Keeping real reform off the table

June 18, 2009

The Democrats say that single-payer is "unrealistic," but the real pipe dream is the idea that concessions and half-measures will do anything to solve the health care crisis.

THE HEALTH care industry is determined to strangle any proposal in Washington for real reform--and the Democrats are acting as accomplices.

Barack Obama's administration and party leaders in Congress have given up without a fight on a single-payer system that could actually solve the health care crisis--and they're allowing the measures they do claim to support to be gutted of anything that might make a difference.

Support for a radical overhaul of the health care system, with a leading role for government-run programs, has never been greater. But with health care legislation expected to take shape over the coming weeks, it seems like Democrats are giving away the store before it even opens--in the name of bipartisanship and political "realism."

This is already a pattern with Barack Obama's White House--promises of "change we can believe in" raise expectations, but the administration concedes to business and conservative political interests on all the important questions, and we're left with policies that differ little, if at all, with the status quo.

Barack Obama discusses health care reform on the campaign trail

History shows there's only one way to break that pattern--a struggle from below that forces the politicians to cave to our side.

OBAMA PROMISED that all sides would be represented in the debate over health care policy, but one proposal was excluded from the start--single-payer, which would eliminate for-profit private insurance companies and cover all Americans under a government system.

While the administration rolled out the red carpet for industry representatives, advocates of single-payer had to kick up a fuss just to be invited to the White House summit on health care in March.

Obama even concedes that single-payer would be the way to go "if I were starting a system from scratch"--but that it would be economically and politically untenable now. Instead, Obama's proposal revolves around a so-called "public option"--the creation of a government-run plan that would be a competitor with private ones, giving people a choice if they didn't like their other options and "keeping the private insurers honest," in Obama's words.

The problem is a public option would still leave private insurance intact, and enjoying unhindered profits from the market for employer-based health insurance, which covers the majority of Americans. Since 78 percent of people who had to file for bankruptcy in 2007 because of overwhelming health care costs started out with insurance when they got sick, it's clear that the health care crisis isn't just about insuring the uninsured.

Nevertheless, Obama's "public option" will seem appealing to many people as at least a step in the right direction--and maybe even progress toward the goal of a nationalized system, since a government-run option that provides quality care without the inflated costs and lack of accountability of private insurers would certainly appeal to a lot of people.

But this is exactly why big business is working so hard to make sure any public option would be crippled from the start by restrictions and limitations--and therefore unable to succeed as an effective alternative.

Moderate Democrats and a few Republicans are floating elaborate schemes and formulas to constrain the public option--for example, splitting up control of a public plan among third-party regional administrators or, worse, all 50 states. Other proposals would require the public option to operate exactly as private insurers do--or put off its creation for years, and then only if it were "triggered" by the private system failing to meet certain (easily manipulated) criteria.

These proposals would guarantee that a public option is a failure. The only way for a public plan to bring down costs and premiums--and thereby out-compete private insurers--is if it used its leverage as a national program to bargain with drug companies and health care providers for lower costs.

Of course, the insurance industry would rather not have a public option at all. It's mounting a multimillion-dollar p.r. campaign to smear a public plan as "unfair"--as if the standard by which fairness should be judged is insurance company profit rates rather than the quality of health care for actual people.

But if the health care bosses do have to tolerate a "public option" in some form, they want it to be as hamstrung as they can make it.

Remember, the health care industry isn't just thinking about profits drying up if a "public option" succeeds. If private insurers can keep the government from encroaching on their market, there are huge sums of money to be made off health care reform. Legislation will be designed to get health coverage for the uninsured, in one way or another. If the plan subsidizes the uninsured going into private plans, that's upwards of 50 million new customers to extract money from over the coming years.

THIS OUGHT to be the perfect moment for supporters of genuine health care reform to make their case.

For one thing, the right wing is still working off the same old discredited talking points--the myths that a government-run system would be inefficient, too expensive and prone to bureaucracy.

Anyone who's had to battle an HMO to get approval for an operation or see a specialist or any of a million other pieces of privatized red tape will doubt these claims immediately.

But even on their terms, the lies about government health care programs are easily exposed. For example, between 1997 and 2006, health spending per person (for similar benefits) grew by 4.6 percent per year under the Medicare system, and by 7.3 percent annually under private health insurance. Medicare enrollees rank their health coverage more favorably than those in private insurance plans. And as far as bureaucracy is concerned, average administrative costs in the Medicare system are around 2 or 3 percent--compared to more than 25 percent for private insurers.

"If Democrats enact a public-option health-insurance program," Republican strategist Karl Rove warned darkly from his new perch on the Wall Street Journal editorial page, "America is on the way to becoming a European-style welfare state."

The question that will come immediately to mind for millions of Americans is: What the hell is wrong with that?

This is an important point. The reason a single-payer system is considered "politically unrealistic" isn't because Americans won't support it. A January New York Times/CBS opinion poll, for example, found that 59 percent of people are in favor of government-provided national health insurance. Even the less favorable surveys show a 50-50 split.

And half the popular opposition that does exist to single-payer would disappear overnight if a political leader of the stature of Barack Obama spoke openly and honestly about what's wrong with the for-profit system--and why a government-run system would be better.

No, the reason single-payer is dismissed as a "pipe dream" is that Corporate America wants it that way--and it has the power over Republicans, Democrats and the media establishment to make sure that this has become the conventional wisdom.

But the real pipe dream is the idea that some form of a public option--inevitably compromised and constrained by members of Congress counting votes, and by an administration that doesn't want to alienate business interests--will solve health care crisis.

It won't--and under the proposals floating around Congress right now, it will make things worse.

So the question that needs to be asked of those who promote Obama's public option proposal as a "realistic" alternative to single-payer is: Why should we be for something we don't want? Shouldn't we instead speak up for what we do want?

That's not to say that a single-payer victory is around the corner. Health care is big business--worth $2.4 trillion a year in the U.S. economy and about 18 percent of gross domestic product. The wealthy corporations that profit from the system won't be giving that up without a fight.

But by the same token, our side won't win any reforms worth having by accepting the limitations of what's "realistic"--because that means accepting what the industry is willing to give up.

We also won't win anything without a struggle. In the absence of pressure from below, the politicians are certain to concede to the pressure of corporate interests from above.

Right now, a small but important core of activists--health care workers chief among them--are continuing the fight for single-payer. This core needs the support of the labor movement and other organizations of working people to grow stronger.

There aren't any short cuts. The struggle for single-payer has to start where it finds itself, develop new ways to connect with the widespread sentiment for fundamental change--and keep building a voice that will be heard in the current debate, and in the years to come.

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