I Mission Impossible We knew it would be tough. Americans voted in the 111th Congress with a clear mandate to make health care universally accessible and affordable in this country. As late as this summer, a whopping three-quarters of us still wanted a Medicare style public option.
http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=1However, history has taught us that the American health care industry (which likes to call itself the best in all the world) is capable of performing
miracles. No, not medical miracles. The dramatic improvements in our quality of life which we have witnessed over the last century have come from various (government funded) public health initiatives which have reduced the rate of infectious diseases and maternal and infant mortality. The U.S. Medical Industrial Complex (MIC) concentrates on performing
financial miracles. Through sleight of hand, they manage to consume $5000/person per year or 15% of our GNP, even though most industrialized countries spend less than half this amount to keep their citizens much more healthy that we are. The MIC does this, in part, by emphasizing the treatment of chronic disease over the prevention of disease. If you doubt me, just look at the some of the payment formulas that the AMA has devised in order to make primary care specialties like pediatrics and family practice financially unattractive, while subspecialty care is kept lucrative.
But we can not fail! We told Congress in no uncertain terms what we wanted! We are their bosses, damn it!Time for a little history lesson. Seventeen years ago, Bill and Hillary Clinton went to Washington with the clearest of mandates to reform health care. And look where we are now, thanks to the “Harry and Louise” ads and Bill Kristol’s make-the-Democratic-Party-look-ineffectual strategy and a political campaign contribution system that gives all the power to those with the deepest pocketbooks.
Obama and the 111th Congress went to Washington with the clearest of mandates to reform health care. And look at them now:
One of Barack Obama's chief allies in the United States Senate hinted on Sunday that a public insurance option could go by the wayside as Congress hammers out its health care legislation.
Appearing on CNN's "State of the Union," Sen. Dick Durbin (D-Ill.), one of the chamber's foremost progressives, said that while he supported a government-run option for insurance, he was "open" to alternatives.
"So we'll see how this ends, but I don't want the process to be filibustered to failure, which unfortunately, many senators are trying to do," Durbin added. "I want to make sure that we do something positive for the American people."
http://www.huffingtonpost.com/2009/08/09/another-blow-to-public-op_n_254961.htmlSorry, Sen. Durbin, but your definition of “failure” and mine differ. To me, “failure” does not mean failing to do “something.” Failure means failing to provide affordable, comprehensive health care access to all Americans. The experts agree that the best way to accomplish this is to allow
We the People to fashion our own insurance plan, one that will be tailored to our needs and budgets. And if any private insurers want to stay in business, they can offer us something better, sort of like the private school industry that exists in parallel with our public schools.
When I read about folks like Durbin insisting that “something” is better than nothing, I get worried. Maybe it is because I can remember some of the ways we have gotten screwed by our elected officials as they attempted to do
something about other problems that plagued us. Problems like rising energy costs and tight credit.
II. Enron and the Banksters or They “Privatized their profit and socialized their risks” Here is a link to remind us of what went wrong for the consumer and right for predators like Enron in the energy deregulation fiasco of the late 1990s.
http://www.commondreams.org/views01/0130-04.htmEveryone remembers that energy producers used changes in the law to price gouge consumers, first in California and now, in Texas. When your electricity bill goes from $50 a month to $500, you sit up and notice. Fewer remember that utilities and power producers used the changes in the law to bilk the tax payers of California out of billions.
The legislation, written and supported by utilities, privatized their profit and socialized their risks. The most glaring example of this was the $28 billion dollar consumer-funded bailout for their so-called "stranded costs." Stranded costs are essentially mortgage payments that the utilities make to cover their purchase of expensive boondoggle nuclear power plants. The utilities argued that the bailout was necessary because they would now be assuming marketplace risk, and the uncertainty of their future profits made the paying off of debts they incurred under regulation too burdensome. To accomplish this bailout, rates were artificially frozen for 4 years, at what was then 50% above the national average cost of electricity. To date, ratepayers have bailed out the utilities for approximately $20 billion dollars through added costs to their electric bills.
These bailouts were used by the companies to purchase interests in other companies. And for campaign contributions so that the power companies could continue to control legislation. And to line their pockets. The only thing these bailout were not used for was to improve service to the consumers of California, who paid higher than market values for their electricity, until the inflated figure arrived at in the mid 1990s was deemed insufficient to fill Enron’s coffers. And then we saw what deregulation was all about, as it enabled the energy industry to conspire to inflate costs, with no risk of government oversight.
Being the kind of people who think that history is “more or less bunk” (to quote Henry Ford), we did it all over again last year, handing the banks hundreds of billions of dollars so that they would loosen up credit by loaning it back to us. I am sure the members of Congress were just as surprised as they could be when the banks turned around and
refused to loan that money back to us.
Why, the nerve of them! Do they take us for fools? Do they think we were born yesterday….Yeah, actually they do. And with good reason. As long as they can make credit card loans with 20 plus percent interest which we can never clear, even through bankruptcy, why would any bankster want to write a legitimate loan?
III. Sometimes Something is Not Better Than Nothing Everyone agrees that
something has to be done. Medical expenses are the biggest cause of bankruptcy in the United States. People forgo necessary care for lack of access. Insurance premiums are costing the nation’s employers an arm and a leg.
But what if their idea of something and our idea of something are not the same? What if by “something”, they mean the energy deregulation nightmares of the 1990s and the banking deregulation nightmares of the 2000s? Remember, we did not get Enron, because we felt the pain of Ken Lay who could not make money fast enough the old fashioned way. Energy deregulation was sold to us a solution to rising energy costs. Banking deregulation was not supposed to make Wall Street act like a bunch of idiots with their heads stuck up their asses. It was meant to increase the amount our 401Ks could earn.
If we strip away the public option from health care reform, what are we left with? What is on the Christmas Wish Lists of the various players in the MIC and health insurance industry?
IV. Republicans Go to Bat for Big (Medical) Business, As Usual Pop quiz. Where is the
real money in health care? If you said
In the hands of the health insurance industry go to the back of the class. The big bucks are in the hands of the members of the Medical Industrial Complex. Right now, they have a sweet deal. No one in the country does anything meaningful to keep us healthy, and then, when we get sick, the government gives us all Cadillac grade medical care. Make that a Cadillac without wheels, since they never seem to put us back the way we were.
With this in mind, what I am about to tell you should come as no surprise. Where ever there is a large accumulation of cash in this country, the GOP is there, kissing some fat cat’s ass.
The
PATIENTS Act of 2009 from Kyl and McConnell would prevent Medicare and Medicaid from refusing to cover medical treatments which are ineffective. Your doctor wants to do psychic surgery and bill the government as if he performed a real procedure? Why not? Sometimes a placebo is better than the real thing. And it sure saves money on overhead.
From Paul Krugman
http://krugman.blogs.nytimes.com/2009/06/17/taking-the-hypocritical-oath/ How bad is it? Let me count the ways.
1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.
2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.
3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.
4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.
Number three is important. The Medical Industrial Complex and the health care industry seem to have come to some sort of agreement. The MIC---hospitals, doctors, medical providers---can get even richer by bilking the tax payers for sham therapy. In exchange, they agree not to argue with the private health insurers right to deny necessary care. Since the people who can not get necessary services through their private insurance will eventually get too sick to work at which point they will go on medical disability and gain Medicare coverage, basically the privates are punting their sickest members to our
public health care plan Yes, Virginia, our country really does have a public health plan. We call it Medicare and Medicaid, and we use it for all the sick people, and pregnant people and poor people (who suffer an increased rate of many diseases) and children (they need all those expensive shots) that the privates do not want to cover. Some will be surprised to learn that our current “public option” (which is not really optional) spends as much per capita per year as the entire health care outlays of a place like Canada or France.
And the GOP wants to make us spend even more. Damn, those don’t-tax-and-spend Republicans are going to be the death of us.
V. The AMA Weighs In Thank God we have doctors who are looking out for the nation’s public health. I am sure that they have other things on their minds, besides money….
Among the AMA's key wants, Nielsen told the group's 543-member policymaking House of Delegates, are increased payments from Medicare and medical liability reform that caps non-economic damages and allows doctors to abide by the coming trend of quality measures that pay physicians based on performance without being penalized for mistakes.
http://www.chicagotribune.com/news/nationworld/chi-ama-obamajun14,0,6599868.storyOh my! I will translate this for the non medical public. Basically, doctors are asking for more money,
because they just can not get by on the $200 to $500 thousand they make each year (depending upon their specialty). http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htmThey want to get paid more by the government, for doing medically unnecessary things (See Kyl/McConnell), and they want to get paid a
bonus if the things they do turn out to be medically necessary. If their lucrative but medically unnecessary treatments end up causing a complication, they do not want to suffer any financial loss. This will allow them to do pretty much anything they want to anyone, without any risk---to their pocket books.
Anyone want to guess what will happen to the rate of elective procedures such as lumbar disc surgery (which is less effective than placebo and fraught with complications)? Pretty soon we will have to hire guard dogs to protect Grandma and Grandpa from the medical predators.
VI. Would You Be Surprised to Learn that the Health Insurance Industry Also Supports Doing “Something”? The private health insurance industry is suffering. The rate at which folks buy private insurance has been dropping for almost a decade. They want Congress to fix their business woes, and the easiest way to do that is to require that everyone buy private insurance.
The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare -- and stop buying private insurance.
Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford to buy it on their own, and enforced with fines.
Such a so-called individual mandate amounts to a huge booster shot for health insurers, serving up millions of new customers almost overnight.
"I think that's why we've seen the industry basically trying to play the administration's game," said Jane DuBose, an analyst with HealthLeaders-InterStudy, an industry tracking firm. "They really could be licking their chops over the potential here."
The “something” which private insurers have in mind is really very simple. The federal government will force all of us to purchase health insurance. And it will prohibit us from forming our own taxpayer supported health insurance program. That means that all of us who are too “well” to qualify for Medicare will end up on the rosters of BlueCross, United Health and the rest, until their denials of care make us sick enough to qualify for the public plan.
VII. Blue Dogs Blues Then we have the so called Blue Dog Democrats. Fox New recently praised them for obstructing health care reform. Among the demands of those Congressional Democrats who are most beholden to the health care industry:
---Exempting businesses with payrolls of $500,000 or below from a requirement to provide insurance to employees or pay a penalty. The existing bill had set the level at $250,000. The penalty would hit businesses with payrolls between $500,000 and $750,000 on a sliding scale before kicking in fully at 8 percent of payroll.
--Poor people would get subsidies to help them buy care after spending 12 percent of their income on premiums, instead of 11 percent in the existing bill.
--Payment rates to doctors and other medical providers would be negotiated with the secretary of Health and Human Services, instead of tied to Medicare rates as the bill now says. The Blue Dogs contend that change will lead to fairer payment rates.
Let’s see, employers—check. Health insurance industry---check. Health care industry---check. Looks like they have all the potential donor bases covered. Too bad they can not buy themselves out of the requirement that they run for re-election. The only people they do not seem to care about are the voters.
http://www.foxnews.com/politics/2009/07/29/blue-dog-democrats-announce-deal-health-care-reform/ VIII. Put It All Together and What Have You Got? Seems to me that Sen. Durbin’s
something is shaping up to be a federal requirement that all of us who are not dirt poor or dying of cancer buy private insurance. I have heard talk that the private insurance industry is even willing to waive its pre-existing conditions clauses, in exchange for tens of millions of new customers. Of course, insurers know ways to cherry pick after you sign up for coverage. They do it by limiting the care options for serious disease while making frivolous, low cost care for the healthy easy to come by. You know, having six podiatrists in your area but no nephrologists. That way anyone sick enough to qualify for Medicare drops their UnitedHealth policy and signs up for Medicare.
And of course, we can expect the private insurance plans to use the JP Morgan strategy. No matter how much money they make from their tens of millions of new members, the nation's health insurers---all of them---will post a paper
loss . And they will bitch and moan that the Democratic Congress ruined their businesses with health care reform, and something has to be done
now or they will stop paying the bills. With American's healthcare held hostage, they should have no trouble robbing taxpayers of even more than the banksters got.
Since few are talking about what qualifies as “health insurance” we can expect to see a lot of cheap policies designed for the working poor that protect against only one thing---the fine you have to pay if you do not buy insurance.
Something will almost certainly include policy changes that will encourage unnecessary surgeries and treatments for the nation’s elderly and disabled. It will cut medical liability, enabling the Medical Industrial Complex to ignore patient safety and get back to what they do best---making money. It will not include anything that might make us healthier and cut down on the incidence of disease. That would be bad for business.
The result will be accelerated health care spending combined with an increased rate of preventable chronic disease--the exact opposite of what we sent all those Democrats to Washington to do. After ten or so years of this, the nation will cry
Enough! But by then, we will all be Medicare age or morbidly obese, so it will be the federal government's problem to take care of us---
Assuming that there is still anyone healthy enough to work in the United States. Thank God for immigrants!
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