Thursday, March 29, 2012

Debating Obama's sell out of healthcare.

As the debate over Obama's health care bill winds down in front of the United States Supreme Court with its very constitutionality and survival at stake, its a good time to remember that had Obama not sold out the public option to healthcare industry lobbyists there wouldn't be a debate in front of the Supreme Court at all.

At the heart of the Supreme Court debate is the individual mandate, the provision Obama inserted as the substitute for a public option in another one of his unnecessary conviction-less capitulations and now as is usually the case when the wrong thing is done for the wrong reasons, its about to blow up in his face since it is now a vitual certainty the mandate will be struck down as unconstitutional. And with good reason.

But while the Supreme Court debate is making front page news, what most people, especially congressional Democrats, their strategists and the news media seem to forget, is just what a catastrophe on every level Obama's selling out the public option really was and how, had it passed, it would have transformed America. Instead Obama sold out the health care of Americans, the justice of a level playing field for healthcare, the Democratic agenda and congressional Democrats who were prepared to pass a public option,by capitulating to the healthcare industry lobby, the drug companies, insurance companies and of course the Republicans in dropping the public option even though the votes were in congress to pass it. And then, as usual, lying about it.

When questioned about his dropping the public option Obama claimed with brazen, blatant dishonesty that he never campaigned for a public option. And in a press conference defending his healthcare bill, lied again claiming that his bill "got health coverage for 32 million uninsured Americans". What his healthcare bill and mandate would have gotten was 32 million new customers for the insurance companies. The mandate was a boon to the health insurance industry as the spike in their stocks have shown, not to Americans without health coverage. And now not only is the mandate almost certainly to be struck down, it could bring down the entire law which wasn't all that great to begin with, and make all the angst and political bloodletting, all the time and money spent on healthcare reform all be for nothing.

But this is what passing the government run public option could have done:

It would have taken the 2700 page law and probably reduced it to 27 pages because most of the provisions in the law directed at insurance companies would have been unnecessary. It would have been unnecessary to require insurance companies to drop pre-existing conditions as a reason to deny coverage or prevent them from dropping people with catastrophic illnesses, or setting caps or a hundred other things because the public option would have had none of that and if insurance companies wanted to keep customers and compete they would be forced to drop those policies on their own.

Secondly, the government run public option would have greatly reduced healthcare costs since the government (and tax payers subsidizing it) wouldn't abide by hospitals charging $50 for an asprin ( or a Michelle Obama being paid $350,000 a year in a patronage job to do PR for a Chicago hospital, which she did while Obama was a senator). Government run health insurance would have done more to reduce health care costs than just about anything else which was one of the goals of reform.

Third, with a government run public option available, employers and workers could have switched to the public option and that would have had a long lasting positive impact not only on their own health but health of the economy.

It's been estimated that 1/3 of the cost of manufacturing a car is health insurance premiums have to pay for their employees. A public option would have greatly reduced or eliminated an employer's health insurance burden as well as eliminated employees contributions to their insurance coverage which comes out of their paycheck. That would have meant more money back in the pockets of employees and less costs for employers. More money in employees pockets would have meant more spending which would have meant increased demand which would have meant increased hiring and lower unemployment. And increases to a bottom line also increases the value of stock to investors. So aside from all the good things it would have brought to the health of the American people, it would have also made the economy healthier. In fact the CBO also scored the public option as reducing the deficit by $160 billion.

Add to that the common sense provisions that a government run public option would have had which included  preventive care and healthcare maintence like regular check ups, enrollment in fitness centers etc., and  it would have made for a healthier population with less need for expensive healthcare procedures. And a healthier population staying healthy for a longer period of time would have reduced  Medicare costs far into the future since as people grew older and were healthier, they would have less of a need for medical care which would have reduced the drain on the system in a much better way than slashing coverage as Republicans propose.

All of this went down the drain when Obama shortsightedly and for his own political fortunes and because he couldn't take even a little political heat, sold out the public option. It also was the single biggest factor in the Democrats getting wiped out in the 2010 election since polls showed an overwhelming number of people wanted and supported what Democrats promised but didn't deliver.

It should also be kept in mind that Obama's healthcare bill without the public option, the bill that some congressional Democrats, strategists and political shills try to call his "signature piece of legislation", was called a piece of "junk" by Howard Dean, former DNC chair, presidential candidate, governor and physician. Tom Harkin and other Democrats could only say about it that it was "better than nothing".  Dean said before the vote on Obama's healthcare plan that it "should be junked and the Democrats should start over".

It looks like the Supreme Court is about to take Howard Dean's advice and do what congressional Democrats should have done to Obama and his healthcare plan two years ago if only Pelosi and Reid had had the backbone to stand up to Obama who didn't have the backbone to stand up to Republicans and the health insurance companies. Only now it looks too late to start over. And it seems that the Supreme Court is not only going to listen to Howard Dean and junk it, even if the rest of the bill stands while the mandate is gone, it's  not going to be "better than nothing," it's going to be nothing,just more medical waste.

In his closing arguments defending Obama's law, Solicitor General Donald Verrilli Jr.lamely tried to tie Obama's mandate to buy health insurance to the concept of liberty, trying to define it as giving people liberty from illness and disease. Rebutting it,Paul Clement said, "it's a funny concept of liberty that forces someone to purchase an insurance policy..."

The concept of healthcare and liberty as related, as well as related to equality ( not racial or gender but human)  is at the heart of the concept of universal healthcare.  And had Obama really cared about healthcare as a civil right he would signed a public option into law. Instead of selling it out.


Anonymous said...

I'm wondering if the Supreme Court is going to compare requirements that people maintain auto insurance and homeowners insurance to the health insurance mandate and how that will play out. Any thoughts on relative constitutionality, Marc?

Marc Rubin said...

"I'm wondering if the Supreme Court is going to compare requirements that people maintain auto insurance and homeowners insurance to the health insurance mandate and how that will play out."

The biggest difference between auto insurance. homeowners and the healthcare mandate is that auto insurance is state law while the health insurance mandate would be federal law and the issue is constitutional and the federal government's reach. The Supreme Court will almost definitely rule the federal mandate to buy health insurance is unconstitutional and beyond the power of congress to mandate while state mandates for auto liability insurance or homeowners liability are within states rights.

SophieCT said...

"remember that had Obama not sold out the public option to healthcare industry lobbyists there wouldn't be a debate in front of the Supreme Court at all."

You can hardly overstate this fact or repeat it often enough.

To the constitutionality of a mandate, I'm not sure insurance is unique. We are mandated to pay for other people’s children to go to school. (Though I’m a proponent of public education, it's still a mandate.) We are mandated pay for wars on behalf of Xenophobic sexists in other countries. We are mandated to pay for 535 half-assed idjits to have much better health insurance than we will ever have.

Anonymous said...

tdraicer: It is hard for me to agree that Obama sold out the Public Option since it seems obvious to me he never had any intention of pursuing one. It was just a diversionary tactic to keep single payer off the table, and once it had achieved that goal, he abandoned it as he always intended to.

Anonymous said...

Another benefit to a public health option would have been to allow people to be more mobile in terms of moving in the U.S. to take different jobs and not being so tied to a current employer and/or more supportive of people taking part-time jobs if they wanted without fear of not having health care. It also would have made companies more competitive to remove that "benefit" as both a cost to them and a differentiator vis a vis other firms. They could focus on what they do as a business and not have to deal with insurance companies themselves and/or pay a third party to manage this. I think it would have been to boon to our country as a whole to decouple it. What a lost opportunity with sad ramificaitons for so many Americans. The repeal will be a mess, too. Thanks for nothing, Obama.

Anonymous said...

I no longer wonder whether the Supreme Court is going to compare the "ACA" to other types f insurance. They seem stuck on the requirement to eat broccoli. Oh, my. We are close to "Idiocracy.'

Marc Rubin said...

"Oh, my. We are close to "Idiocracy"'

We're not close to it, we've been in it for 12 years.