Making excuses for health care non-reform

WITH THE results of the 2008 elections, liberals thought they had a "perfect storm" of conditions that would allow them to win fundamental reform of the health care system.

They had a Democratic president who said in campaign speeches that he considered health care a "right" for all Americans. They had a large Democratic majority in the House of Representatives and a "filibuster-proof" 60-vote Democratic majority in the Senate. And they had an economic crisis whose ravages illustrated the need for health care reform, while discrediting the free-market Republicans who had been one of the main obstacles in the past.

Yet less than a year later, with congressional committees working their way through a $1 trillion health care overhaul, the sense of despair emanating from liberal quarters is palpable.

"[T]he White House has taken an issue more intimate and immediate than perhaps any other in a voter's life and transformed it into an abstract, technical argument about long-term actuarial projections," wrote Nation magazine Washington editor Christopher Hayes. "It's a peculiar kind of reverse political alchemy: transforming gold into lead."

What's more, opinion polls taken in recent weeks show a drop in support for President Obama, stemming largely from the continued deterioration of the economy and perhaps, surprisingly, by increased doubts about Obama's plans to reform health care.

What happened?

Much of the commentary has centered on Obama's failures to "take charge" of the debate, mobilize his supporters, knock congressional heads together or campaign on populist grounds to build public support for an easy-to-grasp health care bill.

While all of these criticisms have merit, they don't get at what it is that Obama and the Democrats are actually trying to sell. Grasping that is the key to understanding why the campaign for reform has seemed so lackluster.

PERHAPS ALL one has to know is that the various proposals for health care reform kicking around the Congress have drawn support from the main pharmaceutical industry lobbying group, America's Health Insurance Plans (a.k.a., the biggest health insurers), the American Medical Association, and a host of other organizations that, in the past, have opposed any notion of health care reform.

The White House and Congress have worked closely for more than a year with these "stakeholders," along with liberal organizations like the Service Employees International Union, Families USA and Health Care for America Now (HCAN), to craft a health care reform that will be as inoffensive to the insurance and medical industries as possible.

The insurance industry faces a shrinking "market" of profitable patients as the population ages and more employers drop or cut back health care benefits. Therefore, the prospect of a government-enforced "individual mandate"--that forces individuals to carry health insurance as states require drivers to carry car insurance--is too tempting a "reform" to pass up.

Mandates, along with billions in government subsidies for the uninsured, with no effective controls on the costs of insurance or medical care--could turn health care reform into a bonanza for insurers.

If the insurance industry tried to sell this massive corporate welfare scheme, it couldn't get away with it. That's why the liberal wing of the capitalist political establishment, the Democratic Party, serves them well.

The "stakeholders" are writing the legislation, and Obama's campaign for it has seemed to pay more attention to satisfying them than to mobilizing public opinion on behalf of real health care reform. Meanwhile, liberal politicians and the organizations that support them have tried to counter the right-wing scaremongers' campaign against any reform with often-passionless words of reassurance.

Many liberals who are honest with themselves know that what's likely to emerge from Congress falls far short of anything that would be considered genuine reform. Still they've chosen to make a fight around a reform that sounds good on its face: the inclusion within it of a "public option" to buy health insurance in competition with the health insurance giants.

But when one investigates further, one finds a lot less to support in the public option. Unfortunately, many of the liberals are trying to make the public option seem to be something that it is not.

As Kip Sullivan recently documented in an article posted on the Physicians for a National Health Program Web site:

The people who brought us the "public option" began their campaign promising one thing but now promote something entirely different. To make matters worse, they have not told the public they have backpedaled. The campaign for the "public option" resembles the classic bait-and-switch scam: tell your customers you've got one thing for sale when in fact you're selling something very different.

When the "public option" campaign began, its leaders promoted a huge "Medicare-like" program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation's largest health insurer, public or private. But today "public option" advocates sing the praises of tiny "public options" contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the "public options" described in the Democrats' legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the "public options" cannot, by themselves, have any effect on the number of uninsured. But the leaders of the "public option" movement haven't told the public they have abandoned their original vision. It's high time they did.

Assuming the "public option" even makes it into the final version of the bill that passes Congress, it is likely to be too weak to have much impact on the health care crisis.

A recent Wall Street Journal report noted that one proposal for the public option would include three tiers of available coverage based on ability to pay. And the recent intra-Democratic deal with the conservative House "Blue Dogs" seems to have included a commitment to make the public option play by the rules of private insurance. If either of these "compromises," ends up in the final bill, this public insurance plan will be worthless.

If the public option sticks around long enough, it will likely become a dumping ground for the sickest and poorest people that the private health insurance companies don't want to cover. As a result, it could end up like the federally funded Pension Benefits Guarantee Corporation, the place where private companies doing away with their defined benefit pension plans send retirees--and where retirees receive federally funded, but much-reduced pensions.

FOR LIBERALS who are committed to the lesser-evil setup of the two corporate parties in U.S. politics, there seems to be no other way. When the other main party appears to be in the grip of troglodytes who want to scuttle the possibility of health care reform altogether, the liberals end up clinging even more strongly to ever dwindling pieces of legislation that can be dressed up as reforms.

The simple truth is that, for all of the rhetoric last year about the "progressive movement's role" in electing Obama, and the vaunted network of millions of people mobilized for the campaign, all this amounts to little in the White House's political calculations. And progressives know it. Chris Bowers, editor of the liberal Open Left blog, perfectly summarized their dilemma:

Even though the legislation that has been signed into law in 2009 has been, due to a variety of factors, much more moderate than progressive, the success or failure of that policy will still determine the public perception of the efficacy of progressive policies and ideology for a long time to come.

For example, right now, the stimulus package pretty much equals left-wing economic philosophy in the eyes of the American people. If it doesn't produce results, we are all going to see our ideas become discredited in the eyes of the American public, even if we thought policies of the Democratic trifecta did not go nearly far enough. The country is never going to say, "Well, that idea didn't work, so let's try a more extreme version of it." People just don't think that way in America.

Whether Bowers is right about "how people think" in America is beside the point. His statement is a perfect example of how liberals think.

Given this constrained vision--where the "progressive agenda" becomes increasingly melded with the White House's agenda--even liberal complaints about Obama's concessions to corporations and "centrist" politicians fall by the wayside. Perversely, of course, this gives even greater license to the White House to make concessions to business and conservative politicians.

Until there is independent pressure from a mobilized social movement, combined with a real political challenge from Obama's left, the type of reforms--even the prospect of reforms--are likely to follow the pattern we're currently seeing in the health care debate.