Health care reform legislation is on its way to the floor of the United States Senate for a debate before it can voted on to become law. The current president is not a man used to losing. He has reached the White House with little political background and barely any political or policy record worth the scrutiny that is often faced by other politicians. He became president based on hope and he wants to deliver it.
The substance of all the reform legislations−health care, energy and financial regulations−is incoherent. It does not reconcile with the goals about which all Americans agree but employs methods with which at least half the country disagrees. The President has decried lobbyists, yet the reforms’ legislations are all well-paid lobbyist operations, as though the soaring idealism of his campaign has come to terms with the political reality of Washington when it came time to getting things done.
The public insurance exchange taxes being imposed by the proposed legislation on Americans to pay for the 47 million uninsured with little regard to the overwhelming evidence that says it will do little to reduce the cost of health care is self-defeating as a reform measure even if the bill leaves the Senate with a partisan political victory. The economy may not recover sufficiently by 2010 or even four years from now, by which time the measure is expected to be fully implemented, to be able to bear the higher health care taxes. It seems as though health care is being used as a platform to raise taxes, because government expenditures are fungible.
The President may continue to win victories given the number of Democrats in the Congress, but “is the country losing?” is the question that we must all ask because the consequences of the reform measures will not be known for some time. Pyrrhic victories is not what a majority of Americans had voted for in 2008. It is best if the health care bill fails in the final vote in the Senate in spite of garnering the bare minimum that were required to avoid a Republican filibuster.
Failure of the President and his Congress’s inexorable legislations must, however, pave the way for alternatives. Otherwise, failure would be as disappointing as the political success of ill-considered legislations, perpetuating the politics-as-usual gridlock in the permanent campaign that is the state of the people’s government in Washington.
The 39 senators who voted against the parliamentary maneuver to bring the health care bill to floor debate do not have a plan. The 60 who had voted for, have a plan written by the health insurance lobby. The people have no lobby but they had voted for their members of Congress and the President, who, they thought, were their lobby. The people’s lobby had ended the moment after they had voted on election day. The stories of their health care plight were gathered and used to lobby against their interest.
The imaginary fear that grips America each time health care is brought up is that any government effort to provide health care without involving the private markets, whether that be Medicaid, Medicare or covering the uninsured who does not fall in either category, could become a slippery slope to nationalized health care. The uncomfortable silence is largely about this imaginary fear when asked, “Why pay the insurance men in the middle, when health care itself can be provided for, when needed, by the government directly to those who cannot afford it in the private markets?”
The insurance industry provides the semblance of the “free market” to save the American ethos even while providing pure public goods such as a social safety net. So, it becomes difficult for the politicians to disregard the insurance lobby. It becomes difficult for them to conceive of solutions that do not involve the insurance industry to reform the nation’s health safety net when, in fact, the government is already providing public health care elsewhere, such as in the military and for veterans, very efficiently and effectively.
An all-public health safety net is not health care nationalization. It is government-provided health care for the unfortunate few who cannot afford it for a variety of reasons. The country does not need a public insurance exchange. It needs public health care at the bottom of the income ladder. This is the genuine public option. Not tax payer subsidized payouts to insurance companies by mandating that all buy health insurance with no mechanisms to control the costs of health care itself.
Such a public option can be provided at a far lower cost than the current Health and Human Services (HHS) spending on health care by consolidating the military and veterans facilities across the country and integrating Medicaid and Medicare into them. Revised eligibility criteria can expand the use of these facilities to others who do not fall into any of these four categories. The insurance lobby will not benefit from such a change, but so be it.
The only tried and tested mechanism to bring down the price of anything is to increase its supply. Both the private health insurance and health care provider markets must be reformed to increase health care supply in a manner that is no different from the auto market. The choice of more auto manufacturers, domestic and foreign operating in the country per American standards, under legislatively mandated price transparency brings down cost.
If the private health care market is so reformed to reduce health care costs, there is no reason why, with the exception of health care for current military personnel and a portion of veterans with chronic medical conditions caused in the line of duty, the health safety net itself at that point cannot become similar to food stamps. Doctors may not like to think of themselves as grocers, but so be it.
The road to “health stamps” is a reform that permanently fixes the broken health care market and the current bill will not do it.