Blog on the Run: Reloaded

Wednesday, December 16, 2009 1:12 am

Who lives, who dies?

Filed under: Sad,We're so screwed — Lex @ 1:12 am
Tags: ,

Under our current system, by every objective standard the worst in the industrialized world, roughly 45,000 Americans die every year as a direct result of lack of health insurance. Will the current bill, flawed though it might be, save enough of them to make it worth supporting?

I haven’t been watching the Senate debate on health-care reform tonight, so I may put a bunch of energy into this post only for it to be overtaken by events by the time I wake up in the morning. But I think Congress and we the people have arrived in the past day or so at a point we’re going to look back at 30 years from now and recognize for better or worse — quite likely worse — as historic.

Sen. Joe Lieberman, who won re-election in his last race as an independent after getting beaten in the Democratic primary, has managed to strip out of the bill the things its most fervent backers wanted most, primarily a public option and, as a fallback from that, expansion of Medicare to include some (paying) people between the ages of 55 and 64. Keep in mind that as recently as September, Lieberman was publicly supporting the Medicare expansion.

As it now stands — and, again, I realize, this could change at any time — the bill gives the powers that be in the current health-care status quo a lot of goodies. And it doesn’t come anywhere close to achieving universal health-insurance coverage.

There are other specifics I’ll get into in a second, but right now, things boil down to this: Under our current system, by every objective standard the worst in the industrialized world, roughly 45,000 Americans die every year as a direct result of lack of health insurance. Will the current bill, flawed though it might be, save enough of them to make it worth supporting? Or, put another way, how many people does it need to save before all the goodies, both up front and over time, that private health insurers and pharmaceutical companies will be getting are justified?

I don’t think there’s a right answer. For damn sure, there’s no good answer.

* * *

Just how bad has Joe Lieberman crapped all over the whole debate on health-care reform? Bad enough that right now, I think it’s time he not only gets no health care, it’s time he gets intestinal cancer in a part of the world where morphine is as yet undiscovered. I mean, really, what kind of sociopath do you have to be to disregard those 45,000 annual deaths and singlehandedly chop up a bill to create something that:

  • Mandates that every American buy expensive insurance from private companies without the choice of a public option and lets the IRS fine you if you don’t
  • Severely taxes middle-class health care plans, rather than wealthy individuals
  • Increases insurance premiums about $1,000 a year
  • Increases health care costs
  • Continues to exempt health-insurance companies from antitrust laws, inhibiting competition
  • Provides a sweet deal for pharmaceutical manufacturers while denying the government the ability to negotiate for lower drug prices for Medicare, something Democrats actually promised three years ago.
  • Apparently won’t let the government import drugs from cheaper foreign sources. I’m told my own junior senator, Kay Hagan, was arguing tonight that this was a “safety” issue, which must come as a surprise to the dozens of other countries that do this every day.
  • Grants monopolies on new biologic drugs so they will never become generics
  • Offers NO public option
  • Offers NO Medicare expansion, even in return for payment, for 55- to 64-year-olds.
  • Limits insurance-company payouts, contrary to President Obama’s promise in September
  • Raises taxes in January while not beginning benefits until 2014.

It’s as if private insurers, Big Pharma and their water-carriers on Capitol Hill are trying to see how bad they can make the bill and still get “reform” supporters to vote for it. As I noted in an earlier post, Ezra Klein of The Washington Post has suggested (and there is some evidence for this view) that Joe Lieberman has done all this simply to piss off progressives. Well, congratulations, Joe — you’ve not only pissed off progressives, you’ve also pissed off me.

It’s also as if Republicans got together and created a bill that they wanted Democrats to run on in 2010 because they knew it would do little or no good while also pissing off people all across the political spectrum, from angry defenders of the status quo to people who wanted far, far more change than this bill can offer.

But it’s Democrats, not Republicans, who are doing this. Republicans, having pledged to oppose any Democratic bill unanimously and lacking the numbers to defeat a bill on their own, have become irrelevant to the debate. This is happening because of the seriously undemocratic structure and operating rules of the Senate and because of conscious choices on the part of Lieberman and other prominent Democrats who ought to know better and whose motives must therefore be called into question. And it’s happening with the approval, if not at the order, of Barack Obama, who has been lying pretty shamelessly about what the bill will and will not do.

* * *

In addition to screwing tens, if not hundreds, of millions of Americans on the substance, this situation also creates an interesting political dilemma for Democrats. Enough progressive House Democrats have pledged to oppose any health-care reform that lacks a public option that anything that can get 60 votes in the Senate, needed to overcome a filibuster, will not pass the House if all those now on record as demanding a public option hold firm.

So it’s not just people who need health care who must choose between a crappy bill and no bill. It’s Congressional Democrats, a bunch of whom must run for re-election next year with whatever happens to this bill as the most important backdrop besides jobs and national security (two other areas where Democrats aren’t exactly shooting out the lights). What makes it really interesting is that if health-care reform is either seen as inadequate or fails entirely, the most vulnerable incumbents aren’t going to be the ones who pushed for far more sweeping changes. It’s going to be the Blue Dogs who are hewing close to Lieberman.

I don’t see 2010 being as bad for Democrats as 1994 was. But I bet the Republicans take back the Senate.

* * *

As you might imagine, there’s a significant split among people who’ve been following this issue over whether this bill is better than nothing. And generally speaking, the policy wonks argue that this bill, while bad, is better than nothing, while the political activists say this thing needs to be killed.

Blogger Jane Hamsher argues that it’s worse than nothing:

Instead [of reducing costs by allowing importation], the “bend” [a reference to the need to slow the growth of health-care costs, often called “bending the cost curve” — Lex] comes from taxing middle class insurance benefits, which makes them worse. According to the CSM report released last week:

In reaction to the tax, many employers would reduce the scope of their health benefits. The resulting reductions in covered services and/or increases in employee cost-sharing requirements would induce workers to use fewer services. Because plan benefit values would generally increase faster than the threshold amounts for defining high-cost plans (which are indexed by the CPI plus 1 percent), over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage.

The cost curve gets “bent” by making the insurance you have through your employer worse. Remember Harry and Louise? They killed health care reform during the Clinton administration by making this claim. Well, now it’s actually going to be true.

Howard Dean, the physician and former governor and presidential candidate, also says this bill must be killed. Digby agrees, saying that the bottom line is that this bill isn’t going to save any lives:

Nobody’s “getting covered” here. After all, people are already “free” to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won’t make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn’t or didn’t want to write. Indeed, it actually looks like the worst caricature of liberals: taking people’s money against their will, saying it’s for their own good. …

What this huge electoral mandate and congressional majority have gotten us, then, is basically a deal with the insurance industry to accept 30 million coerced customers in exchange for ending their practice of failing to cover their customers when they get sick — unless they go beyond a “reasonable cap,” of course. (And profits go up!)

Emptywheel calls it “neo-feudalism”, and my only argument is that she’s being too kind. This is nothing more or less than using government as a mechanism to transfer wealth from the middle class to corporations just as feudal peasants had to pay to the nobles — and the peasants actually got a promise of protection in return, while these corporations, which supposedly will protect us from medical bankruptcy in return, aren’t even legally required to do that:

Consider a family of four making $66,150–a family at 300% of the poverty level and therefore, hypothetically, at least, “subsidized.” That family would be expected to pay $6482.70 (in today’s dollars) for premiums–or $540 a month. But that family could be required to pay $7973 out of pocket for copays and so on. So if that family had a significant– but not catastrophic — medical event, it would be asked to pay its insurer almost 22% of its income to cover health care. Several months ago, I showed why this was a recipe for continued medical bankruptcy (though the numbers have changed somewhat). But here’s another way to think about it. Senate Democrats are requiring middle class families to give the proceeds of over a month of their work to a private corporation — one allowed to make 15% or maybe even 25% profit on the proceeds of their labor.

It’s one thing to require a citizen to pay taxes — to pay into the commons. It’s another thing to require taxpayers to pay a private corporation, and to have up to 25% of that go to paying for luxuries like private jets and gyms for the company CEOs.

Forget whether this will actually make health care cheaper or more available. How is this even constitutional?

I’m no closer now to knowing what we ought to do, or even what I would do were I in the Senate, than I was when I started this piece almost three hours ago. I just know that after all this time and effort, tens of millions of Americans are still going to be uninsured, and tens of thousands will still die next year because of it. And the fact that tens of millions of other Americans think this is acceptable makes me tremble for my country.


  1. “But I bet the Republicans take back the Senate.”

    Never say never in politics, but that seems very unlikely to me — and another reason why we don’t need to approve of crappy health care reform as our last bet hope.

    There are five senators retiring in 2010. Four of them are Republican. Can the R’s hold all four of those seats? I think it is more likely they have a real chance of losing two of them, Floridan and Ohio.

    Looking at incumbents who are also up for re-election it is harder still to find significant Republican gains. I just can’t see Rs keeping the four retiring seats AND picking off eight Democratic incumbents.

    Comment by Roch101 — Wednesday, December 16, 2009 9:39 am @ 9:39 am

  2. I’ve reached the end of your post now. Thanks for the time and effort.

    Comment by Roch101 — Wednesday, December 16, 2009 9:46 am @ 9:46 am

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