Rejecting the Narrative for Health Reform, Believing in a Better Way

November 23, 2009

To the extent that politicians in Washington, D.C. have not attempted reform of this magnitude with a concerted effort for a decade (perhaps, decades depending on how you regard Hillary Clinton's past efforts), the recent votes on health reform in the House two weeks ago and in the Senate this weekend are historic. But, they are no more than contrived milestones in history if you truly assess what the Democrats and their supporters hope this bill will achieve.

The rhetoric of a dominant political culture in America has taken righteous outrage and enthusiastic fervor for real healthcare reform and channeled it into a fight for a weak public option in what Steven Hill recently called America's “House of Lords"--the Senate.

The opportunity to de-commodify health care has been consciously avoided by Democrats and Republicans and solutions to problems created because health care is privatized have been proposed to further entrench and maintain American health care in the very kind of sick care non-system that now leaves over 45 million uninsured.

American politicians, who are primarily Democrats, have warned against overloading the system with demands on healthcare. President Obama and Democrats, on behalf of pharmaceutical companies and private insurers, have managed expectations for healthcare by ensuring the debate on healthcare is tightly limited and controlled.

Debate Begins in Senate

Key Democratic senators behind health reform delivered remarks after the procedural vote on Saturday, November 21st. The remarks showed a keen sense of awareness of what the American people want in terms of reform. (Video)

Majority Leader Sen. Harry Reid (D-NV) said the bill would make sure “all Americans have access to affordable healthcare” and that the plan being considered “saves lives, saves money, and saves Medicare.”

Sen. Tom Harkin (D-IA) said, “I can't think of a better vote to have right before Thanksgiving. I think the American people when they really learn what's in this bill will be very thankful that we're moving ahead.”

But, it was Sen. Chris Dodd (D-CT), a man who as Senate Finance Committee chairman has been embroiled in controversy over loans and bank regulation in the past year, who probably had Americans for real healthcare reform doing a double take:

Dodd remarked that the Senate was “going to have a debate that was long overdue.” He added:

“There are certain things you ought to have a right to. Certain things, not everything. One thing is certain. You ought to have a right to decent health care, to be able to see a doctor when you need it and to be able to afford it without bankrupting in the process. That's what we are attempting to do with this bill. That's what we are attempting to do for the first time in the history of our country---to deal with a national healthcare plan that will serve all of the people of our nation. Nothing less than that is our objective.”

Technically, he is correct. Mandating people purchase private insurance that has no controls on the costs of premiums and saying if you don't buy it you are going to have be fined, is a national healthcare plan. But, it's not a plan any American should be thankful for as they break bread with loved ones on Thanksgiving nor is it a plan that will free Americans from the current exploitation they experience because their insurance is in the hands of health insurance companies.

Dodd and others are right to say each American should be able to see a doctor when necessary and be able to afford healthcare without going bankrupt but they are wrong to say this is the first attempt to establish a national healthcare plan in the history of America.

This statement misrepresents the history of reform efforts in the history of healthcare in America (and maybe that's why Americans are so easily content with letting Democrats place limitations on what can and cannot be done to this bill, on what can and cannot be said of this reform, etc).

Placing Current Reform in Historical Context

Presidents like Franklin D. Roosevelt, Harry S. Truman, and Lyndon B. Johnson attempted to create national health programs for Americans. Eventually, plans turned to a fight for care for a specific age bracket of Americans and, in a span of thirty years, ideas for Medicare and Medicaid came to fruition.

Under LBJ, like today in Washington, D.C., Democrats controlled the executive branch and the Congress. They outnumbered Republicans and were able to shift committees that had traditionally created obstacles for social health programs.

Interestingly, when it came time to debate reform, as with the current health reform plans being discussed, three forms of the bill were offered: one by Republican John Byrnes, one by the American Medical Association (AMA), and one by the president. The AMA bill was not included in final plans for Medicare or Medicaid but Byrnes' plan that doctors' services and drugs be financed and participation in government aid be voluntary was included.

So, with Medicare and Medicaid being signed into law under the Social Security Act of 1965, you had one of the most sweeping overhauls of health care policies in America in the history of the United States.

You also had a template developed that would be followed consistently decades after Johnson's presidency: fill gaps in coverage but do not challenge privatized health insurance or the medical profession's right to set fees.

With Medicare and Medicaid, government intervention created huge profits for the medical-industrial complex in America. That's also what would happen with current health reform being discussed.

The reform would impose some new regulations on private insurers, but, like the credit card regulations recently passed, insurers would have a window to raise premium rates and they would also be ensured a multitude of new consumers.

The public option would remove the private insurers' obligation to insure the unhealthy, the unemployed, and the poor and splits the pool. It would force government to cover the most expensive pool under a weak public option that is designed to fail and it protects and strengthens the private health insurance industry of America.

When placed in context, it should not be surprising that this is where we are at with healthcare. Clinton's handling of Medicare provides a great example of why this should have been expected.

As Lance Selfa explains in Democrats: A Critical History, Clinton embraced “bipartisanship” like Obama has when he removed billions of dollars from Medicare and Medicaid during his presidency. Through the 1997 Balanced Budget Agreement (BBA), he endorsed the congressional Republican leadership's long-term goal of gutting spending on “entitlements” like Medicare and Medicaid.

“The BBA imposed draconian spending “caps” on “discretionary” programs from home heating assistance to legal services. These austerity measures accounted for the first-ever annual decline in Medicare spending in 1999. Between 1997 and 1998, the number of sick and elderly receiving Medicare-financed home health care services fell and astounding 45 percent, with six hundred thousand fewer people receiving care. Under the BBA, Clinton literally abandoned millions of poor, elderly and disabled Americans."

Like Clinton, in Obama's first year, Americans have already seen Obama squeeze Medicare by offering a budget proposal that would halt higher payments that the government gives insurers who cover Medicare beneficiaries through private Medicare Advantage plans.

Obama hopes to help pay for current plans(like the plan that passed the House) by squeezing “$404 bilion out of the projected growth in Medicare and other federal programs over 10 years, including $117 billion from cuts in Medicare Advantage plans. The government pays about 14 percent more for the private plans than it would pay for the same people in traditional Medicare.”

What happened with the Clinton-Gore agreement laid the groundwork for “moving Medicare from a system guaranteeing a set of minimum benefits for all to one that allowed patients who could afford it to opt out and buy their own insurance.”

Under the Senate plan, states could opt out of the already weak public plan being offered as part of health reform.

Thus, America continues to offer free market solutions to address the worst aspects of a free market for-profit healthcare system and politicians have no problem with turning to Medicare as a fund for helping to subsidize the burden private insurers are placing on Americans as they refuse to give Americans the care they deserve.

The Bewildered Herd & Health Reform

The failure of health reform to solve the deepening crisis of health care in America is bad enough, but worse is the fact that all of this has further contributed to the bankrupting of democracy in America.

Compromise should be for the legislative process but Americans compromise the democratic process by willfully compromising before the legislative process has even been completed.

Instead of focusing on the goal of covering the more than 45 million Americans without health care coverage, progressives or liberals are distracted by senators Blanche Lincoln, Mary Landrieu, Ben Nelson, and Joe Lieberman who may or may not block health reform. They willingly consume themselves with worst-case scenarios for healthcare and suggest what they will be willing to settle for so long as these senators allow historic health reform to pass through Congress.

Instead of focusing on the goal of developing a system with parameters determined by patients and profits, progressives or liberals regurgitate Democratic Party talking points on why the Republicans cannot be allowed to get in the way of passing this bill (and at the same time, ignore the fact that the Democratic Party is all too willing to let the GOP set the terms for health reform in the current legislative process).

Instead of focusing on the goal of a system with no out-of-pocket payments, progressives or liberals accuse those arguing for a system that is not market-based of counterproductive infighting, of “making the perfect of the enemy of the good,” of wanting all or nothing in a situation where they could easily get something.

Instead of focusing on the goal of banning for-profit healthcare providers once and for all and ensuring we never have to have a crisis of healthcare like this in America ever again, progressives and liberals are willing to defend the sham that is health reform and suggest we can come back to it and build off it later and develop it eventually someday later into a single-payer system if that is what we must do.

The spineless, weak, gutless characteristics of the Democratic Party under the presidency of George W. Bush and even the presidency of Bill Clinton have become characteristic of the very people who vote Democratic leaders in and out of office, who lobby or refuse to lobby Democratic representatives and senators.

And, so we see "democracy as stupefaction." We see people whose sensibilities have been deadened, who are willing to have their expectations managed and lowered.

Progressives and liberals, as they were with Obama, are deluded with the fear of being on the wrong side of history. They foolishly think that somehow if they obstruct reform at this stage they will be derailing something that could not be attempted again for at least another decade or two.

They let senators like Reid and Dodd continue the exploitation of Ted Kennedy's death to advance reform that is a corporate giveaway, they let politicians compare what is happening to the abolition of slavery and granting women and minorities the right to vote when, ironically, this continues a form of corporate slavery in America and also threatens a woman's right to comprehensive reproductive healthcare in America.

Obama's Presidency

Obama has staked his presidency on health reform. He has put his chips all-in on this one and if Republicans can use that to their advantage, why can't progressives? Why can't progressives counter conservative market-based proposals with progressive humane proposals, which ensure a better future for all Americans?

Why shouldn't we use America's two-party system to our advantage in the same way that the GOP uses it to their advantage?

If Obama fails to pass health care before 2012, he will be one and done. He and his cohorts in the Executive Branch know this and pundits and commentators have hinted at this reality throughout this year.

Translate this into political power. Translate this into leverage for shifting the current narrative in this struggle for reform by making reform about human rights and not what is allowable and not allowable in our nation's so-called free market system.

We as a people are collectively failing each and every uninsured and underinsured person in America with this health insurance enrichment bill.

Stop letting the Democratic Party prevent a genuine economic solution to our country's woes---the expansion of Medicare to cover all Americans to actually provide national coverage to all Americans.

Article Inspired by

Dr. Margaret Flowers

Dr. Paul Hochfeld

Robert Jensen and his book, Citizens of the Empire

Dr. Sam Metz

Lance Selfa and his book, Democrats: A Critical History

Paul Street

Kevin Zeese

And the continued work of Mad as Hell Doctors, Physicians for a National Health Program (PNHP), Healthcare-Now!, and the Mobilization for Healthcare for All even as the Democrats continue to ignore rising populist support for single-payer healthcare in America.

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