The Incredible Shrinking Healthcare Reform

Like soap in a rainstorm, “healthcare reform” is wasting away.

As this week began, a leading follower of conventional wisdom, journalist Cokie Roberts, told NPR listeners: “This is evolving legislation. And the administration is now talking about a glide path towards universal coverage, rather than immediate universal coverage.”

Notions of universal healthcare are fading in the power centers of politics -- while more and more attention focuses on the care and feeding of the insurance industry.

Consider a new message that just went out from Organizing for America, a project of the Democratic National Committee, which inherited the Obama campaign’s 13-million email list. The short letter includes the same phrase seven times: “health insurance reform.”

The difference between the promise of healthcare for everyone and the new mantra of health insurance reform is akin to what Mark Twain once described as “the difference between lightning and a lightning bug.”

The “health insurance reform” now being spun as “a glide path towards universal coverage” is apt to reinforce the huge power of the insurance, pharmaceutical and hospital industries in the United States.

President Obama says that he wants “things like preventing insurers from dropping people because of pre-existing conditions.” Those are not fighting words for the present-day insurance industry. Behind the scenes, massive deals are taking shape.

The president of America’s Health Insurance Plans, Karen Ignagni, “noted that the industry had endorsed many of the administration’s proposed changes, including ending the practice of refusing coverage for pre-existing conditions,” the New York Times reported on August 3. A couple of days later, in a profile of Ignagni, the newspaper added: “Rather than being cut out of the conversation, her strategy has been to push for changes her members can live with, in hopes of fending off too much government interference.”

This year, no more significant news article on healthcare politics has appeared than the August 4 story in the Los Angeles Times under the headline “Obama Gives Powerful Drug Lobby a Seat at Healthcare Table.” http://pdamerica.org/articles/news/2009-08-04-12-46-58-news.php [1]

It’s enough to make you weep, or gnash your teeth with anger, or worry about the consequences for your loved ones -- or the loved ones of people you’ll never meet.

During his campaign last year, Obama criticized big pharmaceutical firms for blocking efforts to allow Medicare to negotiate for lower drug prices. But since the election, the LA Times reports, “the industry’s chief lobbyist” -- former Congressman Billy Tauzin -- “has morphed into the president's partner. He has been invited to the White House half a dozen times in recent months. There, he says, he eventually secured an agreement that the administration wouldn’t try to overturn the very Medicare drug policy that Obama had criticized on the campaign trail.”

The story gets worse. For instance, “Tauzin said he had not only received the White House pledge to forswear Medicare drug price bargaining, but also a separate promise not to pursue another proposal Obama supported during the campaign: importing cheaper drugs from Canada or Europe.”

Meanwhile, with a “mandate” herd of cash cows on the national horizon, the health insurance industry is licking its chops. The corporate glee is ill-disguised as the Obama administration pushes for legal mandates to require that Americans buy health insurance -- no matter how dismal the quality of the coverage or how unaffordable the “affordable” premiums turn out to be for real people in the real world.

The mandates would involve “diverting additional billions to private insurers by requiring middle class Americans to purchase defective policies from these firms -- policies with so many gaps and loopholes that they currently leave millions of our insured patients vulnerable to financial ruin,” says a letter signed by more than 3,500 doctors and released last week by Physicians for a National Health Program.

Days ago, a New York Times headline proclaimed an emerging “consensus” and “common ground” on Capitol Hill. In passing, the article mentioned that lawmakers “agree on the need to provide federal subsidies to help make insurance affordable for people with modest incomes. For poor people, Medicaid eligibility would be expanded.”

It’s a scenario that amounts to expansion of healthcare ghettos nationwide. Medicaid’s reimbursement rates for medical providers are so paltry that “Medicaid patient” is often a synonym for someone who can’t find a doctor willing to help.

But what about “the public plan” -- enabling the government to offer health insurance that would be an alternative to the wares of for-profit insurance firms? “Under pressure from industry and their lobbyists, the public plan has been watered down to a small and ineffectual option at best, if it ever survives to being enacted,” says John Geyman, professor emeritus of family medicine at the University of Washington.

A public plan option “would do little to mitigate the damage of a reform that perpetuates private insurers’ dominant role,” according to the letter from 3,500 physicians. “Even a robust public option would forego 90 percent of the bureaucratic savings achievable under single payer. And a kinder, gentler public option would quickly fail in a healthcare marketplace where competition involves a race to the bottom, not the top, where insurers compete by NOT paying for care.”

While the healthcare policy outcomes are looking grim, the supposed political imperatives are fueling the desires of Democratic leaders on Capitol Hill to produce a victory that President Obama can tout as healthcare reform. Consider this quote from “a prominent Democrat” in the August 10 edition of Time magazine: “Something called health-reform legislation will pass. The political consequences of not passing anything would be too great.”

The likely result is a glide path to disaster.