The Senate’s health care fiasco

FROM BAD to worse to--utterly wretched.

That's the course of so-called health-care "reform" in the Senate. The final version of the legislation is so filled with giveaways to big insurance companies that even leading liberal Democrats are threatening to join Republicans in opposing it.

While the right wing is still shrieking about a government takeover of health care, what's really shaping up is a complete industry stranglehold over government policy.

The public option--a proposal for a minimal government-run health plan available to the uninsured--was road kill early on. Now Sen. Joe Lieberman has singlehandedly blocked a Senate effort to extend Medicare to people aged 55 rather than the current 65--even though he made just such a proposal a few months earlier.

Yes, the Senate plan would extend coverage to the uninsured--by forcing them to buy policies, whether they can afford them or not. Millions of people will have to buy high-premium, low-quality insurance through private health insurance exchanges, or be forced to pay a penalty. Those plans won't cover abortions, if a handful of right-wing Democrats and Republican conservatives have their way.

And remember President Barack Obama's vow to prevent insurance companies from discriminating against individuals with preexisting conditions? That's in the proposed bill--but if you've got such a condition, you could pay up to 50 percent more for your coverage. Ditto for older people, who could pay premiums up to three times higher than younger people.

If you're lucky enough to have a high-quality employer-sponsored insurance plan, you can keep it if you want, as Obama often says. But you'll pay for it, big-time. The Senate has taken Obama's plan to tax "Cadillac" health insurance plans--typically those won by union members over decades--even further, so now more modest "Chevy" plans will be taxed, too.

And under current legislation, today's unaccountable corporate health insurance giants would become even more monstrous. They'd be able to move their nominal base of operations to states with the weakest consumer protection laws in order to shield themselves from patients with complaints. And they'd be shielded from much of current regulation.

As former Labor Secretary Robert Reich wrote:

From the start, opponents of the public option have wanted to portray it as big government preying upon the market, and private insurers as the embodiment of the market. But it's just the reverse. Private insurers are exempt from competition. As a result, they are becoming ever more powerful. And it's not just their economic power that's worrying. It's also their political power, as we've learned over the last 10 months.

THROUGHOUT THIS corporate perversion of health care reform, liberal organizations have mostly bit their tongues and gone along. Health Care for America Now, a coalition that includes labor groups like the Service Employees International Union (SEIU), has continued to put out vague advertisements and calls for action without challenging Obama's capitulation to the insurance and pharmaceutical lobbies.

But the post-Lieberman Senate bill is so awful that some liberal groups are considering jumping ship. The AFL-CIO, for example, held an emergency meeting to discuss whether or not to oppose the legislation.

Liberal Democrats are also being pushed to the brink of opposition--or at least talking about it. Leading the charge is former presidential candidate and former Democratic National Committee chair Howard Dean, a physician, who wrote:

Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform...Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG.

The legislation is now so bad that it presents the Democrats with an impossible dilemma. If they fail to pass health care reform, they will be seen as incapable of governing. But if they do push the legislation through, they'll face a backlash--not only from the Republican right, but from large sections of their voting base who will be socked with higher taxes now, and won't even be able to access the new insurance plans until 2014--and pay premiums that are likely to be still higher than they are today.

HOW DID we get here? How could Barack Obama so spectacularly squander his mandate and give a handful of "moderate" senators nearly total control over health care legislation?

Part of the answer is Obama's repeated commitment to "bipartisanship"--an effort to get both main parties to support what is sold as "historic" legislation. But given that the Republicans are determined to oppose Obama on virtually everything but his war drive in Afghanistan, such efforts were doomed from the start. The administration's strategy had the effect of putting so-called "moderate" Republicans like Maine's Olympia Snowe in command of the process.

But Republican intransigence is only part of the problem. The main reason for this debacle is the nature of the Democratic Party itself. It's not just that a key Senate figure on health care, Max Baucus, is a top recipient of campaign funds from the health insurance industry. Nor can all the blame be placed on Rahm Emmanuel, the pro-corporate New Democrat who runs the Obama White House.

The problem is more fundamental. Big business has dominated the U.S. political system since the rise of industrial capitalism more than a century ago. But in recent decades, corporate dominance of Congress has reached new levels. Health care reform has turned toxic for the same reasons that bankers have gotten trillions of taxpayer money from Congress while hard-pressed indebted homeowners have gotten almost nothing. Bankers, like the health care companies, lavish legislatures with campaign contributions and offer key members of Congress second careers as highly paid lobbyists.

What about Obama, who invoked social movements in his campaign for the presidency? The fact is that Obama was never the outsider he portrayed himself to be. His political rise had grassroots support, yet it was also sponsored by powerful businesspeople and Democratic officials.

Obama came to Washington not to transform the system, but to try to repair its image after eight years of George W. Bush and run it more competently. In other words, Obama's priorities were chosen for him by the established power brokers--not just on health care, but every other issue, from the economy to the wars in Iraq and Afghanistan.

Some reform of the health care system makes sense for the capitalist class. But capital is determined to push the costs of any changes onto workers. Obama will try to sugarcoat that process, but he won't alter its pro-business character.

Certainly, the White House has committed plenty of strategic blunders and tactical stupidities in the process of coming up with legislation. But the reality is that health care is negotiable for Obama--while, for example, his commitment to advancing the aims of the U.S. empire is not. When it comes to Afghanistan, Obama is prepared to move decisively and send 30,000 troops to Afghanistan to kill and be killed. Yet in the face of a threat from Joe Lieberman, he caves on health care in a day--and sends his spokespeople to attack Howard Dean for telling the truth about this terrible health care bill.

Millions of people voted for Obama because they believed he was a vehicle for progressive change--not least on the issue of health care. Many will still be tempted to support the current legislation, if only because the right has made it such a battleground.

But the reality is that everyone interested in genuine health care reform should try to stop this legislation and build a movement for something truly progressive--a single-payer system that would provide decent health care for all.