The Health Care Debate: A Head Fake to Distract Us from Politics As Usual
A couple of nights ago, I watched Jane Hamsher, the founder and publisher of the progressive website Firedoglake.com make a startling statement. She was a guest on The Rachel Maddow Show and was speaking about the fact that members of the congressional progressive caucus had drawn a line in the sand regarding the need for a public option, “after it became clear that Rahm Emanuel and Max Baucus were trying to deal a public plan away to the AMA, the hospitals, Pharma in exchange for keeping the money out of Republican coffers in 2010.” I stopped my DVR and replayed this portion of the interview a couple more times to make sure that I had heard her correctly. It all started to make sense. It made me think about the healthcare debate in a different way. I realized that this debate is not about us – the American people. It is about politics pure and simple.
I have been having trouble understanding how a healthcare reform bill could really lead to true reform if the very industries that have created this mess and have benefited from it have been left untouched. During the debate, there has been no discussion or movement toward:
- Changing the insurance companies model of cost shifting to the patient in the form of higher premiums, deductibles and co-insurance
- Changing the practice of denying patients coverage after the treatment has been pre-certified by the insurance company
- Closing the loophole that allows insurance companies to deny coverage if they find that an individual has committed fraud. i.e., any inconsistency on an application no matter how benign
- Prohibiting insurance companies from the practice of purchasing pharmacy records that detail what medications an individual has been prescribed (a practice that allows them to gain private information about a patient that can later be used against them. e.g., the claim of fraud)
- Stopping the practice of collusion between the pharmaceutical companies and insurance companies by the manipulation of the drug formularies.
- Regulating the pharmacy benefit management companies who act as a middle layer to control what drugs are ‘preferred’ or denied. These PBMs (in some cases owned by insurance companies) take profits off the top thereby raising the cost of drugs to the patients while decreasing the payments to individual pharmacies.
- Restricting unfair trade practices of large retail pharmacy chains that align with insurance companies as the ‘preferred’ pharmacy for their members. This practice cuts small independent pharmacies out because they can’t compete, and therefore lose market share, destroying price control through honest competition.
- Changing the way hospitals are reimbursed by bundling payments into a single fee in order to simplify the reimbursement system and decrease costs for the patients (a system already used to pay physicians).
- Allowing the re-importation of drugs from cheaper countries such as Canada to bring the cost of prescriptions for patients in Medicare and Medicaid down.
- Enacting tort reform to remove the costs associated with defensive medicine
Now I understand it. It is a political move to secure power. Let’s be clear both the Democrats and the Republicans are guilty of playing this cynical game to control the levers of power. The Republicans have contributed nothing to the debate in the hopes that the reform effort will fail. It allows them to point fingers and blame the Democrats in the hopes that they will regain some power in 2010 and by extension 2012. The Democrats have played ball with the insurance and pharmaceutical industries in the hopes that they will change their traditional allegiance from the Republicans to them, thereby solidifying their power.
The public option as it is set forth by the House Bill HR3200 is an economic bonanza for the insurance industry. Mandating that people have health insurance will greatly increase the number of people that will pay premiums while they continue the arbitrary denial of care - business as usual. The pharmaceutical companies will have even more insurance based patients to sell drugs at a 2% discount (but only for the next 10 years, then the price goes back up). Neither of these outcomes is a win for the American people.
As long as the debate centers on death panels and rowdy town hall meetings, Americans will continue to have their needs ignored, because it is not about us. We need to demand that our representatives work for us and by extension for what is best for the country. In medicine to heal a patient, the problem and not the symptom must be diagnosed and treated. True health care reform must fix what is intrinsically wrong with the system instead of expanding the problem and rewarding the players that have contributed to the mess we find ourselves in today.