Blowing It: Obama, the Democrats, and Health Care

Obama and the Democrats are about to blow it big time on health care.

Instead of adopting adopting a single-payer plan, which would both cover everyone and be the most cost-effective solution, they’re going to pass an outrageous insurance-and-drug-industry-friendly bill. Then, they’ll brag about how they passed “landmark legislation.”

At least until the bills come due and the government goes bankrupt.

Despite the armed racist mobs turning their brains off and running their mouths at town halls (Trotsky called them “human dust” in his day), Congress will pass and President Obama will sign into law something mislabelled health care reform. The devil, as always, is in the details.

First and foremost, a robust public option is pretty much off the table, and with it, anything meaningful, substantive, or worthy of the name “reform.” A public option would be a government-run single-payer health insurance program similar to Medicare. You know, that big scary socialist-fascist-communist-anti-American-beginning-of-the-Gulag government program that has sent tens of thousands of patriots to their graves thanks to Soviet death panels? Yeah, that Medicare.

Despite their trash talk, Republicans in Congress refused to kill Medicare in a recent vote. Not a single Republican would vote against this diabolical Marxist scheme. We ought to deport these single-payer-loving commies back to Cuba where they belong, but only after some “enhanced interrogation” at Gitmo, of course. We can start with Michelle Bachmann. At least then she’ll have something real to fear for a change.

President Obama said “those who profit from the status quo” are behind the efforts to sabotage the legislation. The funny thing is, he gave them a seat at the health care reform table in an effort to buy their acquiescence. Instead of going to war with the institutions that have a vested interest in sabotaging his agenda, the president allowed them to shape the legislation. This is Dick Cheney’s Energy Task Force all over again, except its out in the open. When people voted for change, they weren’t voting for lobbyists to use the front door of the White House instead of the back door.

At a “historic” summit, Obama announced that hospitals, drug and insurance industries, and doctors’ associations agreed to $2 trillion savings over the next 10 years. But as the New York Times noted, “None of the proposals are enforceable, and none of the savings are guaranteed. … At this point, cost control is little more than a shared aspiration.”

Obama surrendered any hope of meaningful health care reform in exchange for – nothing. Absolutely nothing. The drug companies, for example, agreed to voluntarily cut costs by $80 billion over the next 10 years. In exchange, the legislation won’t legalize the re-importation of cheaper drugs from abroad, and there won’t be government negotiation of drug prices for Medicare beneficiaries. (For anyone who’s counting, that’s another campaign promise Obama reneged on and another Bush policy he’s adopted.)

Never mind the fact that these agreements don’t have the force of law behind them. Never mind that they are so vague as to be totally meaningless. Never mind the lack of an enforcement mechanism in case these industries don’t live up to their obligations. While we’re at it, never mind health care reform.

The reason the Right is screaming against a single-payer or public option is very simple: it works. Cheap, universal, quality health care coverage is what the drug companies, insurance crooks, doctors’ organizations, and the rest of the health care industrial complex are so deathly afraid of. They stand to lose hundreds of billions of dollars and could be driven out of business if the profit motive is removed from the health care equation.

We get the least bang for the buck because our system is set up to get the private sector the most buck for the bang. In McAllen, Texas, where medical costs are among the highest in the nation, an investigative journalist found that doctors did all kinds of medically unnecessary procedures to increase their income. One doctor claimed that ordering superfluous tests was a necessary evil to avoid lawsuits, to which a general surgeon replied, “We all know these arguments are bullshit. There is overutilization here, pure and simple. … [T]he way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’”

The fee-for-service system, where doctors get paid every time they run a test, see a patient, do a procedure, etc., is one of the reasons health care is so costly. The Mayo Clinic, which Obama touts as a model for the nation, keeps costs low and has excellent outcomes because their doctors are essentially proles. They work under one year contracts for a salary instead of deriving their incomes from individual services performed.

None of the legislation in Congress would touch the fee-for-service system.

David Roderick, the chairmen of U.S. Steel, once commented: “US Steel is not in the business of making steel. It is in the business of making money.” Ditto for doctors’ associations, insurance companies, hospitals, and pharmaceutical giants. They’re not in the business of helping sick people, they’re in the business of making money. The health care system can either prioritize making money, or it can prioritize delivering the best possible health care for the population. It can’t do both.

Private sector profits are at the heart of why the U.S. health care system is number one in the world when it comes to costs but is 72nd in terms of the health of its population.

Plans that fail to address this issue are doomed. The Congressional Budget Office (CBO) says that none of the plans under consideration by Congress would halt or reverse health care inflation. (By contrast, the CBO says single-payer would save $1 trillion(!) over the course of a decade, yet no fiscal conservatives are screaming for single-payer at the town halls.)

Obama’s version of the public option is not even worthy of the name. He says, “it shouldn’t be something that’s simply a taxpayer-subsidized system that [isn’t] accountable, but rather [has] to be self-sustaining through premiums and that [has] to compete with private insurers.” For those who don’t spend their lives inside the Beltway, here’s the translation: I don’t want to drive the insurance industry out of business with an effective public option that would provide cheap quality health care for everyone. So, I want the government plan to emulate what the private sector does, even though those practices are what’s creating the rapid inflation and terrible outcomes for patients in the first place.

Setting up a public option this way guarantees it’ll be a miserable failure. Not only would it lead to political blowback that could dislodge the Democrats from power (not that I care), it would discredit the very idea of a public option (which I do care about). On top of that, it’d make the health care system even more dysfunctional, chaotic, and costly than it already is. It’d do for the Democratic Party what the Bush’s Iraq war did for the Republicans.

Sadly, it looks like we won’t even get the half-assed version of the public option described above, mainly because the insurance industry spent $11 million since 2007 getting Democrats elected to Congress. The Democrats are prepared to bear the political consequences of a deeply flawed version of the public option without even delivering it. In all likelihood, cooperatives will take the place of a public option, thanks to Senate Finance Committee, which the White House directed industry lobbyists to work with.

That’s right: President Obama directed industry lobbyists to focus their efforts on the Senate Finance Committee. Your president has betrayed you.

After the legislation passes, health care decisions will continue to be made exclusively by penny-pinching insurance company bureaucrats. Medical bills will continue to be the number one reason people declare bankruptcy. Denying people coverage because of preexisting conditions will be outlawed, which is well and good. But lawyers and accountants for the insurance companies have probably figured out a way around the ban: charge people with preexisting conditions ten, a hundred, or a thousand times more than the average policyholder. Those who are too poor or sick to buy private insurance will be forced into the co-op system, which will be quickly overloaded and become insolvent. The government will then be forced to either subsidize co-ops with taxpayer dollars, kick people off the rolls, charge them higher rates, or some combination of all three.

The bottom line is that whatever passes promises to be a costly, ineffective failure.

The health care industrial complex is in a win-win situation. If reform fails to pass because right-wing Democrats join the miserable Republican rump, they win. If reform without a real public option, they win. An aide to the Senate Finance Committee admitted, “The bottom line is that health reform would lead to increased revenues and profits.” The law that passes will make buying health insurance coverage mandatory for all Americans. That will boost the industry’s profits as almost 50 million Americas are forced into the insurance marketplace, aided by small tax credits.

Obama said, “I would rather do the right thing and have one term than be mediocre and have two.” At this rate, he won’t be forced to choose. American history has plenty of one-term mediocrities who broke campaign promises at the behest of Corporate America.

Pham Binh is an activist and recent graduate of Hunter College in NYC. His articles have been published at Znet, Asia Times Online, Dissident Voice, and Monthly Review Online. He can be reached at: Read other articles by Pham, or visit Pham's website.

4 comments on this article so far ...

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  1. mike3 said on August 20th, 2009 at 1:10pm #

    And the Republican/GOP stuff is no etter. I’m also quite skeptical of the ability of this “political” system to come up with anything useful. It’s all controlled by special interest and it’s all about fighting and not solving anything. (All partisan systems of politics are fight-based anyway.)

  2. Mulga Mumblebrain said on August 20th, 2009 at 4:44pm #

    Rightwing pathopsychology in action. Hatred of the other not a terrible affliction, but the driving force of all policy, all action. Obama is clearly some sort of Manchurian Candidate, programed, probably by his Zionist patrons who have controlled his career from the beginning, to not only continue Bush policy (in fact to exacerbate is geopolitical brutality)but to return political power to a revivified Republican ultra-Right, demoralise the hordes who were conned and flocked to Obama’s lies about ‘hope’ and hopefully turn them off voting for life, and discredit Black political aspiration for years. I saw the Republicans ‘run dead’, McCain feign senility, Palin chosen for suicidal reasons difficult to discern and I thought the plan was to lumber Obama with the neo-liberal Depression. I simply did not anticipate the extent and depth of Obama’s treachery, the manner in which he spits in the face of the patsies who believed his lies and the enthusiasm with which he serves the real rulers of the US, the moneyed elites. I’m aghast-I have been found guilty of insufficient cynicism with regard to the hypocritical horror of ‘market capitalism’.

  3. United-Socialist-Front said on August 20th, 2009 at 8:02pm #


    i think that it is necessary for political leaders to be active-nihilists, tragic heroes, and to have the enough will to power, and strength of independence like Nietzsche talked about “Free spirits” to crush and destroy the racist values of this society in order to transcend toward a leftist paradigm like Rafael Correa is doing in Ecuador.

    So i think that one of the major problems of most political leaders in both the right and the left is that they don’t have the necessary strength of courage and will to power to confront the real government (Corporations and rich people). Even Bush. Bush was not really evil, but weak to confront the real rulers of USA, and that’s why he did all that he did (The illegal wars, 9-11, Patriot Act, torture, etc.)

    A superman doesn’t have any thing to do with political, military and abusive power, like the Nazis. Nazism and Fascism are elements of capitalism, of corporate exploitation, abuse, racism, chauvinism and evil, they twisted Nietzsches writtings (Specially Nietzsche’s sister who was a Nazi).

    But really, a great man, a Superman (Ubermensch) is this type of revolutionary, rebel, anarchist, totally free individual who has no laws, and authorities over him, he also doesn’t accept the morality and conservative laws of the current regimen, in fact he tries to influence others by breaking the old values in order to teach to other members of his society his new values. A superman would be a revolutionary reformer of new laws, new values.

    My friends, you can find out more about Nietzsche’s superman in the book “Thus Spoke Zarathustra” which even could be used in today’s United States, a country oppressed by 2 corporate capitalist parties (Democrats and Republicans) and where US citizens feel that there is literally no hope, no liberation out of this hell of our kleptocratic Democrat-Republican 1 party monster.

    The main thesis of Thus Spoke Zarathustra is the fact that humans have literally 2 options in this existance, either to accept the current reality and values and succumb to a state of passive-nihilist resignation, or to be an architect of our own destiny, inserted in this reality as a active-tragic nihilist (A destroyer of old values, and creators of new values)

    Here is a short review of Thus Spoke Zarathustra, one of Nietzsche’s best works about the superman. a review of “Thus Spoke Zarathustra” which is a manifesto to gain strength and courage. Which is what the US left needs to destroy the US right.

    Nietzsche’s Thus Spoke Zarathustra is probably his most famous work as well as being the work least popular among readers. This is probably partially because it is written in fictional form. Zarathustra is well designed to frustrate twentieth century conservative bourgeoise philosophy of the analytic tradition, which seeks conceptual clarity at the expense of rhetorical form, indeed often insisting on the separation between a concept and the vehicle of its expression. Moreover, the utilization of the work by the Nazi war effort did little to improve the books reception in the Anglo-American world.

    The book is philosophically interesting, in part because it does employ literary tropes and genres to philosophical effect. Zarathustra makes frequent use of parody, particularly of the Platonic dialogues and the New Testament. This strategy immediately places Zarathustra on a par with Socrates and Christ–and as a clear alternative to them. The erudite allusions to works spanning the Western philosophical and literary traditions also play a philosophical role, for they both reveal Nietzsche’s construct of the tradition he inherited and flag points at which he views it as problematic.

    Much of the book consists of Zarathustra’s speeches on philosophical themes. These often obscure the plotline of the book. The book does involve a plot, however, which includes sections in which Zarathustra is “off-stage,” in private reflection, and some in which he seems extremely distressed about the way his teaching and his life are going. Zarathustra attempts to instruct the crowds and the occasional higher independent man that he encounters in the book; but his most important teaching is his education of the reader, accomplished through demonstrative means. Zarathustra teaches by showing.

    Zarathustra stands in he tradition of the German Bildungsroman, in which a character’s development toward spiritual maturity is chronicled. Zarathustra can be seen as a paradigm for the modern, spiritually sensitive individual, one who grapples with nihilism, the contemporary crisis in values in the wake of the collapse of the Christian worldview that assigned humanity a clear place in the world.

    In the popular imagination, Nietzsche’s idea of the Ubermensch is one of his most memorable and significant ideals. However, the concept of the Ubermensch is actually discussed little in the book. The topic is the theme of the first speech in “Zarathustra’s Prologue,” which he presents to a crowd gathered for a circus. The audience interprets Zarathustra as a circus barker and the speech as an introduction to a performance by a tightrope walker. The concept is mentioned recurrently in Part I as something of a refrain to Zarathustra’s speeches. But the word Ubermensch rarely occurs after that.

    Additionally, the notion of the Ubermensch is presented in more imagistic than explanatory terms. The Ubermensch, according to Zarathustra, is continually experimental, willing to risk all for the enhancement of humanity. The Ubermensch aspires to greatness, but Zarathustra does not formulate any more specific characterization of what constitutes the enhancement of humanity or greatness. He does, however, contrast the Ubermensch to the last man, the human type whose sole desire is personal comfort and happiness. Such a person is the “last man” quite literally, incapable of the desire that is required to create beyond oneself in any form, including that of having children.

    Zarathustra’s opening speech, besides proposing the Ubermensch as the ideal for humanity also places emphasis on this world as opposed to any future world. In particular, Zarathustra urges that human beings reassess the value of their own bodies, indeed their embodiment. For too long, dreaming of the afterlife, Western humanity has treated the body as a source of sin and error. Zarathustra, in contrast, insists that the body is the ground of all meaning and knowledge, and that health and strength should be recognized and sought as virtues which is related to Marxism and Feuerbarch’s slogan of “You are what you eat” (Remember how right-wingers despise reality, economics, and physiology)

    Another prominent theme in Zarathustra is its emphasis on the relative importance of will. In part, this emphasis follows Schopenhauer in claiming that will is more fundamental to human beings than knowledge. However, Nietzsche stresses the will’s attempt to enhance its power, whereas he views Schopenhauer as placing greater stress on the will’s efforts at self preservation. Nietzsche’s famous conception of will to power makes one of its few published appearances in Zarathustra.

    Much of the plot of Zarathustra concerns his efforts to formulate his idea of eternal recurrence. At times, the idea possesses him in the form of visions and dreams. At others, he seems reluctant to state it categorically or to accept its implications. During a particularly despairing moment, he shudders at the implication of his doctrine that “the rabble,” the bourgeoise people who comprise most of the human race, will also recur. The fact that Zarathustra objects to the recurrence of the rabble is indicative of Nietzsche’s preference of a system in which we would be architects of our own destiny. Consistently, Nietzsche and Zarathustra contend that human beings are not equal and clones. Nietzsche objects to the bourgeoise conservative movements of his era in favor of more participative, libertarian and democratic forms of social organization that would place economic-control in the hands of each individual, instead of a few corrupt corporate crooks and burocrats like representative bourgeoise democracies (our current system).

  4. balkas b b said on August 21st, 2009 at 6:44am #

    we can expect less and less honorable behavior towards lower classes.
    can we also expect more and more meekness from the oppressed people?
    perhaps not!?
    Perhaps, the time is not ripe for an awakening by some 150mn americans. But as we keep educating people, the time will arrive for that long-awaited dream to put some old-fashioned resistance to the mafioso-like org. that US ruling class is. tnx