Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It's become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.
The system doesn't work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it's a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they're sick with incurably expensive illnesses.
The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that's the good news. The bad news is our failed health care system won't get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.
Over the course of this summer, those two failed systems have collided in a spectacular crossroads moment in American history. We have an urgent national emergency on the one hand, and on the other, a comfortable majority of ostensibly simpatico Democrats who were elected by an angry population, in large part, specifically to reform health care. When they all sat down in Washington to tackle the problem, it amounted to a referendum on whether or not we actually have a functioning government.
It's a situation that one would have thought would be sobering enough to snap Congress into real action for once. Instead, they did the exact opposite, doubling down on the same-old, same-old and laboring day and night in the halls of the Capitol to deliver us a tour de force of old thinking and legislative trickery, as if that's what we really wanted. Almost every single one of the main players — from House Speaker Nancy Pelosi to Blue Dog turncoat Max Baucus — found some unforeseeable, unique-to-them way to fuck this thing up. Even Ted Kennedy, for whom successful health care reform was to be the great vindicating achievement of his career, and Barack Obama, whose entire presidency will likely be judged by this bill, managed to come up small when the lights came on.
We might look back on this summer someday and think of it as the moment when our government lost us for good. It was that bad.
Here's where we are right now: Before Congress recessed in August, four of the five committees working to reform health care had produced draft bills. On the House side, bills were developed by the commerce, ways and means, and labor committees. On the Senate side, a bill was completed by the HELP committee (Health, Education, Labor and Pensions, chaired by Ted Kennedy). The only committee that didn't finish a bill is the one that's likely to matter most: the Senate Finance Committee, chaired by the infamous obfuscating dick Max Baucus, a right-leaning Democrat from Montana who has received $2,880,631 in campaign contributions from the health care industry.
The game in health care reform has mostly come down to whether or not the final bill that is hammered out from the work of these five committees will contain a public option — i.e., an option for citizens to buy in to a government-run health care plan. Because the plan wouldn't have any profit motive — and wouldn't have to waste money on executive bonuses and corporate marketing — it would automatically cost less than private insurance. Once such a public plan is on the market, it would also drive down prices offered by for-profit insurers — a move essential to offset the added cost of covering millions of uninsured Americans. Without a public option, any effort at health care reform will be as meaningful as a manicure for a gunshot victim. "The public option is the main thing on the table," says Michael Behan, an aide to Sen. Bernie Sanders of Vermont. "It's really coming down to that."
The House versions all contain a public option, as does the HELP committee's version in the Senate. So whether or not there will be a public option in the end will likely come down to Baucus, one of the biggest whores for insurance-company money in the history of the United States. The early indications are that there is no public option in the Baucus version; the chairman hinted he favors the creation of nonprofit insurance cooperatives, a lame-ass alternative that even a total hack like Sen. Chuck Schumer has called a "fig leaf."
Even worse, Baucus has set things up so that the final Senate bill will be drawn up by six senators from his committee: a gang of three Republicans (Chuck Grassley of Iowa, Olympia Snowe of Maine, Mike Enzi of Wyoming) and three Democrats (Baucus, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico) known by the weirdly Maoist sobriquet "Group of Six." The setup senselessly submarines the committee's Democratic majority, effectively preventing members who advocate a public option, like Jay Rockefeller of West Virginia and Robert Menendez of New Jersey, from seriously influencing the bill. Getting movement on a public option — or any other meaningful reform — will now require the support of one of the three Republicans in the group: Grassley (who has received $2,034,000 from the health sector), Snowe ($756,000) or Enzi ($627,000).
This is what the prospects for real health care reform come down to — whether one of three Republicans from tiny states with no major urban populations decides, out of the goodness of his or her cash-fattened heart, to forsake forever any contributions from the health-insurance industry (and, probably, aid for their re-election efforts from the Republican National Committee).
This, of course, is the hugest of long shots. But just to hedge its bets even further and ensure that no real reforms pass, Congress has made sure to cover itself, sabotaging the bill long before it even got to Baucus' committee. To do this, they used a five-step system of subtle feints and legislative tricks to gut the measure until there was nothing left.
STEP ONE: AIM LOW
Heading into the health care debate, there was only ever one genuinely dangerous idea out there, and that was a single-payer system. Used by every single developed country outside the United States (with the partial exceptions of Holland and Switzerland, which offer limited and highly regulated private-insurance options), single-payer allows doctors and hospitals to bill and be reimbursed by a single government entity. In America, the system would eliminate private insurance, while allowing doctors to continue operating privately.
In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.
Everyone knows this, including the president. Last spring, when he met with Rep. Lynn Woolsey, the co-chair of the Congressional Progressive Caucus, Obama openly said so. "He said if he were starting from scratch, he would have a single-payer system," says Woolsey. "But he thought it wasn't possible, because it would disrupt the health care industry."
Huh? This isn't a small point: The president and the Democrats decided not to press for the only plan that makes sense for everyone, in order to preserve an industry that is not only cruel and stupid and dysfunctional, but through its rank inefficiency has necessitated the very reforms now being debated. Even though the Democrats enjoy a political monopoly and could have started from a very strong bargaining position, they chose instead to concede at least half the battle before it even began.
Obama wasn't the only big Democrat to mysteriously abandon his position on single-payer. House Speaker Nancy Pelosi and Rep. Henry Waxman, the influential chair of the House commerce committee, have both backed away from their longtime support of single-payer. Hell, even Max-freaking-Baucus once conceded the logic of single-payer, saying only that it isn't feasible politically. "There may come a time when we can push for single-payer," he said in February. "At this time, it's not going to get to first base in Congress."
And helping it not get to first base was … Max Baucus. It was Baucus' own committee that held the first round-table discussions on reform. In three days of hearings last May, he invited no fewer than 41 people to speak. The list featured all the usual industry hacks, including big insurers like America's Health Insurance Plans (AHIP), Blue Cross and Aetna. It's worth noting that several of the organizations invited — including AHIP and Amgen — employ several former Baucus staffers as lobbyists, including two of his ex-chiefs of staff.
Not one of the 41 witnesses, however, was in favor of single-payer — even though eliminating the insurance companies enjoys broad public support. Leading advocates of single-payer, including doctors from the Physicians for a National Health Program, implored Baucus to allow them to testify. When he refused, a group of eight single-payer activists, including three doctors, stood up during the hearings and asked to be included in the discussion. One of the all-time classic moments in the health care reform movement came when the second protester to stand up, Katie Robbins of Health Care Now, declared, "We need single-payer health care!"
To which Baucus, who looked genuinely frightened, replied, "We need more police!"
The eight protesters were led away in handcuffs and spent about seven hours in jail. "It's funny, the policemen were all telling us their horror stories about health care," recalls Dr. Margaret Flowers, one of the physicians who was jailed. "One was telling us about his mother who was 62 and lost her job and was uninsured, waiting to get Medicare when she was 65." The protesters were sentenced to six months' probation. Baucus later met with them and conceded that not including single-payer advocates in the discussion had been a mistake, although it was "too late" to change that.
Single-payer advocates have had an equally tough time getting a hearing with the president. In March, the White House refused to allow Rep. John Conyers to invite two physicians who support single-payer to the health care summit that Obama was holding to kick off the reform effort. Three months later, a single-payer advocate named David Scheiner, who served as Obama's physician for 22 years, was mysteriously bumped from a prime-time forum on health care, where he had been invited to ask the president a question.
Many of the health care advisers in Obama's inner circle, meanwhile, are industry hacks — people like Nancy-Ann DeParle, the president's health care czar, who has served on the boards of for-profit companies like Medco Health Solutions and Triad Hospitals. DeParle is so unthreatening to the status quo that Karen Ignagni, the insurance industry's leading lobbyist-gorgon, praised her "extensive experience" and "strong track record."
Behind closed doors, Obama also moved to cut a deal with the drug industry. "It's a dirty deal," says Russell Mokhiber, one of the protesters whom Baucus had arrested. "The administration told them, 'Single-payer is off the table. In exchange, we want you on board.'" In August, the Pharmaceutical Research and Manufacturers of America announced that the industry would contribute an estimated $150 million to campaign for Obamacare.
Even the Congressional Progressive Caucus, whose 80-plus members have overwhelmingly supported single-payer legislation in the past, decided not to draw a line in the sand. They agreed to back down on single-payer, seemingly with the understanding that Pelosi would push for a strong public option — a sort of miniversion of single-payer, a modest, government-run insurance plan that would serve as a test model for the real thing. But one of the immutable laws of politics in the U.S. Congress is that progressives will always be screwed by their own leaders, as soon as the opportunity presents itself. And with a bill the size and scope of health care, there was plenty of opportunity.
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