(2009-09-18) Taibbi Healthcare Reform Political Failure

Matt Taibbi thinks that Healthcare Reform is impossible given the breakage in the US political system.

Over the course of this summer, those two failed systems have collided in a spectacular crossroads moment in American history. We have an urgent national emergency on the one hand, and on the other, a comfortable majority of ostensibly simpatico Democrats who were elected by an angry population, in large part, specifically to reform health care. When they all sat down in Washington to tackle the problem, it amounted to a referendum on whether or not we actually have a functioning government. It's a situation that one would have thought would be sobering enough to snap Congress into real action for once. Instead, they did the exact opposite, doubling down on the same-old, same-old and laboring day and night in the halls of the Capitol to deliver us a tour de force of old thinking and legislative trickery, as if that's what we really wanted. Almost every single one of the main players - from House Speaker Nancy Pelosi to Blue Dog turncoat MaxBaucus - found some unforeseeable, unique-to-them way to fuck this thing up. Even Ted Kennedy, for whom successful health care reform was to be the great vindicating achievement of his career, and Barack Obama, whose entire presidency will likely be judged by this bill, managed to come up small when the lights came on. We might look back on this summer someday and think of it as the moment when our government lost us for good. It was that bad.

The president and the Democrats decided not to press for the only plan that makes sense for everyone, in order to preserve an industry that is not only cruel and stupid and dysfunctional, but through its rank inefficiency has necessitated the very reforms now being debated. Even though the Democrats enjoy a political monopoly and could have started from a very strong bargaining position, they chose instead to concede at least half the battle before it even began.

It was MaxBaucus' own committee that held the first round-table discussions on reform. In three days of hearings last May, he invited no fewer than 41 people to speak. The list featured all the usual industry hacks, including big insurers like America's Health Insurance Plans (AHIP), Blue Cross and Aetna. It's worth noting that several of the organizations invited - including AHIP and Amgen - employ several former Baucus staffers as lobbyists, including two of his ex-chiefs of staff. Not one of the 41 witnesses, however, was in favor of Single Payer - even though eliminating the insurance companies enjoys broad public support. Leading advocates of single-payer, including doctors from the Physicians for a National Health Program, implored Baucus to allow them to testify. When he refused, a group of eight single-payer activists, including three doctors, stood up during the hearings and asked to be included in the discussion. One of the all-time classic moments in the health care reform movement came when the second protester to stand up, Katie Robbins of Health Care Now, declared, "We need single-payer health care!" To which Baucus, who looked genuinely frightened, replied, "We need more police!" The eight protesters were led away in handcuffs and spent about seven hours in jail.

Single-payer advocates have had an equally tough time getting a hearing with the president. In March, the White House refused to allow Rep. John Conyers to invite two physicians who support single-payer to the health care summit that Obama was holding to kick off the reform effort. Three months later, a single-payer advocate named David Scheiner, who served as Obama's physician for 22 years, was mysteriously bumped from a prime-time forum on health care, where he had been invited to ask the president a question.

Even the CongressionalProgressiveCaucus, whose 80-plus members have overwhelmingly supported single-payer legislation in the past, decided not to draw a line in the sand. They agreed to back down on single-payer, seemingly with the understanding that Pelosi would push for a strong public option - a sort of miniversion of single-payer, a modest, government-run insurance plan that would serve as a test model for the real thing.

On July 9th, in a harmless-sounding letter to Pelosi, 40 Blue Dog-s expressed concern that doctors in the public option "must be fairly reimbursed at negotiated rates, and their participation must be voluntary." Paying doctors "using Medicare's below-market rates," they added, "would seriously weaken the financial stability of our local hospitals.".. In the end, the Blue Dogs won. When the House commerce committee passed its bill, the public option no longer paid Medicare-plus-five-percent. Instead, it required the government to negotiate rates with providers, ensuring that costs would be dramatically higher. According to one Democratic aide, the concession would bump the price of the public option by $1,800 a year for the average family of four.In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, "about the same as what we have now," as one Senate aide puts it.

If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance "exchange." In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their shitty plans protected by a grandfather clause... Low-wage workers currently offered these plans often reject them and join Medicaid, effectively shifting the health care burden for WalMart employees on to the taxpayer. If the HELP committee's grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart's crap employer plan and taking the comparatively awesome insurance offered via Medicaid will now be rebuffed by the state and forced to take the dogshit Walmart offering.

One of the reasons for this chaos was the bizarre decision by the administration to provide absolutely no real oversight of the reform effort. From the start, Barack Obama acted like a man still running for president, not someone already sitting in the White House, armed with 60 seats in the Senate... On the same day Rahm Emanuel was passing the buck to senators, Obama was telling reporters that it's "still too early" to have a "strong opinion" on a public option. This was startling news indeed: Eight months after being elected president of the United States is too early to have an opinion on an issue that Obama himself made a central plank of his campaign?

The so-called "individual mandate" is currently included in four of the five bills before Congress. The most likely version to survive into the final measure resembles the system in Massachusetts designed by Mormon glambot Mitt Romney, who imposed tax penalties on citizens who did not buy insurance. Several of Romney's former advisers are involved in the writing of ObamaCare, including a key aide to Ted Kennedy who was instrumental in designing the HELP committee legislation. The federal version of the Massachusetts plan would slap the uninsured with a hefty tax penalty - making the HELP committee clause barring people from opting out of their employer-provided plan that much more outrageous. If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that has already been proved not to work.

Democrats pointed out that under the House plan, the federal government would pay the costs of any "newly eligible" members of Medicaid. But that phrasing, it turns out, was a semantic trick designed to undersell the cost to the states. When Massachusetts imposed a similar mandate under Romney, thousands of people who were already eligible for Medicaid, but had not enrolled, immediately joined the program in order to avoid the tax penalty for being uninsured. So while the House plan would pay for "newly eligible" patients, it won't cover the "oldly eligible."

By blowing off single-payer and cutting the heart out of the public option, the Obama administration robbed itself of its biggest argument - that health care reform is going to save a lot of money. That has left the Democrats vulnerable to charges that the plan is going to blow a mile-wide hole in the budget, one we'll be paying debt service on through the year 3000. It also left them scrambling to find other ways to pay for the plan, making it almost inevitable that they would step in political shit with seniors everywhere by trying surreptitiously to whittle down Medicare. As a result, the Democrats have become so oversensitive to charges of fiscal irresponsibility that they're taking their frustrations out on people who don't deserve it. Witness Nancy Pelosi's bizarre freakout over the Congressional Budget Office. When the CBO questioned Obama's projected cost savings, Pelosi blasted them for "always giving you the worst-case scenario" - which, of course, is exactly what the budget office is supposed to do. When you start asking your accountant to look on the bright side, you know you're not dealing from a position of strength.

So what's left? Well, the bills do keep alive the so-called employer mandate, requiring companies to provide insurance to their employees. A good idea - except that the Blue Dogs managed to exempt employers with annual payrolls below $500,000, meaning that 87 percent of all businesses will be allowed to opt out of the best and toughest reform measure left. I agree with that SmallCo exemption: a Public Option would be a great choice for these cases. Or some other non-employer-focused system.

All that's left of health care reform is a collection of piece-of-shit, weakling proposals that are preposterously expensive and contain almost nothing meaningful - and that set of proposals, meanwhile, is being negotiated down even further by the endlessly negating Group of Six. It is a fight to the finish now between Really Bad and Even Worse. And it's virtually guaranteed to sour the public on reform efforts for years to come.