Posts Tagged ‘healthcare’
Matt Taibbi has one of the most lucid posts on the recent health-care scandal I’ve seen recently.
You may remember the California Anthem Blue uproar that occurred a week or so ago, wherein they arbitrarily and unilaterally jacked up their prices almost 40%. Taibbi asks the logical question – “Why can’t California customers just switch to another, cheaper provider?” – and then answers it: “Because they have no choice.”
You see, as it turns out, health insurance providers are exempt from anti-trust legislation, which means they can hold veritable monopolies over huge areas and no one can do a thing about it. This was certainly news to me.
Dating back to 1947, what was supposed to be a “temporary” exemption quickly became a permanent loophole in the Sherman Anti-Trust legislation.
As Taibbi says:
This is why insurers (especially insurers with large market shares in small states) are easily able to gouge customers and deny coverage. There’s really no legal mechanism for preventing the firms from getting together and arranging price-fixing and other outrages. In a normal market customers would be able to get better coverage and cheaper rates from a competitor, but insurance is really more like a series of competition-free fiefdoms where the customers can’t go elsewhere for a better deal.
The exemption is known as the McCarran-Ferguson amendment, and so long as it’s still on the books health-care providers will continue to have a monopoly over large swaths of land. This is yet another reason why the “individual mandate” in Obama’s health-care plan is so goddamn offensive. “Reform” is impossible without repealing McCarran-Ferguson. How many of you think that’s likely?
(c/o Kevin Drum)
Mr. Drum makes a nice find in today’s LA Times. The health insurance industry knows, of course, that if and when health care reform passes, they’ll see a massive new influx of customers, as America’s 45 million uninsured become required, by the stroke of a pen, to purchase a health plan from them. So what do they do with that knowledge?
Some excellent reporting from the LA Times:
Health insurers across the country are dramatically increasing rates and slashing benefits for many of the estimated 17 million consumers with individual insurance policies, while making it almost impossible to obtain affordable alternatives.
The problems have captured national attention as President Obama steps up his campaign in Washington for a healthcare overhaul and Congress investigates rate hikes of as much as 39% by Anthem Blue Cross in California.
The money quote:
“A lot of what you see today is a product of the way the market works,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying arm. “The market is broken. Those people who do need the coverage wind up covering the cost of everyone else.”
When the spokesman for Big Insurance tells you the market is broken, I think you had better listen to him. Maybe all those “tea party” protesters fighting against “Obamacare” and “Obamnuism” ought to take note.
One year into his prophesied presidency, Mr. Obama addressed the nation on the issues he thinks plague it the most. The speech was 5 parts economy, two parts health care, one part budget, and a few throwaway references to “national security” and Haiti thrown in as well (for spice). Unsurprisingly, the speech was a hit with the mainstream commentariat. The inimitable Joe Klein seemed to think this was “Obama at his best“; Yglesias, of course, thought it was “just great”; and Greg Sargent praised its “mix of charm and good humor”. As we all know, the main things our belaguered republic lacks at this juncture are “charm” (and/or) “good humor”.
I guess nobody took notes on what Mr. Obama said, as the reactions I’ve seen are based on qualitative nonsense (“How did he look? Was he friendly? Did he get the Republicans’ goat?”) A shame, because a close reading of the text of the speech reveals evasions, inconsistencies, and, at times, willful manipulation of data. Let’s dive in, shall we?
As Mr. Obama said early on, “It begins with the economy”.
Our most urgent task upon taking office was to shore up the same banks that helped cause this crisis. It was not easy to do. And if there’s one thing that has unified Democrats and Republicans, and everybody in between, it’s that we all hated the bank bailout. I hated it — (applause.) I hated it. You hated it. It was about as popular as a root canal. (Laughter.)
So I supported the last administration’s efforts to create the financial rescue program. And when we took that program over, we made it more transparent and more accountable. And as a result, the markets are now stabilized, and we’ve recovered most of the money we spent on the banks. (Applause.) Most but not all.
To recover the rest, I’ve proposed a fee on the biggest banks. (Applause.) Now, I know Wall Street isn’t keen on this idea. But if these firms can afford to hand out big bonuses again, they can afford a modest fee to pay back the taxpayers who rescued them in their time of need. (Applause.)
Did you really hate it so much, Mr. Obama? I mean, the largest contributors to your campaign were financial institutions, and they certainly didn’t hate it. And your Treasury Secretary, Timothy Geithner, was practically appointed by Goldman Sachs, and went on to distribute trillions of untraceable dollars to unknown banks. He certainly didn’t hate it. Especially when your read about how Geithner willfully colluded with AIG to defraud the taxpayers of billions, it just seems like you’re making up all this populist “oh I hated it but it had to be done” nonsense ex post facto.
You’re well aware that the largest banks consider your so-called “bank fee” a joke, and that the $90 billion you plan to extract from them doesn’t cover 1/100th of the total money their malfeasance lost our economy. Also, paying back the government was stipulated in the TARP to begin with. When the banks accepted the money back in September ’08, they did so with the knowledge that they’d eventually have to pay it back. So all this “fee” does is force the banks to uphold the contract they already signed.
Moreover, you are well aware what $90 Billion won’t even cover the current outstanding bank debt. As Propublica reports, the net outstanding in the TARP program is $316 Billion. Not $90 Billion.
Concerning the “Recovery Act”:
The plan that has made all of this possible, from the tax cuts to the jobs, is the Recovery Act. (Applause.) That’s right -– the Recovery Act, also known as the stimulus bill. (Applause.) Economists on the left and the right say this bill has helped save jobs and avert disaster. But you don’t have to take their word for it.
Talk to the small business in Phoenix that will triple its workforce because of the Recovery Act.Talk to the window manufacturer in Philadelphia who said he used to be skeptical about the Recovery Act, until he had to add two more work shifts just because of the business it created. Talk to the single teacher raising two kids who was told by her principal in the last week of school that because of the Recovery Act, she wouldn’t be laid off after all.
Or you can talk to this guy, who got a $24 million stimulus award after numerous accusations of bribery. Or you could talk to this crumbling school district unable to access its stimulus funds for “bureaucratic red tape”. Or, again, these six companies, currently under criminal investigation, who nevertheless received $30 million from your free money giveaway. As Mr. Obama says in his speech,
There are stories like this all across America.
But what about clean energy? Well, he’s glad you asked:
But to create more of these clean energy jobs, we need more production, more efficiency, more incentives. And that means building a new generation of safe, clean nuclear power plants in this country. (Applause.) It means making tough decisions about opening new offshore areas for oil and gas development. (Applause.) It means continued investment in advanced biofuels and clean coal technologies. (Applause.) And, yes, it means passing a comprehensive energy and climate bill with incentives that will finally make clean energy the profitable kind of energy in America. (Applause.)
You clearly aren’t a scientist, Mr. Obama, because those suggestions don’t make a lick of sense. As I’m sure you’re aware, no nuclear plant has ever been built on time or on budget. Ever. “Breeder Reactors” are still an experimental technology, and there is no safe way to dispose of the waste current reactors produce. What should we do with “zombie reactors” – those crumbling ’70s-era nuclear plants we can’t find the budget to inspect? They constantly break down, and constitute a major public health risk. Shouldn’t we do something about those, first? Oh yeah, “Spending Freeze”. Well, I guess we can do like the French and just dump our N-waste in Russia.
As for “Clean Coal”, your colleague Al Gore called that a “lie” months ago. There is no such thing as clean coal. You know it and I know it. But, as you and the coal lobby so fervently hope, the American public doesn’t know it. And let’s not even mention the world food crisis your vaunted “advanced biofuels” had a hand in creating. Or the massive deforestation now going on in Brazil and Indonesia to meet our “advanced biofuels” demand. That technology is wasteful, inefficient, and impracticable. Europe would have to use 70% of its landmass exclusively for biofuel crops in order to meet its energy demands. America doesn’t even have enough landmass to grow enough biofuels to meet its demands. And never mind that the distillation of biofuels requires orders of magnitude more energy than we get from them.
We move on to Health Care:
After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans. The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care.
It would also require every American to purchase health insurance, whether they want it or not (indeed, whether or not they can afford it) – but that’s not a popular aspect of the bill, so we better not mention that. In fact, given your recent defeat in Massachusetts, it’s probably better we move on altogether.
So now let’s talk about… the deficit!
Starting in 2011, we are prepared to freeze government spending for three years. (Applause.) Spending related to our national security, Medicare, Medicaid, and Social Security will not be affected. But all other discretionary government programs will. Like any cash-strapped family, we will work within a budget to invest in what we need and sacrifice what we don’t. And if I have to enforce this discipline by veto, I will. (Applause.)
So your plan is to cut everything but the three biggest contributors to the deficit? How is that a good idea? And is “national security” really something we “need” at this point? You are aware, I’m sure, that we spend on the order of $1 trillion per year prosecuting our misbegotten murder rampages in Iraq, Afghanistan, Pakistan, Yemen, Somalia, and whomever else wish to inflict misery upon.This spending benefits no one, and it demonstrably makes us less safe. You think that might be something we would “cut” if we were trying to save money. I really can’t stress this point enough. We spend the equivalent of South Korea’s GDP murdering Arabs. This is completely baffling to me. Would a “cash-strapped family” really refuse to “sacrifice” its largest and most wasteful expenditure that also happens to actively harm it?
But it’s not just a “deficit of dollars” – it’s also a deficit of… trust. Getting that trust surplus back is what Mr. Obama came to Washington, apparently, to do.
That’s what I came to Washington to do. That’s why -– for the first time in history –- my administration posts on our White House visitors online. That’s why we’ve excluded lobbyists from policymaking jobs, or seats on federal boards and commissions.
But we can’t stop there. It’s time to require lobbyists to disclose each contact they make on behalf of a client with my administration or with Congress. It’s time to put strict limits on the contributions that lobbyists give to candidates for federal office.
Actually, that bolded statement turned out not to be true. When you said “we have excluded lobbyists”, you might have added, “except for the ones I personally approve of.” You know you’ve given waivers to several former lobbyists to work for your administration. Why lie about it? Oh yeah, you’re doing the populist thing. But it kind of detracts from the whole “honesty” message if you have to lie while you’re making it.
So then while he’s on a roll, Mr. Obama attacks the Supreme Court bribery decision, even though the idea that “campaign donations are free speech” was a major reason why he got elected.
With all due deference to separation of powers, last week the Supreme Court reversed a century of law that I believe will open the floodgates for special interests –- including foreign corporations –- to spend without limit in our elections. (Applause.) I don’t think American elections should be bankrolled by America’s most powerful interests, or worse, by foreign entities. (Applause.) They should be decided by the American people.
Is this some kind of joke? You raised $680,000,000 in the most expensive presidential campaign ever. You took money from every major financial institution, including some of the biggest beneficiaries of the Geithner-Bernanke giveaway. I’m really at a loss for words here.
Finally we come to the part about terrorism. I think he’s almost done.
Since the day I took office, we’ve renewed our focus on the terrorists who threaten our nation. We’ve made substantial investments in our homeland security and disrupted plots that threatened to take American lives. We are filling unacceptable gaps revealed by the failed Christmas attack, with better airline security and swifter action on our intelligence. We’ve prohibited torture and strengthened partnerships from the Pacific to South Asia to the Arabian Peninsula. And in the last year, hundreds of al Qaeda’s fighters and affiliates, including many senior leaders, have been captured or killed — far more than in 2008.
No you haven’t. Well, maybe you have, but – wink! – we’ll never know, right? The “black site” at Bagram air base is expanding; Guantanamo hasn’t closed; you believe in extra-legal kidnapping and assassinations (even of American citizens!) And given that you refuse to prosecute Bush-era torturers, even though their actions constitute high crime under the Geneva Conventions, the Nuremberg Code, and our own World War II legal precedent, it’s hard to believe you’re really against torture. Oh, and by the way, I know of a massive plot to take American lives. In fact, it’s killed more than 5,000 Americans already, almost twice as many as 9/11 did. Do you know what it is?
Aaaaand that about does it. A few more references to the “heroic” American response to Haiti (our decidedly ‘un-heroic’ IMF loansharking, of course, went unmentioned), a throwaway reference to some random lady who says “we are tough, we are American”, one last “God Bless America!”, and we’re clear! Another logically inconsistent, factually dubious, rabble-rousing excuse of abuse that managed to tell us nothing. Congratulations, Mr. Obama.
I’ve tried to stay away from the unholy imbroglio of our “health care debate”, more, perhaps, from a love of sanity than a lack of interest. The endless grubbing for votes, the pointless Republican obstructionism and the overt deviation from Senate rules (bills are supposed to need only 51 votes, remember?) have left me thoroughly disgusted with the affair. The one ray of hope was the surprising resurrection of the public option debate, but that, too, has been taken from us.
An interesting question now arises as to whether health-care reform would still be worth it without a strong public option. I admit I have not combed through the 4,105 page bill currently being discussed, but my feeling is that “health care reform” without a public option becomes “health insurance reform”. While both schemes promise to extend insurance to a proportion of America’s currently uninsured (say, 25 million out of 45 million now without insurance), “health insurance reform” would leave much of the industry’s profits intact. “Health care reform” would instead bite into the for-profit paradigm that now prevails.
Aside from the Public Option, the other significant part of the proposed reforms is the “mandate”. Way back, during the 2008 Democratic Primaries, Hillary and Barack had a minor feud regarding this bit of policy, which produced an amusing bit of histrionics from our Secretary of State (“Shame on you, Barack Obama!”). Obama then attacked Hillary for her health care plan, objecting to her “mandate”, which would force Americans to buy insurance (in much the same manner as car insurance is mandated). Shortly after winning the Presidency, Obama changed course (“flip-flopped”, as the expression goes) and came out in support of the mandate, which is now featured prominently in our present health care bill.
It stands to reason that a country-wide mandate without an adjoining non-profit health exchange would be a massive boon to the existing health-insurance providers. With a stroke of the legislative pen, these companies will immediately receive tens of millions of new customers, who, after all, have no choice but to buy health insurance from them or pay a hefty fine. Meanwhile, with no non-profit alternative, our existing “health providers” can make out like bandits on fees and overcharges.
The Huffington Post has got the scoop on the recent protests that erupted outside the American Banker’s Association in Chicago yesterday. Unlike the “9/12 Tea Party” protests last month, however, these outraged citizens saw very little mainstream coverage. CNN merely reprinted a Reuters dispatch which quoted none of the protesters but plenty of the meeting’s attendees, all of whom professed their unequivocal innocence. Fox News, unsurprisingly, had very little to say on the matter. Even the New York Times could not be bothered to toss the story a brief. In all, the mainstream reaction to these demonstrations stands in pitiful contrast to the 24-hour live feed which blared into millions of homes on September 12th.
When one gets a sense of who these protesters are and what drove them into the street, the reason for a lack of discussion becomes clear. This demonstration did not occur within controlled paramters; its organizer, National People’s Action, has made no direct campaign contributions, and their stated aims, in contrast to the Fox News 9/12 Movement, are antithetical to the aims of our corporate industry.
Instead of agitating against a health-care public option (opposition to which has benefited our insurance industry enormously), this group seeks strong regulation of the financial instruments which threw them into poverty – CDOs, CDSs, etc. The current proposal to achieve this end creates a “Consumer Finance Protection Agency” (or CPFA) in a highly-contentious bill which is now on the senate floor and is being vigorously opposed by the financial establishment.
As Esther Kaplan reports in The Nation:
“‘We had this image of big bankers sipping martinis and saying, ‘Did we really get away with this?'” said lead organizer George Goehl, director of National People’s Action. “Then two months ago we found out the American Bankers Association was having its annual meeting here in Chicago.” The ABA, not so incidentally, has fiercely fought against new regulations on the banking industry, and is lobbying hard now against the CFPA.
This is something to watch for, much more so than the protests last month, as yesterday’s demonstration reflects, so far as one can tell, a genuine outrage over the status quo. Yesterday’s protest was small (estimates of just under 1,000 people), but one would like to think a small demonstration against a real grievance would carry more weight than a large, manufactured demonstration over a non-existent one. It will be interesting to see whether similar demonstrations crop up, or, starved for lack of media attention, this CPFA movement dies down. We know which option our bankers prefer!
Ezra Klein gives a cheery update on the healthcare imbroglio to report that Senator Reid is “leaning toward” discussing a public option.
As he writes:
“We’re leaning towards talking about a public option,” said Harry Reid at a press conference today. Greg Sargent, along with a lot of other reporters, thought this was a weird comment. I think it reveals more than people realize, and it should make public option supporters very happy.
Klein argues that if the option is discussed during the negotiations phase there is a high likelihood of some sort of “compromise” slipped into the bill – whereas, if the option goes directly to vote it would not get the 60 votes necessary to override a filibuster, and thus die.
In his words:
That’s a big win for public option advocates. If they get something in during negotiations, opponents will need to muster 60 votes to remove it on the floor. If the public option has the 52 supporters that Sen. Tom Harkin estimates, then that’s impossible.
Unfortunately, the entry ends with that revelation – Klein does not question why a compromise must be struck if the public plan already has 52 supporters. The answer points to a persistent feature of our modern politics: the filibuster. Unheard-of in the 19th century, and still quite rare by 1940, the use (and threat of) “talking a bill to death” has overshadowed nearly all of our legislation since. No longer is it sufficient, as prescribed by the Constitution, to have a simple majority in Congress. Now one requires a “filibuster-proof” majority (in our scheme, 60%) to pass any significant legislation.
In practice this development has acted largely to the detriment of the public interest – most famously in the case of Strom Thurmond’s filibuster of the Civil Rights Bill of 1957. With regards to a healthcare public option, the threats of a filibuster will doubtlessly cause the Senate to act directly against public opinion. The “filibuster-proof” requirement also places undue influence on specific members of the Senate. All eyes are now upon Olympia Snowe of Maine, who holds the swing vote and can literally dictate her own terms on the final bill.
The tragedy in this is that our elected officials have not even the pretense anymore of acting in the interests of the public they serve. It is clear, according to nearly every polling agency, that a majority of Americans support a non-profit publicly owned health provider. It is also clear, from every analyst not directly in the pay of the insurance or pharmaceutical lobbies, that a public health plan would significantly drive down costs. Yet these facts hold no weight in our Senate.
Which I would put forth as rather dismal news for supporters of the public plan.
The New York Review of Books (not to be confused with the New York Times Book Review), has an excellent dissection of the recent conservative protest movement in this week’s issue. In it, Michael Tomasky attempts to answer the questions: Who were those protesters outside Capitol Hill on Sept. 12? Where did they come from? What are their aims? And perhaps most important: Should they be taken seriously?
Tomasky’s superb analysis yields some very dismal conclusions. According to him a new coalition has arisen, reactionary and corporate-funded, which comprises approximately 25% of the population. While opposition to “big government” and “bailouts” forms a strong part of their ethos, the movement’s greatest demonstration – the September 12protest – focused its denigration upon one piece of one issue ( the public option and reform in genral). They are heavily patronized both by rich benefactors and the entire conservative media apparatus, most notoriously, Fox News. With manufactured outrage and serious financial support, they give the distinct impression of populism on issues where very little popular outrage exists.
The article is valuable for its discussion of the underlying philosophy of the protest movement: the Ayn Rand – Objectivist viewpoint that has compelled so many to act against their material benefit. The financiers of these protests and the party theorists behind them seek little more than the removal of the programs many of those overwhelmingly middle-class protesters enjoy. Concepts such as the minimum wage, social security, medicare, unemployment benefits and many like them simply cannot coexist with the de-regulated “small government” the protesters apparently wish for. The wealthy capitalists behind this movement seek a government with their wealth in mind – not that of the middle class.
Tomasky makes the astute observation that the sentiments expressed betray a nostalgia for the Bush administration, and that their adherents likely comprise the 24% of Americans who viewed President Bush favorably as he departed. However he spends little time discussing a major hole in the protest’s ideology. There is a distinct difference between the protester’s stated aims of “smaller government” and their tacit support of our wars abroad. Their paragon, President Bush, expanded government almost beyond recognition, with his “Department of Homeland Security”, his 3 Trillion dollar wars, warrantless wiretapping, politicization of the Justice Dept, employment of mercenaries, and many, many other actions. That these protesters choose such a minor manifestation of “big government” shows the divestment between their ideology and practice.
The problem, then, is not so much with the size of government, but the ends to which the government works. Government spending in the direct interest of Corporate America – no-bid contracts, costly wars, so-called “privatization”, etc. – comes under no scrutiny. Instead the objection comes mainly to the public manifestations of government spending, to government in the public interest. Hence, there was no specific opposition to a government mandate that all citizens must carry health insurance (a major goal of the health insurance industry), merely opposition to a public option (which would cut into industry profits.)
It is clear to see why our nation’s most wealthy citizens should wish to curb government spending on items they don’t purvey. But their ability to foment a purely artificial movement (Tomasky calls this phenomenon “astroturf” – corporate-funded grassroots) and manipulate a public, with the major media complicit, into protesting against their tax-paying interest serves as a dismal reminder of the sheer power moneyed interests hold in our country.