Better than nothing or worse than nothing?

Judging from Barack Obama's speech, the final version of health care "reform" could be so compromised by concessions that it would amount to nothing more than a grand exercise in corporate welfare for the insurance industry.

PRESIDENT OBAMA'S September 9 speech on health care reform seemed to regain some of the momentum he lost during the summer. The question is whether that will turn out to be a good thing or a bad thing.

Columnist: Lance Selfa

Lance Selfa Lance Selfa is the author of The Democrats: A Critical History, a socialist analysis of the Democratic Party, and editor of The Struggle for Palestine, a collection of essays by leading solidarity activists. He is on the editorial board of the International Socialist Review.

Certainly, many people who want a genuine reform of the irrational, wasteful and cruel system of health care delivery in this country were happy to see Obama draw the line against right-wing smears that have been flung his way.

But reform supporters shouldn't get carried away.

While they were still clapping for Obama's calling out of the hysteria around "death panels" as "a lie, pure and simple," Obama managed to slip in two concessions to the right--his hitherto unannounced health care plan wouldn't cover undocumented workers (the rebuttal that prompted cracker congressman Joe Wilson of South Carolina to shout "you lie" at the president), nor would it allow federal funding for abortion.

Liberals like MSNBC's Keith Olbermann and Rachel Maddow were so enthralled with Obama's refutation of right-wing talking points--and so happy to give Wilson a well-deserved bashing--that they didn't even ask two key questions: Why shouldn't anyone, regardless of immigration status, be eligible for health care? And why shouldn't women expect to have an essential health care procedure, abortion, covered under a reformed health care system?

President Obama speaks on health care reform to a joint session of Congress  (Larry Downing | Reuters)President Obama speaks on health care reform to a joint session of Congress (Larry Downing | Reuters)

Apparently, "universal health care" isn't really universal after all.

If Obama's and the Democrats' health care plans are so willing to toss immigrants and women's health care overboard, what does this say about the rest of the health care reform?

When you peel away all the rhetoric, you find a pro-corporate program that offers the carrots of "insurance reform" and subsidies for low-income people in return for the stick of forcing the uninsured to buy insurance.

In his speech, Obama used stories of insurance industry atrocities to make the case for measures like barring companies from denying people coverage because of "preexisting conditions." No doubt, these were among the most well-received parts of his speech, aimed as they were at health insurance companies, one of the most hated institutions in the country.

Yet Obama moved on to describe the requirement for people to carry insurance as comparable to state requirements for drivers to carry auto insurance--and he said this was necessary to prevent individuals from "gaming the system."

However flippantly, he at least made clear what has been obscured in the health care debate so far--that "universal health care" is a euphemism for forcing people, under penalty of law, to buy health insurance.

In all the tumult over "death panels," the "public option" and Medicare funding, hardly anyone has even commented on whether requiring people to buy health insurance is fair or feasible. Even the "don't tread on me" tea-party types--always ready to object to the oppressive hand of government--have hardly raised an objection to this. Why?

In the main, the prospect of a new, 40 million-strong, government-created "market" for its defective product has kept the insurance industry--though it has nevertheless helped to fund some of the opposition to health reform--on board with the administration's overall approach.

The industry is willing to furnish propaganda against the "socialism" of allowing the uninsured to have the choice of buying insurance from a publicly funded vendor--the so-called "public option. But it has no problem with the government forcing people to buy its product, no matter how expensive or insufficient it is.

Despite the town hall theatrics of August, none of the major industry players that have been working with the Obama administration--the insurance lobby, big Pharma, hospitals, the American Medical Association--have jumped ship. This, more than anything else, should assure that something called "health care reform" will pass the Congress.

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IN AUGUST, when the right wing captured the initiative with its demonstrations at congressional town hall meetings, it became common for liberals to mock elderly protesters who warned members of Congress to "keep your hands off my Medicare." Either these people were too stupid to know that Medicare is a government program, or they were too selfish to care about the uninsured, the argument went.

Bob Cesca, writing on Huffington Post, put it this way: "I don't claim to know the full stories behind the variety of senior citizens who have been recruited to disrupt these town halls, but one thing is clear. They're participating in a corporate lobbyist-driven campaign to prevent the rest of us from acquiring the same affordable, reliable public health care they enjoy."

But conservatives, however cynically, have tapped into genuine anxiety among the elderly about Medicare, and the left would be foolish to discount it.

After all, when Obama talks about financing his plan with $500 billion in "savings" from "waste, fraud and abuse" in the Medicare program, the elderly hear "cuts"--and they're right.

When Obama called for, in a little-noticed passage in his speech, the creation of an "independent commission of doctors and medical experts" charged with searching for waste in the program, he was endorsing a policy-wonk idea of an unelected commission to lower hospital reimbursement rates for hospitals and doctors--another way to enforce cuts to Medicare spending without making elected representatives implement the cuts.

And if Medicare recipients are skeptical of government promises, perhaps it's also because their experience with Medicare itself isn't as great as proponents of health care reform often assume. Although liberals hold up Medicare as an example of an efficient and generous health insurance system, it actually suffers from many of the deficiencies and irrationalities of the private insurance system on which it is modeled.

Medicare recipients pay premiums, co-pays and substantial parts (between 20 percent and 50 percent) of their medical bills. Medicare Parts A and B don't even cover many essential types of health care. Medicare Part C fills the gaps in Parts A and B, but at a cost to seniors. And Part D, the prescription drug benefit, requires seniors to buy insurance from private insurance companies.

As Medicare recipient and health care advocate Mary Lynn Cramer wrote recently on CounterPunch:

There is no way anyone could say that Medicare by itself is adequate coverage for all. It is not even adequate for the seniors who rely on it. I would like to see the Obamas and members of Congress try to cover their medical expenses with this so-called "single-payer" program. They would never trade the comprehensive coverage they have for Medicare. Medicare needs to be expanded to cover all basic medical needs (set out above). However, that is not in the President's plan for health care reform.

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FOR OBAMA and progressives on Capitol Hill, all of the problems that remain in preserving the private health insurance-based system are supposed to be solved with a "public option" that will, as Obama said, hold the insurance companies "accountable."

The public option, a government-funded entity offering health insurance for the uninsured in competition with private insurers, is the main part of Obama's plans that liberals have pledged to fight for. In July, members of the House Progressive Caucus even threatened to vote against health care reform if a strong public option wasn't part of the bill.

Ever the clever speaker, Obama managed to say enough in his speech about the "public option" to give progressives the feeling that he would fight for it, while not actually committing to it being in the bill. And since the speech, a number of conservative Democrats, Republicans and Washington pundits have already proclaimed it a dead letter.

If these efforts succeed, a bill could pass that requires the uninsured to buy insurance from private health insurance companies that are responsible for much of the mess in the current health care system. Without even the pretence of "accountability" that the public option is supposed to provide, health care reform would simply be a grand exercise in corporate welfare for the insurance industry.

More likely, a bill including something called a public option will pass, but it will apply to so few Americans (Obama suggested "fewer than 5 percent") and be so hemmed in by industry-friendly regulations that it will, at best, resemble something like Medicare Parts A and B described above.

In case you think that the House Progressive Caucus won't allow such a travesty to pass, think again. Already, many leading progressives are qualifying their strong stands in favor of a "robust public option" so as to ready themselves to vote for whatever health reform package makes its way through the Byzantine protocols of the U.S. Senate.

So we may end up with health care reform by the end of this year. The real question will be whether it helps ordinary Americans--or the medical-pharmaceutical-insurance-industrial complex.