Depressing to read this assessment at Huffington Post written by Michael Bremer: “Obama has blown health care reform, big time. The opportunity of a lifetime has been squandered. …Serious health care reform is gone with the wind. It cannot be retrieved.”
Bremer catalogues, “the dismaying reality”:
- no public plan;
- no wealth tax to help pay for cost incurred; no right for the government to bargain with Pharma on drug prices;
- no meaningful enforcement mechanisms to ensure that vested, for profit interests comply with whatever undertakings, explicit or tacit, that they have made.
And, in answer to the question, “What do we gain?”, Bremer says, “Not much.”
- A commitment that everyone must be insured, yet with a much weakened employer mandate to accomplish it.
- An elimination of the most egregious practices of insurance companies re. e.g. pre-existing conditions, arbitrary termination of coverage.
- Some small subsidies for the working poor. These last are minimal. Someone earning $20,000 a year will get no subsidy unless insurance premiums reach $2,400 — according to the Finance Committee bill.
Bremer says, “It is Barack Obama who is to blame for this. For months, he stayed aloof from the out-of-control Congressional maneuvering based on a strange belief in some kind of bipartisan collective will emerging by osmosis. He never leaned the weight of his person and his office to elements of reform that has been touting as candidate and then President. He deceived the country by pursuing secret talks with the very lobbies who are the heart of disgraceful national health care situation. He entered into deals that were weighted heavily in their selfish interest rather than the national interest. In short, we have gotten from him the antithesis of what we were promised and expected — in the substance and process of policy both. We have instead a conventionally minded politician overly respectful of the status quo and deferential to those who control and profit from it, A man with no apparent fixed convictions.”
Great! But my guess is these guys will keep trying. Government health care reform was never about health care or health insurance. It was about taking over a segment of the economy and making everyone dependant on government.
I don’t like what goes on in government today they don’t seem to have us in mind I especially dislike couselling for people to committ suicide every 5 years no one with a conscious is going to go along with that .
Clarence Page had a similar article today, comparing Obama on health care to Bush in Iraq, i.e. underestimating the insurgents and not being prepared with enough resources.
Of course, most recognize that Obama tried to avoid what happened to Clinton, who had the insurance companies write a bill and then tried to sell it to the public. Instead Obama has tried to let Congress, who are elected supposedly to do these things, to work out the details.
While most agree that the overall health care system is not functioning and is dragging down manufacturing where the GMs must compete with companies where health care is not a cost to employers but to everyone, it also appears that it may be impossible to accomplish change politically.
1. America is politically dominated by corporate money, which pays for access and lobbyists. Corporation are adverse to change, unless they will do better than they are doing now. They are also adverse to each other, divided among employers, insurers, medical providers.
2. America is divided between “red” and “blue” America, which are separating themselves in a “Big Sort” and do not relate to or deal with each other, mostly demonize each other. Red America controls the majority of the opinion media, on talk radio, cable tv talk and like minded internet groups, which generates animosity out of anxiety. While the idea of becoming more cooperative seemed widely popular during the election, for structural reasons cooperation doesn’t happen. Instead leading Republicans like Grassley and Palin create the euthanasia scare out of legitimate end of life issues and then fan the flames.
3. Health care payment reform only seems possible when Blue America is at the height of its political power. However that power has been quickly defeated politically due to lack of political resources..
4. There are inherent problems theoretically in trying to resolve competing interests in health care. We are concerned with availability, cost, quality, service fairness and medical progress.
5. There are concepts that do not fly politically, making reform efforts vulnerable to concepts like rationing and government takeover that are unavoidable. We can not afford to provide all possible care to all possible people. Therefor there is a sense rationing. Now it is done by private insurance companies which compete to insure the healthy and get rid of the costs of the sick. It could be done other and perhaps better ways but we will be more aware of the change and afraid of it. Similarly the marketplace will not make private companies make changes (that is what happened the last time with HMOs) so whatever happens can be depicted as government interference or takeover.
6. Like other major systemic weaknesses like campaign finance reform, solutions to the conflicting demands have not percolated from the ground up, with a public consensus determining what to do. Instead the solutions come from special intersts or political compromises that are often too much sales pitches to be trusted. Or lets call it something different. That plus the complexety of any change makes it easy to attack and hard ot trust.
7. There are here and now political problems. The bad economy created anxiety and limits available funds to expand coverage. It also left manufacturers, who need change, without political capital compared to the finance insurance sector, which does not.
8. There are many underlying problems that drive the anxiety that resists change. The bad economy elected Obama but does not help create the cvonfidence needed for change, and took away many resources. We live in a country where unproductive people are not valued, and this includes the elderly, the ill and the disabled as well as children and most of the poor. They are seen as consumers rather than producers, drains instead of contributors. If they are different from us in some significant way we think even less highly of them and care less about their fate. Furthermore we have not really kept the compact between the generations. Instead of setting aside resources to fund pensions (includeing the public one Social Security) and health care (including the public ones), we are now dismantling private pension and health care systems like GM’s, and the public ones can’t be far behind. We have replaced public systems with limited ones like 401ks and the like, the equivalent of giving people an oxygen tank and telling them to swim across the ocean and see how far they get before it runs out. The public ones are under periodic political attacks (usually when Red America is at the height of its political power) which tells the young that the compact between the generations will not be there for them. And the 401ks have disappeared as the financial system looted peoples wealth and produced fake wealth in its place.
While our present system of competing insurance companies competing to insure the healthy, ditch the sick and game the system is very wasteful, it is not clear that eliminating useless costs from that are sufficient to fund what is needed. There is a sense that profit oriented providers can not be trusted to keep utilization and costs down. It is also not clear that expecting people to limit costs by either making wise health care choices, or by paying them not to seek care, makes any sense.
End of life care, with an aging population, is a difficult question to deal with. We have an increasingly vulnerable and expensive group of people, and it is hard to have consensus about the right course of action, perhaps depending on whether it is you or your parents or someone else and theirs.
Is there any question people do not trust why a major change in the status quo, and why it is so easy to generate anxiety and opposition?
If they get national health insurance passed, after a while the first question will be, “What is your political affiliation?” It may sound paranoid but those pushing socialized medicine want control. If they wanted to really improve the system they would enact tort reform.
It doesn’t sound paranoid. It sounds like a political scare tactic. Other countries have national health insurance that serves everyone in every political party, so we should be able to as well. This scare tactic seems to be a favorite of conservatives, that “the left” is full of control freaks that want to take over everything. I’m not sure why it is so popular with them, but it does divert attention from the fact that everyone needs access to affordable care, everyone else in the world but us manages to do it and basing health care access to employment when no one else does that has bad consequences in the global economy.
“Tort reform” is a red herring. The medical insurance industrial complex has been making lawsuits harder to file and win for decades, so lots of cases are not large enough to file. As a doctor admitted in a New Yorker article “We all know these arguments (that fear of lawsuits causes huge numbers of unnecessary and costly tests) are b#$%sh*t. ” http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all.
Healthcare reform is complex because there are a number of things to accomplish. These include access, cost, fairness, quality and medical progress. Immunity from responsibility for injuries done to people leads to things like the mortgage debacle. Lawsuits have lead to providers cleaning up their act in ways they would not if there were no consequences. And they are at most a minor cost factor. However bashing lawsuits and lawyers fits in well with conservative politics and worldview.
Stan, lots of insightful observations, but I’ve got to think you are overstating the truth, when you conclude, “We live in a country where unproductive people are not valued, and this includes the elderly, the ill and the disabled as well as children and most of the poor.”
On the contrary, I believe a big majority of Americans would disagree with your conclusions. It seems to me that we have a big disconnect in our country between what a big majority of what most Americans value and how the country actually functions. This disconnect should alarm us all to the fact that our democracy is not working as it should. Ours is a weak and broken democracy that, at present, seems incapable of doing the will of the people, and the way this whole health care reform process is playing out is pretty dramatic evidence of how broken our democracy actually is.
You write, “America is politically dominated by corporate money, which pays for access and lobbyists. … Solutions to the conflicting demands have not percolated from the ground up, with a public consensus determining what to do.”
Exactly. Every analysis of why America behaves as it does, I feel, should emphasize that the behavior of America indicates that our democracy is in real need of vitalization — and the need for this vitalization is the central theme that progressives should be emphasizing and, as a first priority, pushing to correct. I’ve emphasized this point to David Esrati and urged him, and Gary Leitzell, to use the theme of democracy in their election campaigns.
How in the world have we allowed the US House of Representatives to become comprised of individuals who owe their first allegiance to big money, where 90% of House seats, each election, are considered “safe.” A representative body where 90% of the members are perpetually reelected sound more like a House of Lords, than a House of the People. Where are the rallies where people are showing their outrage that our democracy has become such a travesty?
What is needed is a lot of effort aimed at grassroots organizing. And, I feel, the place to start is at the level of the local political parties. Our local political parties, at the county level, have become obstacles to vigorous democracy, and they are in need of reform. (See this article that I wrote about Mark Owens and the Montgomery County Democratic Party.) Our local parties fail us because they are content to support and advance mediocre candidates and because they actively suppress, in their own organizations, authentic democracy. (See articles here and here.) There is a huge amount of frustration concerning the ineptness and brokenness of our democracy — the key is to turn this frustration into practical action.
The way I see it, the heart of the problem is the fact that our democracy is failing us. A big reason our democracy is failing us is because our political parties are failing us. The only hope for an individual to have meaningful influence in the political parties is via a grassroots approach. A lot more people need to become actively involved in their local political parties — Democratic as well as Republican. In next May’s Democratic Primary, each precinct in Montgomery County — 548 precincts — will have the opportunity to elect a member to the Central Committee for the Montgomery County Democratic Party. The Central Committee serves as the legislative body that determines the policies and actions of the party for the next four years. The first action of the Central Committee is to reorganize and elect a Party Chairperson. In 2006, when Montgomery County Democrats met to reorganize, only about 100 elected members of the Central Committee showed up — to reelect, without debate, by acclamation, Dennis Lieberman as Party Chair.
In April, 2008, I reported here, Montgomery County Republicans filled only 133 Central Committee positions — out of 548 possible. I never heard how many of the 133 showed up for the Republican Reorganization meeting.
Stan, you state, “It doesn’t sound paranoid. It sounds like a political scare tactic.” However, our President is a devotee of Saul Alinski, has Rahm Emmanuel as Chief of Staff, and whose stimulus bill based in part on partisanship. The US A Today reported that on a per capita basis, the states that voted for the President got twice as much money as those that voted for Senator McCain. That is fact not a political scare tactic.
As an attorney I can tell you that tort reform is not a red herring. I was told by a emergency room doctor in Indiana, which has the most physician favorable laws in the United States that half the tests he prescribed were only the cover his rear. The American Trial Lawyers Association and trail lawyers individuals have historically been the biggest contributors to the Democrat Party.
I agree with you that health care reform is a complex issue. Tort reform alone would be totally insufficient, but it is a necessary part.
Mike, I believe that one of the reasons our political system is failing is that the government controls so much and spends so much money that the stakes are much to high. From a human perspective why not bribe a government official to get a $1 billion contract? Or a congressman to get a bill passed? When the stakes are so high, it is worth it for various groups, from ACORN to defense industry associations to try to get more federal dollars and the public interest be damned.
I believe that another reason our political system is broken is that the American people are so evenly split and so full of venom towards the other side. If the nation were peacefully sundered into red states and blue states, my guess would be that the system in the two new nations would work a lot better than what we have now.
The USA article Rick mentions about stimulus money is very inconclusive. It makes it appear that the additional spending duplicates what happened with spending during 2007-07 when Bush and the Republicans were in charge. Also they are counting counties where Obama won compared to the counties McCain won, McCain won 2234 counties to Obama 872, nearly 3 times as many. Clearly Obama won more populous counties, including cities in need of stimulus, so it’s hard to know how valid the data is. Plus they point out certain kinds of aid went more to places that didn’t favor Obama
“The reports show the 872 counties that supported Obama received about $69 per person, on average. The 2,234 that supported McCain received about $34.
Investigators who track the stimulus are skeptical that political considerations could be at work. The imbalance is so pronounced — and the aid so far from complete — that it would be almost inconceivable for it to be the result of political tinkering, says Adam Hughes, the director of federal fiscal policy for the non-profit OMB Watch. “Even if they wanted to, I don’t think the administration has enough people in place yet to actually do that,” he says.
“Most of what they’re doing at this point is just stamping the checks and sending them out,” Hughes says.
The stimulus package Obama signed in February includes about $499 billion in new spending, and to date, the Obama administration has allocated about $158 billion to specific projects and programs. Most of that money has gone directly to state governments, which then disperse the money to prevent school layoffs, repair roads and fund social services. That contrasts with the $17 billion that Washington distributes directly to local communities.
Including the larger chunk of money given to state governments, the aid favors states that voted for Obama, which have received about 20% more per person
Not all of the money favors places that supported Obama. About a third of the $17 billion, or $5.5 billion, in contracts that the federal government has signed for projects ranging from repaving runways to cleaning up nuclear waste has gone overwhelmingly to counties that supported McCain.
Jake Wiens, an investigator with the non-profit Project on Government Oversight, says it’s too soon to draw meaningful conclusions about whether the type of aid in the stimulus favors Obama’s constituents.
But, he says, “it will be important to pay close attention as the data come in to ensure that political favoritism plays no role.”
The imbalance didn’t start with the stimulus. From 2005 through 2007, the counties that later voted for Obama collected about 50% more government aid than those that supported McCain, according to spending reports from the U.S. Census Bureau.”
http://www.usatoday.com/news/washington/2009-07-08-redblue_N.htm
Also I am not convinced that Saul Alinsky and Rahm Emanuel (and Reid and Pelosi for that matter) are names that are the equivalent of curse words. I don’t know that Alinsky would have put Goldman Sachs in charge of the recovery, fixing the banking system and saving homes from foreclosures, but I also don’t know that he would have denied health care to anyone. Emanuel seems to be typical of people who have held the Chief of Staff role in prior administrations, generally tough, get things done kind of people who use the power that is available. Furthermore it seems like Obama has reached out to Republicans a lot more than Republicans have tried to work out solutions to America’s problems. Maybe that’s just me.
They have also been the leaders in venom. Actually, while the country has been going through “the Big Sort” (described in a book by that name) where people of different political views and values do not live near or interact with each other, there is no clean division between “red” and “blue” America, particularly in populated areas. As in Dayton, you have an East/West City and inner v. outer suburbs kind of division. Even within communities there are divisions. Yoiu can have liberal and conservative churches next door to each other that barely speak. So just finishing the civil war and separating the South and mountain west into a separate country wouldn’t work, any more than it did in India/Pakistan or in the Balkans.
A better question is why there is so much venom, much of it coming out in the health care debate. There is a real question as to the extent that we can have a society that functions as a whole. One issue of course is that we somehow fund and support Limbaugh and Coulter type of media figures who generate negative emotions, ridicule, demeaning and loathing for their opponents. That is not how a community works, nor does it help solve problems. But more important is why people like that have any followers, whose emotional needs are being met. Like with drug abuse, we need to beat the problem at the demand side, because if there is a demand side someone will provide the supply side, particularly if it helps them get power. We need to fix the trhings about our society that leave people feeling that angry and taken advantage of.