You can be forgiven if this week's noise on health care reform in Washington has left you confused, confounded and befuddled. It's gotten messy and little is getting done.
I have given up tracking the different proposals being issued from various committees and subcommittees of both the House and the Senate, and more are threatened to be forthcoming from individual and groups of legislators. Everybody in Congress has a plan that everyone else opposes and the din is ear-splitting.
The Public Option
The public option, a government insurance plan to compete with private plans, was almost shot down by White House chief of staff Rahm Emanuel in an interview with the Wall Street Journal this week:
"The goal is to have a means and a mechanism to keep the private insurers honest," he said. "The goal is non-negotiable; the path is negotiable.”
“The path,” also referred to as the trigger, in the public plan
“would kick in,” explained the WSJ, “under certain circumstances when competition was judged to be lacking. Exactly what circumstances would trigger the option would have to be worked out.”
Emanuel's apparent back pedaling from one of the president's central goals for health care reform was so off the mark that Obama felt obliged to take time from the G8 summit in Moscow to slap down his aide even though his statement, quoted in The New York Times, was tepidly less than specific:
“...one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest. I look forward to a final product that achieves these very important goals.”
The public option is supported by 72 percent of Americans in a recent CBS News/New York Times poll, and by 69 percent in a Quinnipiac survey. The biggest landslide in a presidential election history was the 61.1 percent of the popular vote given to Lyndon Johnson in 1964. By that standard, support for the public option is tsunami. It's time for Congress to put it writing and move on to the next reform issue.
Health Industry “Agreements”
On Wednesday, Vice President Joe Biden trumpeted an agreement between the White House and the country's hospitals for the industry to contribute $155 billion in health care savings over the next ten years. “Historic,” said Biden, echoing President Obama's description of big pharma's similar pledge a couple of weeks ago to cut drug costs by $80 billion over ten years.
The hospital contribution would reduce federal payments to hospitals, but one catch is that several legislators have said they have no obligation to include these White House agreements in health care legislation. Another, specific to the hospital agreement, was pointed out on NPR by Richard Kirsch of Health Care for America Now, a consumer group working for a health overhaul bill.
Because a significant part of the money being pledged currently goes to help pay for care of uninsured patients, he explained, hospitals would need less money anyway once health care reform kicks in and most people are insured.
So the pledges, which are minuscule compared to the estimated cost of one to two trillion dollars over ten years that Congress is wrestling with, are mostly PR - an appearance of sacrifice by the health professions in hopes of "purchasing" as weak a reform bill as possible.
Tax Surcharges and Taxing Health Care Benefits
Another reform issue is the proposal to tax employer-provided coverage and separately, to enact a tax surcharge on salaries of $250,000 and more to help pay for health care reform. These are contentious issues and there is not much clarity yet. We'll have to wait and see.
Personally, I would rather see the cap on the Social Security deduction eliminated and there won't be much chance for that if there is already a benefit tax and surcharge.
Rationed Care and Bureaucratic Health Decisions
Meanwhile, there are dueling commercials on television and radio over what conservatives call rationed care and over their warning that government bureaucrats will be making people's health care decisions if a public option is included. These are red herrings meant to scare and distract people.
We already have rationed care in the United States – rationed by money rather than need: if you are rich, you have coverage; if you are poor, you don't. I like Michael Kinsley's take on rationed care:
"Here is a handy-dandy way to determine whether the failure to order some exam or treatment constitutes rationing: If the patient were the president, would he get it? If he'd get it and you wouldn't, it's rationing."
And, we already have bureaucrats making our health care decisions – corporate bureaucrats whose jobs are to deny every claim possible and cancel coverage if you dare use your coverage. After three years of experience with Medicare, I'll take government bureaucrats over corporate ones in a heartbeat.
Paying for health care reform to cover all Americans is a complex and valid issue that our lawmakers need to figure out. I don't envy them. But all the rest of the noise – all of it – is driven by the largest insurers, medical groups, pharmaceutical companies and hospitals attempting to retain as much of the current system as possible to maintain their profits and control.
They have hired 350 lobbyists and are spending $1.4 million per day to sway our representatives (many of whom got elected through the same corporations' large political donations) to their cause. It is not cynical, in these circumstances, to wonder who speaks for the American people.
Well, no one except for a few underfunded consumer groups who cannot compete with the Midas-rich health corporations.
But this is our only chance for meaningful health care reform. If it fails now, it will be another 15 years, as it has been since the Clinton health care initiative, before it comes up again. In our current, dismal economic circumstance, which will not end soon, that would be a disaster for additional millions of people piled on top of the already-uninsured 47 million. There is no overstating how crucial this legislation is.
So it is up to each of us individually to speak out, to flood Washington with the people's point of view. Write and phone your senators and representative. But don't stop there. Contact the majority and minority leaders in each house of Congress. The committee chairs and members. And don't stop. Keep doing it. Again and again. Here's the link to reach all of them.
At The Elder Storytelling Place today, Brenton “Sandy” Dickson: Two Memories.