Saturday, November 07, 2009

Public Option: Now You See It, Now You Don't

It is inevitable in Washington, DC: a good idea will get deformed beyond recognition by compromise and expediency. So it goes with the public option that is part of the House reform bill that may be voted on today. What started as a compromise to single payer health insurance, the public option was intended to be an efficient, low cost counter-balance to the inequities and waste of a broken system of private health insurance. After the political machinations on Capitol Hill, it has become an expensive boutique program that will not be serious competition for the private insurance industry, but will actually funnel millions of new customers into a system that does only two things well: produce profits and pay exorbitant salaries for executives. America, far from having the "best health system in the world"--a monstrous myth--is 31st in life expectancy, 37th in infant mortality, and 34th in maternal mortality according to the World Health Organization. One authoritative study put us dead last among 19 developed nations in avoiding "preventable deaths". The Congressional Budget Office has concluded the public plan in the House bill will cost more than private plans and only 6 million people will sign up. Forty-four promised us a public system that would cover one out of four Americans. Now it is one out of fifty. At first public subsidies were to be used only for enrolling in the government plan. That idea was hijacked by the insurance industry, so now only private insurance can be purchased with subsidies. Speaker Pelosi said it best, private insurance companies "are going to get 50 million new customers, many subsidized by the taxpayers" because of the individual mandate to buy insurance.

Unable to completely stop this farcical intrusion into their captive market, the insurance business and its lobbyists have now focused on minimizing in every way possible the effect of any government plan that makes it past the Senate filibuster to the conference committee. They will do this by seeking to impose a trigger mechanism to prevent any government competition until insurance companies allow it through their own shear incompetence, and by limiting the number of Americans eligible to participate in the public plan. They will also insist that their industry continue to be protected from anti-trust laws despite their collusive market behavior. Insurance lobbyists have already succeeded in increasing the premiums for public health insurance by requiring reimbursement rates be negotiated with the private sector instead of being fixed by Medicare rates. Senate Majority Leader Reid still does not have the necessary votes in hand to guarantee a sixty vote super majority, so he is delaying presenting the Senate bill on the floor for debate. Senators dependent on insurance companies, like former insurance executive Ben Nelson of Nebraska, are withholding their vote, hoping to gain these further concessions. Even if states are allowed to opt out of this corporate welfare, they will not be able to opt for a single payer system because Nancy Pelosi quashed an amendment passed out of committee that would have allowed it--this despite the official position of the California state Democratic Party supporting single payer reform. The state legislature has twice passed single payer bills only to be vetoed by the 'Governator'.

Whatever public option comes out of the process will be emasculated beyond recognition, thus insuring a continuation of outrageous corporate overcharging for health care in America. AARP is supporting the House bill primarily because it fixes the "doughnut hole" in Medicare Part D. The AMA is supporting the bill because of the devil they do not know and a promised increase in Medicare reimbursement rates. What real choice do unemployed persons (the official rate has reached 10% for only the second time since WWII) not eligible for Medicare or Medicaid have when the market and Congress is controlled by oligopolists with unlimited funds? Answer: None, and that is why Lady Liberty is covering her face in shame.