The First Test is Healthcare

The Democrats’ Plan to Sabotage Reform for a Generation

The progressives who have been pushing for eight long years to throw off the yoke of Bush Republicanism reached a variance in perspective in this last election. Those who backed third party candidates hoping to build support for a specific leftist agenda failed to win a significant number of voters to their cause. On the other hand millions of people who undoubtedly believe in that agenda decided that every last vote was needed to ensure Obama’s win and that any pre-election pressure that they exerted would only handicap him in the preeminent task of defeating the Republicans.

The call is now going out to begin exerting post-election pressure. The operating belief among Obama progressives is that the leftist position is now stronger because all of these empowered voters will demand specific policies.

Nowhere will this strategy be put to a greater test than in the battle to reform the nation’s healthcare system, sure to be one of the foremost initiatives in Obama’s first hundred days. That is because nowhere will the centrist paradigm of getting elected come into greater conflict with the desires of progressives to have effective reform.

The middle way on healthcare reform, which Obama used to parry and parrot Hillary Clinton’s plan in the Democratic primaries, is premised on the idea that the power of the health insurance lobby is too strong to be assailed head on. Therefore the most expeditious approach to providing healthcare for all is to give the insurance companies what they want: continued control of the system and access to more business, paid for out of the Federal Treasury. These concessions will then open the door for fairness provisions: requirement to insure preexisting conditions, tax credits to pay for insurance, expanded Medicaid and S-CHIP, pooling mechanisms and a limited public plan.

Powerful forces within the Democratic Party and the liberal media are already marshaling to push this initiative early. Senator Max Baucus of Montana is introducing the legislation. The lavishly funded HCAN organization is ubiquitous. Hillary Clinton is expected to weigh in forcefully. The internal conflict among Democrats is already being framed as — will buying insurance be mandatory or voluntary.

But the real story on healthcare reform is less apparent and much more alarming. The newly empowered centrist faction of the Democratic Party may well be pushing a plan that is destined to fail, and in so doing they may sabotage reform for a generation.

Passing legislation and having it signed by the president may be the least of their problems. Much more central to the discussion is, will the middle way prescription realistically work? Here’s what the Obama plan won’t do: save the country any money. The modus operandi of all politicians, whether Democratic or Republican, is to defer to the powerful and rely on the largesse of the Federal Treasury.

The last thing that the Democratic leadership wants to admit is that their acquiescence on the $850 billion Wall Street bailout has seriously crippled their ability to expand spending on social programs, especially ones that represent burgeoning outlays into the future.

The working model of the Obama/Baucus plan of mixed private and public coverage is the Massachusetts universal care program. Passed under Republican Mitt Romney and implemented by Democrat Deval Patrick, its effect on public spending is unequivocal. The Boston Globe reports:

The subsidized insurance program at the heart of the state’s healthcare initiative is expected to roughly double in size and expense over the next three years — an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.

Massachusetts is now turning to the federal government for help in making up the difference. They will be joining the queue behind AIG, Lockheed-Martin and Kellog, Brown and Root.

If reducing the cost of healthcare was easy it would already have been taken care of by now. But the aforementioned political realities have kept key considerations off the table. Namely that roughly 30% of every healthcare dollar goes to maintaining the for-profit insurance infrastructure — administrative costs, advertising, promotions, lobbying, CEO salaries and profits. This is potential savings that the Democratic conciliatory approach is not attempting to reach.

Instead the cost-containment mechanisms in the Obama/Baucus plan are so generic that they are nearly identical to those in John McCain’s plan and are likely to be implemented by the industry irregardless of government action. These include improvements in information technology and a greater emphasis on maintaining good health.

Another aspect of rising healthcare costs that gets little attention is the reliance of Wall Street on private healthcare companies as a growth industry. Certainly a legitimate part of a capitalist economy it none the less creates perverse incentives within the fee-for-service structure to provide the kind of care that keeps the stock prices for these companies rising, i.e. late stage treatment over prevention and countless unnecessary tests, treatments and hospitalizations. In both of these components of the private system, for significant savings to ever be realized, someone is going to have to cut off the cash cow to these corporations.

That makes the centrist impulse of leaving the private structure intact almost the same as no action at all. If the level of public debt that we are now facing proves to be unsustainable then even liberal initiatives like H-CHIP and Medicaid may be threatened let alone the new spending this plan entails. If the economy continues on its current trajectory the Obama plan, like the Massachusetts model will be headed for the dust heap of history.

The activist community needs to come to terms with how formidable their task is. In healthcare, as in scores of other issues, no change will take place until there is an actual confrontation with entrenched power. The reallocation of public resources to the needs of the people will never happen unless those resources are wrested from the clutches of the military/industrial complex and the corporate welfare state.

The private insurance industry is not fearful of Obama’s plan, rather they welcome it. Their stock values have plateau-ed and they are anticipating a huge influx of cash as the uninsured are added to their roles, paid for with taxpayer dollars. They have given substantial contributions to both Obama and the Democrats, outstripping their support to their former allies in the Republican Party.

The mainstream of the Democratic Party, the corporate dominated media and centrist lobbying groups like Health Care for America Now are creating an impenetrable wall on the issue of reform. What is blocked out by this wall of hoopla is the third option on healthcare, the one that actually represents a possible solution to our current morass.

If one were to look at the examples of other industrialized countries that offer universal, quality healthcare at about half the cost of the United States then it becomes manifest that our best option lies with a single payer system. This shouldn’t be confused with “socialized” medicine where the government takes over the entire healthcare industry. Rather it means Medicare for all, where the government replaces the private insurance industry with a single risk pool and keeps healthcare delivery in the hands of doctors and hospitals.

With the investment industry nearing a dysfunctional state; with governments — state, local and soon federal — struggling to finance basic services; with the auto industry on life support largely because of their healthcare obligations, circumstances are propitious for confronting the inefficiencies of the current structure and building a viable, less expensive system that will see us through the hard times ahead. But the efforts of the centrists to rush Obama’s plan through the first hundred days of the new administration are having the effect of confusing the American people and protecting the insurance industry. If the aim of HCAN is to build grassroots support for change, wouldn’t it be just as easy to promote change that serves the interests of the grass roots?

Obama progressives who believe that they are in a position to influence his policies need to be cognizant of this situation. They are up against not only the Republicans and the Health Insurance Association of America but also the centrist Democratic leadership and the president that they just endorsed. It is a moment and an issue where only a progressive solution will do and the left needs to clearly differentiate itself from the center.

A unified Democratic push for single payer would be a difficult enough battle. A divided Democratic party doesn’t bode well. But a Democratic initiative that is inadequate and does not fix the problem will be the worst outcome of all, for it will discredit the left and the idea of healthcare reform for years to come.

Doug Rogers is a playwright and composer and for many years designed ladies' sweaters. He is now a student again at Empire State College in Buffalo NY. He can be reached at: Read other articles by Doug, or visit Doug's website.

4 comments on this article so far ...

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  1. Max Shields said on November 14th, 2008 at 8:13am #

    The so-called “center-right” are firmly in control of the Federal gov’t.

    Noticed that with the slow decline of the hoopla, the turn-out for this election was no better than 2004. The corporate elite rule.

  2. Guy said on November 14th, 2008 at 10:53am #

    The key point – is – PROFIT!

    Healthcare will not change while those profits are allowed to influence government.

    There’s a reason Marx and Engles didn’t like insurance companies.

  3. Brian said on November 15th, 2008 at 12:17am #

    Just another reason why I voted for Nader.

    Nicely argued. Absolutely solid conclusion.

  4. bozhidar bob balkas said on November 15th, 2008 at 8:11am #

    isn’t money/its (ab)use, root of all evil on interpersonal and international levels?
    i say yes! so, what can we expect? less evil? more evil? sameness?
    i say, more evil?
    add to the money, the classful societies and their misteachings/disinformation, serfdom will be w. us for long time.
    it actually may never evanesce. thnx