Wednesday, December 16, 2009

The Healthcare Bill: One Part Awesome To Four Parts Suck

There are things to celebrate in this healthcare bill. Not many but there's a couple. The major one's are a ban on pre-existing conditions and recission. The pre-existing conditions thing has been an immoral, lunatic clause for years. Quite apart from anything else, it made people with lifelong conditions (diabetes, for example) either impossible or prohibitively expensive to cover. So that's a good thing. Likewise, the ban on recission is a plus. If you don't know, "recission" is a very nasty trick that insurance companies use all the time where they cut off your insurance as soon as you need it. You pay your premiums for years and, as soon as you get something expensive (cancer, say), they cut off your care. That's not insurance, that's a lottery. So that's gone too and that's a gain. Last I heard, there was also a cap on profits at 10%. That's good and 10% is reasonable but I don't have much faith it'll make any difference. I'll get to why in a second.

Now, let's get to the suck.

First off, the Medicare buy-in is dead. So is the public option. The former can be laid on Joe Lieberman, the latter on conservative Dems and Republicans generally. We'll get to them later. What isn't in the bill is even more important. There is nothing in this bill which will control costs. No additional competition for insurance companies (and I've never been convinced that would do much good anyway) and no cap on premiums. This is why I'm doubtful that a cap on profits will make any difference. If your premium was, say, $500 and insurance companies are only allowed to take 10% as profit, what's to stop them doubling your premium to a cool thousand and skimming a tenth of that? Is your care going to be twice as good? You're kidding, right? The insurance industry is not set up to pay claims. Much like the British benefits system, it's set up to deny any claim it can.

And then, there's the mandates. Now, when there was a public option, the mandate could be justified because there would have been a non-profit national option to join. But without the public option, a mandate just funnels epic amounts of cash to the insurance companies who caused this mess in the first place. Granted, there will be some subsidies but, knowing how governments do business, those subsidies won't be anything like enough.

Why is funneling people to the private insurance companies a bad thing? Doesn't the free market work? Well, it works fine for hamburgers or running shoes but it doesn't and can't work for certain things. Four or five services; water, gas, electricity and healthcare; comprise what are called "captive markets". What that means is this: When the price of a Big Mac gets too high, you just skip lunch, that's fine but with captive markets, you don't have the option of walking away from the market because without those few sectors, you cannot live in any kind of meaningful way.We all need these things and we need them all the time. Because we cannot walk away from the market, the companies which control the market can game the system, pursuing a race to the lowest common denominator at the highest price. We saw this here in England when Thatcher (and Major and Blair to a lesser extent) privatised everything in sight. The result was always the same. In every single case, prices exploded, service collapsed and standards were taken out back and shot. Now, some especially stupid conservatives will try to tell you that if this is true, why shouldn't that argument extend to food, running shoes, etc? They are either stupid or insane. That argument fails because A) it's stupid and B) food and running shoes are things which can be easily produced by individuals or small groups whereas the essential services cannot. So, there is nothing in this bill which will control prices and, indeed, every incentive for insurance companies to continue their skyrocketing prices.

Now let's play the blame game. And there's a lot to go around in this edition. On this day which bloody well should live in infamy, it would be very easy to speak of crucifying Joe Lieberman (who's being figurative?) but nailing a Jewish guy to a cross this close to Christmas would confuse the right no end. And really, Joe is just being Joe. He's a self-serving, lying little weasel and we've all known that for years, ever since he felt so entitled to his Senate seat that he started his own party rather than respect the wishes of the Democratic caucus. He's never forgiven liberals for that and, right now, he's in the "if they're for it, I'm against it" area of blind spite. But we knew this, it's a little like saying motherfuckers do indeed fuck their mothers.

We could say much the same for the Blue-Dog Democrats. I wish the media would cease calling this lot "moderates". They're not moderates. First off, the American political scene is tilted so far to the right that Obama (who constantly gets called "socialist" by stupid people) is centre-right in reality so being to the right of Obama puts you NOWHERE NEAR the centre. That's like saying halfway between Obama and Rush Limbaugh makes you a moderate. No, it still makes you bugfuck insane. And they're not moderates even by American standards, they're corporatists, brought-and-paid-for corporate shills. If the Congressional Republicans are 100% the voice of the Mega-Corporations (and they are), the Blue-Dogs are the Corps contingent in the Democratic party although, really, both parties are cults of wealth-worship. American has become a mixture of Ayn Rand's celebration of naked greed and Bill Gibson's dystopian vision of a nation run by and for the convienience of corporations. And no, conservatives, corporations are not your fucking friend.

Harry Reid has to take some blame as well. Taking reconciliation off teh table was a fucking stupid move. While reconciliation was available, Republicans and conservative Democrats had some incentive to be reasonable and compromise because if they didn't, they might just find the bill rammed through against their wishes. Without reconciliation, the conservative coalition pays absolutely no political price for naked obstructionism. They can afford to just say "NO" to everything because, without their cooperation, without "compromising" with them (and the Republican idea of compromise is "we don't budge an inch and you come to us"), nothing gets done. Conservatives like to say that if Democrats could keep their own party in order, they could pass anything and there's an element of truth to that. But it ignores that, firstly, Democrats only have 58 Senators. The two independents who caucus with the Dems are Sanders, who votes Democratic much of the time and Lieberman, who takes a perverse glee in fucking up Democratic plans. Secondly, it ignores that, outside of Congress, the media leads the people around by the nose much of teh time and the media is, for the most part, conservative (anyone who talls you there's a liberal bias in media is either lying to you or is too stupid to realise they've been lied to). Third, what the fuck have the party whips been playing at?

Finally, Obama has to take a fair amount of blame. While Obama talked a good game about healthcare reform during the primaries and campaign, he has conspicuously failed to lead while the process has been ongoing. I think his rationale was that, if he got personally involved, the bill would become about him and thus, a way to attack him. That's either charmingly or dangerously naive on Obama's part. The bill was always going to be identified with him and the Republicans were always going to lockstep vote to filibuster and/or kill absolutely anything that he wanted to see passed. Even leaving aside the numerous, mostly reliable reports that the Whitehouse (and Rahm Emmanuel especially) have repeatedly been trying to "compromise" away real reform, one has to accuse Obama of a failure to lead during this process. Instead of coming out and laying out a case for X, Y or Z reform, Obama has been passively willing to accept anything passed by Congress. Bill Clinton managed to lead his party in getting some reforms passed (not always to the good). Cheney organised the Republican party like a cult of personality and got virtually everything he wanted. Obama has been weak and failed to either lead or push his party. In general, I've been disappointed in Obama's first year. But that's a story for another time (and conservatives, that's doesn't mean I think McCain wouldn't have been worse. I don't want to be on your team, pick another kid).

So that's it. The healthcare bill is a couple of good things wrapped in a pile of suck. Is there enough good there to justify the piles of suck? I don't think so. Howard Dean (an actual doctor, so he has some credibility on this issue) doesn't think so. But it looks like it's going to pass anyway. And that's it. Healthcare won't be revisited again during Obama's presidency and probably not for another ten to fifteen years.

Oh, and did I mention that it's not going to save anything like as much money as the public option or single payer would have?


  1. Actually it's four parts suck. The insurance companies will still be able to discriminate and reject people with expensive pre-existing conditions (like diabetes) because those people tend to have bad credit thanks to medical debt. Guess what the bill doesn't ban? Rejecting people based on a bad credit report.

    The rejections will remain the same. The only difference will be the excuse stamped on the form. It'll say "Unacceptable credit risk" as opposed to "Pre-existing condition." Note that practically nobody in the political world is talking about this rather ENORMOUS loophole that undermines pretty much everything good that's left in this shitty, field-stripped carcass of a bill. I guess they're hoping we won't notice.

    So yeah. It is *entirely* suck. Ain't life grand?

  2. The whole thing depresses me. I'm thinking now that I was unforgivably naive in placing so much [uncharacteristic] hope in Obama. (Not of course that I would ever have voted oterwise.)

    I'm trying to cheer myself up: Oh well, I haven't had access to healthcare in more than five years and so it's not like I'm actually losing anything. My poverty's no more a death sentence than it always has been. Oh well.


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