Wednesday, June 24, 2009

It's Not Single Payer But...


President Obama speaks before the AMA at its annual convention in Chicago earlier this year.

The more I read about Obama's still-nebular plan for health care, the more mixed feelings I get. It's obvious by now that, Obama's old senior colleague Dick Durbin's comments notwithstanding, it isn't just the banks who "run the place" but also HMO's, Big Pharma and the insurance giants. Simply because of that and their army of lobbyists, anyone who still holds out hope for universal single payer coverage that includes the 47,000,000 uninsured probably still believes in Santa Claus and that the Cubs will win this year's World Series.

I keep going back to what Dr. Howard Dean said last year about health care reform being the cornerstone of our economic recovery and I've always believed he may be right. The only good thing about this public vs private sector competition is that it would give us the power to choose the cheaper government option over that of the HMO's. Naturally, when we begin defecting in droves, that'll be a wakeup call to them to stop jerking us around and bleeding us dry with their upwards spiraling premiums, constant co-pays and $1000 deductibles. There are 119,000,000 people with private health insurance and the consensus is that they want out.

So, while it may not be single payer, we will still ultimately exercise some control over the cost and they will have no choice but to start offering competitive rates. But is that what will happen? Consider the case of the oft-overlooked Commonwealth of Massachusetts in the post-Mitt Romney era.

Just prior to leaving office, then-Governor Romney signed into law a "health care" bill that not only made health care mandatory, it immediately resulted in upwards spiraling health care costs that only resulted in much higher premiums, more co-pays, higher deductibles ($500-1000 is the norm) and less coverage than ever.

The public option, Mass Health (formerly available primarily to welfare recipients), is hardly any better than the health care plans offered by the state's employers. For instance, using myself as an example, I gave them my age and a bit of other information and got a quote that cheerfully told me, "You can get a health plan for as low as $314.15 a month."

Wow! That's just under $80 a week, which is $15 more a week than the outrageous Fallon health care plan offered at my last job. Even working fulltime at $11.30 an hour, minus taxes and $103 in child support garnishments, that left me with about $265 a week. Taking the "public option" here in Massachusetts meant I would've been working 40 hours a week and taking home about $185. Note, also, that the Commonwealth's "public option" left in place by Romney and the state congress is co-opted by six of the state's largest insurers. In other words, it's a pre-rigged ball game designed to keep HMO's squarely between the hashmarks of the playing field. Depending on how badly such a plan will implode over the next few years, it could be the one thing that will get Obama voted out of office.

Plainly, competition between the public and private sector doesn't work in Massachusetts and I have no realistic expectation that rates will be driven down with a more competitive marketplace. And, of course, that's the ultimate aim of politicians on Capitol Hill, who have benefited enormously over the years from Big Pharma, HMO's and insurance companies. Just as the Clinton health care bill in the early 90's would've been co-opted by five of the largest health insurers of the day, so this health care bill, whatever shape it'll take, will ensure that the BC/BS, Fallons and the others will continue getting a big chunk of the pie.

What's worrisome is that recent polls are suggesting that the vast majority of Americans are supporting the president's initiatives even though no one, certainly the president or the Senate Finance Committee's panel, has any idea what shape that plan will take, what bargaining chips (such as the involvement of the public sector) will get tossed and which ones will stay in. 57% of Americans have stated they'd be willing to pay higher taxes to get everyone insured.

Or, to cite a more personal example of how easily even intelligent people who work in the field can be duped, my ex Significant Other is an LPN, a health care professional who's been working exclusively in the health care field for two consecutive decades. Her IQ is perhaps high enough to get her into MENSA. And when Romney's bill went into law, she kept insisting that Mass Health offered flexible options (which it does, although they range from unaffordable to outright exorbitant) and at rates that were even lower than what was being offered at my job. See above.

Yet the CBO recently stated that the Senate's recommendations would not only cost $1.6 trillion over the next decade, but that it would cover only a third of the 47,000,000 currently without health care. A revised draft by the Senate brought down the projected cost to one trillion but it still didn't address how to cover the other 30,000,000 or so uninsured Americans who would have to help foot the cost of a bill that still excludes them.

So while it may be nice to dream about a more competitive marketplace that would force the HMO's to finally wake up and start offering realistic health care plans that don't bankrupt families and capriciously drop others for "pre-existing conditions", if you want to see what Obama's plan would look like, especially if health care is mandatory (according to Ted Kennedy's sketchy plan), the penalty being even higher taxes, look no further than Massachusetts where even welfare health care is beyond the reach of working class Americans.

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