FLAIT

After more then a year, health care reform finally got through Congress and onto the President's desk. But not before the Democrats had to run the gauntlet of contentious town hall meetings, chants of "death panels," Senate filibusters, the loss of a Senate seat, pedantic pro-lifers and Republican obstruction, immaturity, attacks and lies. For that President Obama and the Democrats get credit. However, the process was a train wreck, the legislation didn't go far enough and a golden opportunity was lost.

A Lack of Leadership

As I pointed out here and here, our health care system's main problem is the way the "free market" has set it up: for-profit and employer-based. That's what got us into this mess. So if President Obama and the Democrats really wanted to fix the system, they had to change the system. And they had the mandate to do that. Barack Obama took office with 53% of the vote and overwhelming Democratic majorities in both the House and Senate. So with all that political capital, and the country expecting "change," the mandate was there. But they didn't use it (unlike George Bush and the G.O.P. who never had a domestic mandate but "governed" as if they did).

So the opportunity was there to take on this monstrosity and reform our health care system once and for all. Instead, they came away with health insurance regulation, not health care reform. But from the very beginning, that was all we were going to get:

The Huffington Post's Miles Mogulescu:

President Obama made a backroom deal last summer with the for-profit hospital lobby that he would make sure there would be no national public option in the final health reform legislation.

And Obama cut a similar deal with big Pharma. From Salon's Glenn Greenwald:

...the administration had agreed to oppose drug re-importation and bulk price negotiations, measures Obama (and the Democrats generally) repeatedly promised to enact. Indeed, when it came time to vote on drug re-importation, the administration concocted false "safety concerns" about re-importation in order to whip against Byron Dorgan's re-importation amendment, rather than admit that they really opposed it because they secretly promised they would to PhRMA, which hates drug re-importation because it lowers prices.

So instead of standing up to Washington's corrupt influence peddling, and taking on the powerful health care industry, Obama played along with them.

The Huffington Post's Lawrence Lessig:

Obama's victory was achieved because his team played the old game brilliantly. Staffed with the very best from the league of conventional politics, his team bought off PhRMA (with the promise not to use market forces to force market prices for prescription drugs), and the insurance industry (with the promise...that they would face no new competition from a public option), so that by the end, as Greenwald puts it, the administration succeeded in "bribing and accommodating them to such an extreme degree that they ended up affirmatively supporting a bill that lavishes them with massive benefits." Obama didn't "push back on the undue influence of special interests," as he said today. He bought them off.

And remember Sen. Max Baucus's plan? Actually, his aide, Liz Fower, wrote it. She was a former V.P. for Public Policy and External Affairs at WellPoint (a more detailed explanation of the health insurance industry's lobbying effort is here).

Real health care reform never had a chance.

July insert: Surprise, surprise. Liz Fowler has been hired by the Department of Health and Human Services to oversee the implementation of the health care legislation. Talk about the fox guarding the hen house.

Enforcement

With most of the attention given to "death panels" and angry mobs, there's been very little attention paid to the enormous power that Health and Human Services Secretary's will have in implementing and enforcing this legislation.

With that in mind, a Republican will become president, one day. And since his or her's partisan political interests won't coincide with the welfare of the country, you can be certain that the next Republican HHS Secretary will do whatever it takes to make sure this reform doesn't work because it won't be in their political interests for it to. Why? Because as this blog has proven, the Republican Party's Cult's only priorities are nasty partisan politics, and if the legislation fails, they can blame Democrats (their third favorite pastime), scream at Democrats (their second favorite pastime), and in the process, use it to keep their moronic base in this perpetual state of enraged anger at Democrats (their favorite pastime).

Also, if this legislation worked, it would prove Republican propaganda wrong and Republicans wrong (like they always are). And they can't won't allow that to happen. So it's in their interests for this legislation fail; or at least make sure the (made up) negatives drown out the positives. Fox "News," talk radio and the conservative media will take care of that.

So if when rates, costs, deductibles and co-pays skyrocket under a Republican administration, the G.O.P.'s propaganda machine will spring into action. It'll be "Obama's fault," "the Democrat's fault" and "the fault of their 2010 big government take-over of health care." And their moronic base will take it from there: "Na-na-na-na-na-na...We told you Obamacare wouldn't work...We were right and liberals were wrong!...na-na-na-na-na-na...I'm going to cover my ears...la-la-la-la-la-la!...Obamacare failed!...Big government failed!...Obamacare failed!...Big government failed!...Obamacare failed!...la-la-la-la-la-la...!"

You don't think a Republican administration would pull something like this? Keep in mind, this legislation mainly regulates the insurance companies. And regulation is only as strong as the government that's standing behind and enforcing those regulations. When have Republicans ever - ever! - cared about government institutions and regulation enforcement? Heck, when have Republicans ever - ever! - governed responsibly?

George Bush and the Republican Party Cult appeased the oil, coal, gas, timber, banking, finance, pharmaceutical, insurance and defense industries at every given opportunity (I guess Socialism's okay when Republicans engage in it).

Bush dismantled FEMA, ignored mine regulation, safety and inspections, and gutted the S.E.C., allowing Bernie Madoff and the rest of the Wall Street fraud to pass undetected right under its nose (which is what happens when you allow "the industry to police itself").

While Republicans acquiesced on Wall Street reform last month (well, not really), they met secretly with bank executives, twice, the second time for a fund raiser. So you can be sure they'll find make up an excuse to block, or at least water down, finance regulation. Oh wait, they already obstructed the legislation, they have blocked it, and are now making stuff up (gee, what a surprise).

This is nothing new. Republicans always do whatever corporations and big industry want. So when health insurance companies start finding the smallest of loopholes in the finest of fine print to wiggle through - things like this, this, this and this - and Americans need the administration to fight for them, whose side do you think a Republican President and his or her HHS Secretary will take? Republicans are already talking about repealing the legislation. What does that tell you?

Forget about Republicans having a legal, moral, responsible or ethical obligation to enforce government regulations because, as this blog has proven, their political obligations trump everything, including the welfare of the country.

If that's not enough, it's in the G.O.P.'s interests for "big government legislation" to fail because that would validate their propaganda that "government is bad, incompetent and doesn't work" (and volia! A new Republican voter is born!).

So they have a number of reasons not to enforce "big government" regulations. And these new health insurance regulations, most of which don't kick in until 2014, won't be any different.

More flaws of the health care bill are here and here. Winners and losers are here.

The legislation

One of the key components of this legislation are the "exchanges," or "marketplaces," where insurance companies will compete for those who will be forced to buy it (a picture of cattle being "forced" to slaughter just went through my head).

But most health insurance costs are picked up by employers. How will an individual or family, whose employer doesn't offer insurance, afford a plan that can cost in excess of $10,000, plus deductibles and co-pays, if they don't qualify for subsidies? Isn't that the problem now?

And then there's the business mandate which forces companies of at least 50 employees to offer health benefits. But businesses are having a difficult time with payroll taxes as it is. How does forcing them to add health coverage on top of that help them? And how are they supposed to compete with businesses around the world who don't have to provide health insurance?

And if the employer doesn't pick up any of the cost, and the employee has to pay for all of it, isn't that what got us into this mess in the first place?

The employer-based health insurance system is the epitome of what's wrong with it. So forcing business to provide it would be like, if you're in hole, you kept digging.

Competition to the rescue

One of the rationals to these "exchanges" is that it will bring "competition" to the system and that will result in lower costs. First, I'll believe it when I see it. Second, if it does lower costs, deductibles and co-pays, it won't be by much. And third, health care and health insurance aren't like hammers, toasters or HD TV's. For example, if someone can only afford a basic low-end HD TV, then that's all they're going to get and they'll live without the bells and whistles (literally). But health care and health insurance are different because everyone needs quality insurance that will not only provide them with the best possible care, but enough insurance to cover (most of the cost of) everything from the flu, to a broken leg, to cancer.

So unlike HD TV's, no one should have to "live" with "low-end" health insurance. In fact, when it comes to health care, everyone needs all the "bells and whistles." And how is a part-time waitress supposed to afford that? How is a free-lance artist supposed to afford that? How are the unemployed supposed to afford that? And that's the problem and what needs to be addressed. But that's something the right will never understand (or doesn't want to because they don't give a crap).

Contrary to what we've heard, it's not as if there's no health insurance competition out there. So if it hasn't worked all these years decades, why should we expect it to work now? "More competition" will just mean more bureaucratic complexity and more money thrown at an industry whose only priority is higher profits.

Besides, if "competition" is so wonderful, and "brings costs down" why is the price of something simple, such as printer ink, the same at Staples and Office Depot?

So this notion of "competition" in an extremely complicated, costly and bureaucratic system, run by enormous for-profit insurance cartels that have to satisfy Wall Street - who can grease politicians whenever they need a break and already have the G.O.P. on their side - is largely a myth. And trying to turn health insurance, and ultimately health care, which is a necessity and a matter of life and death, into a hammer, toaster, TV set or printer ink, will prove to be a fool's errand.

So no matter how much "competition" there is, you can be sure that the price of health insurance (relatively speaking when taking deductibles and co-pays into account) will be A) all the same and B) extremely high.

(This puts brainwashed Republicans into a bind. If they defend this "competition," then they would be defending this "big government"/"Socialist" legislation and would have to explain why they viciously opposed it. If they don't defend the "competition," and agree with me, then they'd be admitting that "competition doesn't work." Well Republicans, which one is it?).

(Apr. 21, 2011 insert: Paul Krugman on health care and why patients should not be thought of as consumers in the marketplace.)

Yes or no?

While progressives admit this legislation didn't go far enough, one of their selling points is that Social Security and Medicare were both phased in over time and improved incrementally. And they see this health care legislation as the first step of a process.

But Republicans will never take up health care. And Democrats won't take it up either; at least not until they have enormous Congressional majorities, which might not happen again for decades. And where will our health care system be five years from now (assuming it hasn't bankrupted us by then)?

If they do "revisit" health care, that means we'll have to go through this "debate" crap again: the angry town hall meetings, the chants of "death panels" (and worse), Senate filibusters, and Republican obstruction, immaturity, attacks and lies.

And when the Democrats finish (a year later) they'll come away with a "watered down" bill that was "the best we could do," but too little, too late, like it always is, and and we'll remain a step mile behind, like we always are. And then they'll "take it up again" a few years after that? Forget it. Why bother?

Why couldn't they just do it right this time when they had the mandate and the majority so they wouldn't have to "revisit it."

Oh, that would make too much sense. Can't have any of that in Washington. In the meantime the price of real reform gets more expensive and more difficult everyday.

But since kicking the can down the road is something Congress does extremely well - aided by political contributions, corporate influence and lobbying legalized bribery, underhanded dealings and dishonesty - "incremental reform" is a pipe dream. It's not going to happen.

So, should this legislation have been passed? It depends on how you look at it. If you didn't want Democrats to look like idiots because your concerns were with November's elections, then you appease, you cave, you sell your soul, you appease again, you cave again, you break out the pom-poms and convince yourself, and others, it's a good bill and push like hell to get it through.

But if your concerns were to deal with this extremely complicated and costly issue realistically, practically, maturely and intelligently, and not politically, and your priority was addressing the fundamental problem with our asinine for-profit, employer-based system, then no, it should not have passed.

That said, I fully understand staunch liberals like Dennis Kucinich changing their mind and voting for it. Under the circumstances, he had no choice.

The Media

1) After Republican Scott Brown won Ted Kennedy's Massachusetts Senate seat in January, the message coming out of the so called "liberal media" was that "Obama and the Democrats tried to do too much too soon and should just give up..."

I'd be willing to bet that over the past five, ten, 15 and even 20 years, the issue that Congressman have gotten the most faxes, phone calls, letters and e-mails were about health care and health insurance. By far. But as this health care (cough, cough,) "debate" and legislative process were winding down, and especially after Brown's victory, the media - the liberal media - was practically questioning why Obama and the Democrats took up the issue at all. They made it sound as if we have the most efficient and the most cost effective universal health care system in the world, and wondered why they were taking a bulldozer to it (as if that's what they were really doing).

2) Polls on the health care legislation were basically split. But what the so called "liberal media" didn't clarify was the number of Americans who opposed the plan - not because they (incorrectly) believed it contained "death panels," and not because they (incorrectly) believed it was a "government takeover of health care" - but because the plan didn't go far enough.

Roughly 15% of those who opposed this health care bill were from the left who thought it didn't go far enough. But the "liberal" media didn't break the polls down. So they were added to the right who opposed the bill because it went too far, making it look as if the country was split, or even opposed the legislation when that wasn't the case at all (FWIW this poll had the "didn't go far enough" number at 39%).

But I'm getting tired of these polls. How well would raising the gas tax poll? And yet, the gas tax should have been a lot higher a long time ago. And if the polls mattered, Obama wouldn't have sent more troops to Afghanistan, twice.

3) From the very beginning, the public option, as well as opinions and voices from the left, were considered "controversial," even "radical," and reported with a roll of the eyes. And it was the enraged mobs that were given air time and credibility. To this day, chants of "death panels," "Socialism" and a "government take-over of health care" can still be heard.

Eric Alterman:

...according to the Pew Center on People and the Press, the Tea Party movement got more coverage than health care during the second week in April despite the fact that more than 60 percent of Americans have either never heard of them or had not bothered to form an opinion.

So much for the "liberal media."

Conclusion

James Evans in an episode of Good Times:

Florida, we're poor...nobody wants to be poor. If you wrote a list of everything you wanted to be, poor would be right there on the bottom, right above "sick" and "dead."

It's a great line. It really is. Think about it. It sums up why government needs to be involved in health care; because you'd rather be poor then sick, but you'd rather be sick then dead, and death is guaranteed. So it's the least government can do. And should do. For moral and practical reasons. The rest of the world figured that out a long time ago. And James Evans figured it out, and he wasn't even talking about health care. So why can't we?

Democrats and liberals are celebrating this legislation and describing it as "historical" and comparing it to landmark legislation such as Social Security and Medicare. But this legislation can't be compared to them because great, historical, groundbreaking legislation such as Social Security and Medicare - along with the GI Bill, Civil Rights, the Tennessee Valley Authority and maybe even the WPA - were indeed "big government" programs that helped hundreds of millions of Americans and made this country what it is.

Again, all Congress did was slap some regulation on the insurance industry. That's all. Contrary to the G.O.P., there's nothing in this legislation that makes government a health insurance payer or provider (by forcing all Americans to purchase health insurance from the insurance companies, they actually gave more power to the private sector. Where's the tea baggers and "free market" Republicans on that? In fact, this legislation is very similar to what Republican Gov. Mitt Romney passed in Massachusetts in 2006. So I guess it's okay for "government to take over health care" when Republicans do it.).

We'll have to wait a few years to find out if this works. But no one can predict because, as I pointed out, HHS's Secretary's will hold a lot of power. So the legacy of this legislation could very well depend on the 2012 presidential election because it will be in a Republican president's interests for that legacy to be failure.

That said, I think things will get marginally better. More Americans will be able to buy insurance and that means more money will be thrown into the pot. And that's good. But we'll still be paying through the nose for health care, costs will continue to rise, uncontrollably, and we'll still have tens of millions of Americans uninsured and under insured, which will be passed on to government and taxpayers, one level or another, one way or another, just like they've always been.

But what do you expect? When most of the time and energy is spent on spin, focus group tested talking points, cutting deals with Congressmen and lobbyists, being forced to defend yourself and your side against incessant attacks and lies, and having to maneuver around deliberately placed political and procedural roadblocks because the other side wants to sabotage the whole thing, it shouldn't be a surprise that the issue gets lost and we end up with "watered down" legislation that "doesn't go far enough" but was "the best we could do."

I know "this is how how Washington works" and in order to get legislation like this through the "sausage grinder" you have to "play the game" (and we wonder why the country's in the shape it's in). But who said it has to be that way? It's only that way because there's not one honest politician anywhere who cares enough to change the system.

Maybe if we had a honest leader who did care enough and despised this corrupt system - the dishonesty, bribery, lies, spin, manipulation, corporate influence, partisan politics and political assassination - and put an end to "the game," we could have had a mature, honest, intelligent and practical discussion on health care reform and it would have been done right.

The pharmaceutical industry wrote into the (2003) prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee, who pushed the law through, went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game playing in Washington. You know, I don't want to learn how to play the game better, I want to put an end to the game plan.
- Barack Obama, in one of his 2008 campaign ads

We needed Obama and the Democrats to hit a home run with this thing, but all we got was a hit-by-pitch. And we all know where we got hit.

August insert: While HHS Secretary's will hold a lot of power, the states will be administrating, or managing, much of this reform. But that's what we have now. So some states will be tougher on the insurance companies and have more oversight on the exchanges, while others will allow the insurance companies to do whatever they want.

Also, many of these states are controlled, and will be controlled, by Republicans, who as I've said, have a political interest in this initiative failing miserably. And with 14 Attorney's General - 13 Republicans and one Democrat - going to court trying to block this reform altogether, we can get an idea just how (cough, cough) tough those states would be on the insurance companies, assuming their efforts fail.