(Note: I occasionally write political pieces, like this, this, this, this, this, and this. Here’s another one.
Can someone please explain why I should support the health care reform bill that seems to be taking shape? This is a genuine plea for answers.
In the last presidential election I was an early supporter of John Edwards because of his advocacy of Medicare-for-all. I wound up supporting Barack Obama in large measure because of his promise to reform health care, including a “robust public option.” Although it seemed a lot like re-inventing the Medicare wheel, I always took “public option” to mean a government run health insurance program that anyone could buy into.
This makes sense to me mostly because private health insurance companies are very inefficient in that they need to take about 30 percent off the top to pay incredible executive compensation, profits, and marketing/advertising (no small potatoes). In many respects they’ve become this way because, inexplicably, it is the only industry other than Major League Baseball that enjoys an exemption from anti-trust laws. In other words, it’s legal for insurance companies to collude with one another and do things like fix pricing based on things other than the laws of supply and demand. This has lead to what are essentially bloated health insurance monopolies, with nothing better to do with their money than pay executive salaries and stockholder dividends. In most parts of the country, people only have 1-2 legitimate choices. A robust public option as I envisioned it would offer real competition which is the free market antidote to monopolies.
Medicare runs on about 5 percent overhead because it pays modest salaries, doesn’t need to earn a profit, and has no marketing expenses to speak of, which means that 95 percent of the money it takes in goes to actually paying for healthcare. I’d always assumed that a public option could be run on a similar model, which would pose a formidable competitor to private health insurance. I can see how this would require private companies to get lean in order to compete. It would force the break-up of these monopolies. That’s how capitalism in a democracy should work – competition should be making things increasingly better for we the people, not the capitalists. When that isn’t happening, something is out of whack.
This does not mean that I'm not a supporter of real capitalism. In fact, I have no doubt I that there’s an entrepreneur out there right now who will figure out a way “beat” the public option in spite of its built-in advantages. That is something I’d like to see. That will be American ingenuity at its finest. One of the reasons I support a robust public health care option that is available to everyone is because I’m convinced we can produce an entrepreneur who can do it even better and more efficiently. And if current health insurance behemoths can’t compete, they’ll have to change, shrink, or die, which is what would have happened long ago if they had had real competition.
But the House bill does not propose a public option that will create competition. According the Congressional Budget Office, only 2 percent of us will wind up using the public option as proposed by the House bill. That’s because, as I understand it, only people who are currently uninsurable will qualify for “the exchange,” which will be the only place the public option is available. Largely, these will be the sickest people; those who aren’t profitable anyway. How does that provide competition to private insurers? I simply don’t understand how this version of the “public option” will work to keep down costs unless we can all buy into it. I suppose it will insure a few more people, which is a good thing, but as proposed, it seems anemic at best. Some studies have concluded that the pubic option will actually cost more than private sector policies, which means it will really just become the health insurance of last resort.
But what strikes me as most outrageous is that the House bill will require most of us to enter into contractual relationships with private health insurance companies. We will all be compelled under penalty of federal law (via what is referred to as the “health insurance mandate”) to enter into contractual relationships with companies that have already demonstrated their willingness to place profits over our well-being. As for-profit enterprises, our courts have held that they can, in fact, be sued by stockholders if they don’t do everything in their power to maximize profits. One of the easiest ways to maximize profits is to deny or delay health care. If I’m diagnosed with cancer, for instance, it doesn’t take a genius to understand that the best way to bolster profits would be for me to die quickly so it minimizes payouts. I do not trust these people, yet I’m going to be mandated to enter into a contractual relationship with them. (As far as I’m concerned this is the equivalent of being coerced into signing a contract, which should automatically invalidate it.)
This is particularly heinous because the House bill offers only mild regulations on the behavior of private health insurance companies. Yes, it will curb some of their most heinous abuses, but without a real public option there’s nothing in this bill that will lead to cost control, which leaves affordability at the hands of their profit margin. In other words, our health care – our lives and the lives of our children – is going to be in the hands of corporations that stand to profit from providing as little heath care as they possibly can. I repeat, I do not trust these people. What they do can legitimately be called “murder by spreadsheet,” but if this bill becomes law, we'll all be required to go into business with them.
Then there’s the so-call Stupack Amendment, which essentially makes abortion only available to wealthy women. This disgusting amendment amounts to the greatest impingement on a woman’s right to choose since the Hyde Amendment passed in 1976, and this in an era during which the Democrats control two of the three branches of government. I pray that this is the kind of thing that will be stripped out of the final bill the president signs.
And the cherry on top of this mud and pickle sundae is that most of it won’t go into effect until 2013, which means that even if the final law will taste better than it looks, we’re going to be at the mercy of these unregulated corporations who have already announced their intention to jack their prices into the stratosphere if health care reform legislation passes.
As it now stands, I’m going to be urging my congressman to vote against this bill. I believe it contains a public option that is designed to fail because it will not provide real competition. I’m deeply troubled by the fact that we will be compelled by law to sign contracts with untrustworthy business partners. Not to mention the anti-choice amendment and the long delay before the key components of the bill are implemented.
I’ve spent the last couple days reading the bill passed by the House, which I understand won’t differ greatly from the one the Senate will pass. These are my conclusions. As much as I hate to write this, I think we ought to scrap the whole thing and start over with Medicare-for-all as our starting point. We might have to wait until we’ve elected more and better Democrats.
Now, I know that there are a number of readers of this blog who are strong supporters of this legislation, which I was until I really got a look at what it’s going to do. I’m hoping that I’m somehow missing the hidden beauty of this bill. Please point them out to me. I really don’t want us to miss this opportunity for real reform, but I fear that we already have missed it with this weak, weak bill. I will be moderating comments to avoid having to publish flames, cursing, and name-calling, but I promise to publish your comment as long it’s civil.
I hope I just misunderstand. Please help me.