlers, both sides work for the same bosses, for Big Pharma, Big Insurance, and the biggest medical providers. The real health care fight waged by the Obama administration has not been against Republicans, who never had the votes to stop, let alone dictate or pass anything.
The administration’s effort all along has been to pass the worst bill possible, with the greatest amounts of corporate welfare and loopholes, and the fewest protections for patients, while silencing, neutering and coercing the voices of most Democrats, who have favored some form of single payer, or Medicare For All from the beginning.
The Fake Reform
On the whole, the Obama health care legislation is just plain bad. It’s fake reform. Most of the people getting medical coverage for the first time under its provisions will get through an expansion of Medicaid. The Medicaid expansion and inclusion of children in their parents’ policies till the age of 24 are perhaps the only unambiguously positive aspects of the bill, and both these could have been passed through the House and Senate at any time since the end of 2006.
Supposedly, insurers can’t refuse to insure anybody, or jack prices on the basis of pre-existing conditions, and can’t revoke policies when people get sick enough to actually use them. But so many loopholes and end runs have been written into the legislation that these and other widely ballyhooed provisions to safeguard the interests of patients are in fact meaningless. The ban on pre-existing conditions for example is negated by allowing insurers to offer “wellness” discounts. The older, the fatter, the less physically fit and the already sick need not apply for these discounts, and the fit will lose them when they gain a few pounds.
Insurance policies will continue to cherry pick their customers in the marketing, and like the credit card industry, insurers will now be able to evade already weak state regulators by selling policies across state lines. This will undoubtedly lead to concentrations of insurance companies in the least regulated states, and a race to the bottom. Health coverage that many working Americans now get will be steeply taxed, and to evade this tax employers will simply offer policies worth less, provoking yet another downward stampede.
Big pharmaceutical companies are assured exclusive rights for even longer periods than before to new classes of drugs, and insurance companies are prohibited from paying for the re-importation of drugs originally manufactured here from Canada, or combining to negotiate drug prices downward.
The ban on selling low-cost health insurance to the nation’s twelve or fifteen million undocumented means the border will now extend to every doctor’s office and emergency room in the land. And insurance policies offered through “the exchange” are prohibited from covering abortions or a list of reproductive health services.
Private insurance companies will use their all-too-real death panels to continue to decide which procedures they will cover, and which ones they won’t, and how much they will pay for them. Health insurance premiums will be capped at just under ten percent of a family’s income, but this will not include already high co-payments, or deductibles. In Massachusetts, where a version of the president’s plan has been law since 2006, sick people are forgoing treatment because they cannot afford the high co-payments and deductibles, and the flood of bankruptcies from unpayable medical bills is continuing.
The legislation is not a step toward single payer, as it removes none of the legal obstacles facing states which choose that path on their own. It’s almost a good thing that most of the bill’s provisions don’t take effect till 2014.
And of course the too big to fail private health insurers get a stream of compulsory customers, some of them paid for in part with government money.
The Fake Fight
The legislation just passed is a million miles away from anything Democrats campaigned on in the 2006-2008 run for the White House, and incomparably worse than anything House Democrats would have passed in the first months of the Obama administration. The 2007-2008 class of House Democrats included 99 co-sponsors of HR 676, the Single Payer Medicare For All. All but one or two of these were sworn in for the current Congress.
What happened? Persistent and single-minded interventions of the White House and its minions in the Senate and House Democratic leadership have relentlessly censored and excluded single payer viewpoints from the public conversation and pushed the actual legislation further and further in the directions the insurance companies, the drug companies, and the biggest medical providers desired.
The White House met continuously in early 2009 with representatives of pharmaceutical companies, and insisted that their super-profits be protected. A former VP of WellPoint, one of the nation’s top insurers was allowed to write large portions of the Senate version of the Obama bill. Senate Democratic leader Harry Reid handed the writing of its legislation over to a committee of senators who had more money from private insurers and Big Pharma than any of their fellows, and which gave its Republican members veto power over its final product.
To cover their own impotence, Democrats who had once supported single payer became outspoken advocates of a phantom policy called “the public option,” which polled well because it sounded something like universal health care or single payer, but never in fact existed. The president definitively stomped on their fake public option back in September 2009, when he said his version of it would only apply to fiver percent of the market at most, and was not essential to his proposal anyhow. House leaders balked a little, and corralled their members behind whatever the president wanted, and whatever the pea party fanatics declared they didn’t want.
A much better health care bill could have been passed at mid-year 2009, and a less good, but still somewhat better one was possible at year’s end. But the Obama administration was convinced that still more could be given to Big Insurance and Big Pharma, and so delayed the bill into 2010. Even as late as December a majority of Democratic senators were willing to pay lip service to the public option. For the Obama administration, that meant it was still too soon to pass its version of heath care.
The Real Fight
The margin and distribution of votes last weekend reveals White House effort to blame Republican obstruction and Democratic progressives for the delay in passing health care to have been utter scams. Not one Republican voted for the bill, and no Republican votes were ever needed. While the White House allowed 26 of 58 Democratic Blue Dogs to vote against the bill, including Art Davis of Alabama and John Marshall and John Barrow of Georgia, it applied incredible pressure against Dennis Kucinch and other advocates of single payer to line up behind the pro-corporate, anti health care bill. They, and the movement for real universal health care, for single payer, were the White House’s real foes.
It’s Not Over. For the next several years 18 or 20 thousand people will sicken and die each year who don’t have to, thanks now to Barack Obama and his hand picked Democratic leaders in the House and Senate. The most awful failures of this legislation will not be obvious for several years, as most of it does not even take effect till 2014. More than six hundred thousand bankruptcies truggered by unpayable medical expenses will continue to happen yearly at least till then, with their numbers not greatly reduced on the other side.
The Single Payer Movement, among whose leading organizations are the National Nurses Union, HealthCare NOW, and Physicians For a National Health Care Plan are preparing for a long struggle. Not this year or the next, but in a decade or less, many predict, single payer will be enacted. California has passed single payer three times now, but has never had a governor with the guts to sign it. Pennsylvania and a few other states are thought to be close to passing single payer on their own. That’s how it happened in Canada. One province did it, everybody saw how it worked, and it became national policy.
In health care, as in war and peace, as in the environment and education, as in the rights of women and immigrants, the First Black President’s historic role is clear. His job is to smile and speechify and neutralize the left on every front, while taking the country further to the right than his white Republican predecessor would ever have been able.
Bruce A. Dixon is managing editor at Black Agenda Report, and based in Atlanta. He can be reached at bruce.dixon(at)blackagendareport.com.