Friday, September 04, 2009

Health reform at this point: sympathy for the devil

The Washington Post is a constant source of disappointment to me. For all kinds of reasons. Seeing as it is my hometown newspaper, though, I continue to subscribe, reluctantly. Today, below the fold on the front page, the Post explored the pressing issues of how the "death panel" myth got started and whether or not Senator Bob Corker, the junior senator from Tennessee, might be willing to compromise on healthcare.

Bob Corker was only recently elected to the Senate (2006) and he does not sit on any of the Senate committees that are responsible for reporting out healthcare legislation. In an interesting side note, Corker was able to beat Harold Ford for the Tennessee seat by launching an 11th-hour racial attack ad that insinuated that Ford, a black man, was a party guy who slept with white women. Oops, I forgot. The Republican Party launched that ad and didn't tell Bob about it.

Anyway. On page A4 of The Washington Post, the premiere American newspaper for political goings-on, there was a small story (at the bottom of the page) entitled, "Obama Will Lay Out Specifics in Health-Care Speech, Aides Say." Buried in the middle of this article were a couple of paragraphs that read:

In the Senate Finance Committee, where negotiations on a bipartisan compromise are underway and a conference call is scheduled for Friday, lawmakers are trying to reach a deal by Sept. 15 with perhaps as many as three Republicans on board. The White House is focused on one of the three, Sen. Olympia J. Snowe of Maine, who they view as the Republican most willing to reach an agreement with the White House.

On Thursday, aides to Snowe confirmed that the senator is talking with administration officials, particularly with regard to her "safety-net fallback option." Under that proposal, the government would sponsor a nonprofit insurance plan but it would become available only in states or regions where private insurance firms had failed to offer a reasonably priced product that would be affordable to 95 percent of the population.

This strikes me as being much more important to the process of healthcare legislation and the public interest than what Bob Corker thinks or how the death panel rumor got started. I mean, am I reading Tiger Beat for policy folks when I read the Post, or what? (Btw, that article can only be found on if you use their search engine.) Senator Snowe is part of the group on the Finance Committee, under the tutelage of Sens. Baucus and Conrad, who have been responsible for holding up the development of healthcare legislation in the Senate. Any movement there is real news.

By scanning several articles in the Post, including the remainder of the Bob Corker article (to be fair), I could collect references, but not in-depth coverage, for a handful of positions and attitudes that are making their way through the Senate and House, some through the actions of various individual offices:

  • an insurance exchange, "unrestricted by the current boundaries of state insurance laws" that would offer people without insurance vouchers or tax credits
  • limiting those who are required to purchase insurance to purchase only catastrophic plans
  • creating special risk pools for people with serious illnesses
  • a safety net option designed to give insurance companies a second chance to provide affordable coverage
  • support for a public option
  • an understanding that a "substantial departure from the status quo" is necessary
  • a fear of financing healthcare

This collection of ideas may or may not make its way into any final legislation that lands on the President's desk. Where does the process currently stand? I can give you an approximation, but I cannot guarantee 100% accuracy. Several committees in both the House and the Senate are responsible for reporting out bills designed by those committee members only--the Senate Finance Committee, the Senate Health, Education, Labor & Pensions Committee, the House Energy and Commerce Committee, the House Ways & Means Committee, and the House Education and Labor Committee. The three House committees collaborated on a joint bill, H.R. 3200. The Senate HELP committee passed a bill authored by Ted Kennedy--but I can't find a bill number for it, although I can call up the legislation--it appears to be related to H.R. 3200. The Senate Finance Committee, as it is well known, has not yet produced a final bill.

Once the Committee bills are prepared, the House and Senate leadership will each work through their chamber's multiple legislative efforts (both committee and individual office offerings) to produce a final House and a final Senate bill, each of which may be amended by any member. Then each chamber votes on its own bill. For legislation as critical as this, the bill will not come to a floor vote unless the leadership knows it has the votes to pass. Then the bills will proceed to conference, a series of meetings in which members and staff from both chambers work together to produce a final congressional bill, which is then returned to each chamber for a vote. If the bill passes in both chambers, it will be sent to the President, who will sign it or veto it.

In short, we have miles to go before we sleep--or before Senator McCain's gloved and masked aides slip a hypodermic needle filled with perma-sleep into the vein in the crease of the elbow.

McCain's office is proposing the creation of special risk pools for people with serious illnesses, which is a death panel if I ever saw one. As you can imagine, the insurance industry is in favor of this--it's what they've sought for years. If only those pesky, expensive sick people didn't have to be underwritten by us. If only we could put them in their own group, make them pay their own way. McCain's version of this does not include public support for people with serious illnesses, just the steadfast belief that private industry can deal with this. Can you imagine the premiums you'd have to pay if you became ill? Can you imagine the paucity of the coverage you'd receive if private industry put the sick people together in one group and wrote a policy just for them?

Personally, I don't see the harm in letting people who don't especially want to purchase insurance to be told they only have to purchase a catastrophic plan. In some respects, private health insurance rips off most people because, by covering all of your doctor's visits for routine issues as well as most of the generic, low-cost medications most people take, the cost of policies is astronomical.

Hypothetically, catastrophic insurance costs less--I could easily pay, for example, for almost all of Robert's routine doctor/specialist visits and his generic meds with what I pay in insurance premiums--and look at all the visits we have! Paying for a clinic visit is actually not that expensive for most Americans, but the airline seating principle comes into play: if you pay out of pocket, you're paying a lot more than the person sitting next to you is charged through both co-pay and insurance payment. And the person across from you is charged a third price. If it weren't for insurance companies negotiating raw deals with doctors' offices by threatening to cut off their supply of patients, the cost of an office visit for anyone who needed it would settle somewhere in the middle range between what doctors charge the uninsured to recoup costs and negotiate with insurers, and what insurers are willing to pay. Um, 'free market' anyone?

But insurance isn't packaged that way. I can't get catastrophic coverage for Robert, who has a pre-existing condition. And if I don't have the full-Monty insurance plan, I can't pay for Robert's surgeries, DME, or other items.

As for the "insurance exchange," without more detail, who knows what that is? And that's all caught up in the Republican's favorite hobbyhorse: vouchers and tax credits. Let me remind you all that tax credits do nothing to help the poor purchase anything because the taxes paid by the poor are zero or minimal. Tax credits are typically administered on a sliding scale, by income, so they won't do much for you if you make a decent living. Vouchers are always kind of hazy when you hand them to someone who has to choose between the rent and the electric that month and the voucher doesn't cover the full cost of the service anyway.

Senator Snowe's "safety net" public option, which is triggered by the cost of a policy and not by what it covers, is like a clueless wife trying to give the husband she wed at 19 in an ill-advised shotgun wedding yet another chance, despite his alcoholism and gambling debts.

I mean, COME ON! We could hand everyone in the U.S. a low-cost insurance policy tomorrow if it didn't cover surgery, durable medical equipment, brand-name drugs, orthotics, certain therapeutic treatments (like chemotherapy), more than a one-night stay in a hospital per year, and so on. Want a yearly checkup, penicillin, and vaccinations for your kids? We got ya covered. Get sick? Move to Canada.

I hate to say it, but the problem with health insurance is not the uninsured. The problem with health insurance is that it is insurance. The problem with insurance is that it is a business agreement that is not subject to the terms of human compassion and general ethical standards.

As Marie Antoinette reportedly said, "If there is no bread, let them eat cake!" And cake is expensive, so your senator is not going to be handing that out to you, either. Even if you're starving. Or dying of cancer. As the case may be. (Cake is for banks.)

But you see how I could be disappointed with the Post when the compromise most likely in the Senate Finance Committee bill is going to be Snowe's idea, and the news about that is essentially hidden from the public by the Post's editors.

What I absorbed this morning, from the news collage that each of us must assemble for ourselves, is that the President will give up the public option, that reform will be focused on what's fair for the insurance industry, that if the uninsured could only obtain a virtually worthless paper policy at a low cost that would be acceptable, that the sick and disabled are just drains on the system and worth no more than a casual afterthought, and no one at all is going to listen to Nancy Pelosi, apparently because she is a girl.

Speaker Pelosi still supports the public option. She insists that the House support the public option. The Senate, like your tedious older brother who read Nietzsche his freshman year in college, cannot be bothered by the practicalities of life as it is experienced by your average person. Or your average person who just received a diagnosis of cancer or gave birth to a child with severe disabilities or was hit by a drunk driver with no money to sue over. Practicalities such as: the ability to recover from illness or live with it or be included in society despite disabilities, the ability to take a job in another state despite health problems, the ability to stay solvent despite the costs of illness, the ability to start your own business and hire people without worrying about them losing work due to illness, the ability to remain independent and free in an American society that denigrates and denies autonomy and freedom to people who show signs of 'weakness': the sick, the disabled, the elderly.

Insurance companies are running scared from the public option because it will inject actual free market competition into the American health care system. Right now they sell to your employer, not to you. And Congress has made sure, in the past, that market risk to corporations is minimized in terms of care and services to the sick, the poor, the disabled, and the elderly.

Senators are running scared from the public option because they don't know an economic stimulus package when it's right under their nose: if Americans had relief from healthcare costs and security when they became ill, more people could start more businesses, stay solvent, stay in their own homes when disabled and old, transmit to their heirs some inheritance not eaten away by end-of-life costs and long-term care costs, change jobs and careers when so inspired and follow their own dreams. And, finally, have more discretionary income to spend on all the ridiculous and well-beloved trappings of the American Marketplace.

The public option is not about losing freedoms--it's about human ethics and preserving the health and, therefore, the autonomy (yup, that's a fancy word for freedom), of Americans and what we used to call dreams.


Lee said...

In a more just world, you would be a syndicated columnist and your sentiments, particularly the last three paragraphs, would get the coverage they deserve.

Elizabeth said...

I echo Lee's comments. Very powerful stuff, but I feel like a broken record telling you that.

Have you read this?
Let me know what you think of it. Long and sometimes difficult and tedious (unlike your writing), I found it unlike any other arguments I had read. The trouble with me is that when people speak in an articulate way, I tend to "believe" them. And then I get confused and don't know what I believe. That's when I resort to the personal...

Dale said...

Christ. I came here because you're a brilliant poet, and I find you're a brilliant political columnist as well. And these are both things you do on the the side? Yikes.

Peter said...

I've also been disappointed by the Post's coverage (I live in Virginia west of the Beltway), starting with their editorial page, which as early as this past winter asked the Obama Administration not to pursue health care reform until after the recession was over. To me that's like not calling the doctor because I'm sick.

Great post.