Health Care Mess

Well, it looks like the Democrats may get some sort of healthcare bill through the Senate. The debate and "negotiations" in the Senate were truly American democracy at its worst. Even though the Democrats won clear and overwhelming wins in both 2006 and 2008 and now "control" 60% of the seats in the Senate, they've allowed themselves to be held hostage at first by Republican "moderates" and then by conservative "Democrats." If this were a parliamentary system as found in Canada or Great Britain, there would have been no need for compromise with the opposition and a bill would have been passed months ago.

First, without even a debate, they gave up on the single best chance at cost control and universal coverage, a single-payer system, in exchange for a strong public option. Then they gave up the strong public option in exchange for a weak public option. Then they gave up the weak public option for an early Medicare buy-in. Then they gave up the early Medicare buy-in to get the support of Joe Lieberman, even though he had campaigned on that option as a vice-presidential candidate in 2000 and championed the idea as recently as three months ago. Then they had to strengthen the anti-abortion language to get the support of Ben Nelson. (Why, alone in the Western world, are Americans still debating abortion?) Opponents of the bill gave up nothing and got lots in return.

What are we left with? A mandate to buy insurance from private companies in return for not denying coverage to those compelled to buy from them. In spite of industry opposition to the bill, I think they are thrilled with the prospect of 30-40M new customers. They can still charge more for older and already sick people. And if those new customers can't afford the rates, the government will subsidize the payments. Sounds like a good deal except for those who will have to pay up to 17% of their income to pay for insurance.

The Democrats blew it big time. Starting at the top with Obama himself. He's been largely invisible in the whole process. If he devoted as much time to the healthcare debate as he did to Afghanistan, we'd be ahead in the game. If he were willing to spend as much on universal healthcare as he will spend in Afghanistan, none of us would ever have to worry about medical bills ever again. But no, he gave some fuzzy guidelines to Congress and let them hash it out. And hash is exactly what we are left with.

The Democrats picked the wrong enemy. They demonized the insurance companies rather than the rest of the medical-industrial establishment. There's nothing inherently outrageous about the way the insurance companies ran their businesses. It was like car or house or life insurance. Using actuarial tables and statistics, they try to pick the winners and try not to insure the losers. I'm not saying that body shops and parts suppliers are corrupt and monopolistic, but if car insurance rates were as crazy as medical insurance rates, it would be like singling out the insurers for the outrageous rates they charge rather than going after the corrupt and monopolistic body shops and parts suppliers. Medicine as practiced in the USA costs more than twice as much as every other industrial nation because every procedure, be it a CT scan or a blood test, and every drug costs twice as much as it does anywhere else, and American doctors order more of those procedures and prescribe more drugs. The 25-30% that US insurers take off the top only accounts for a small fraction of the difference in costs. (I think Canadian administrative costs are something like 8-10% of the healthcare bill.)

As far as I can tell, cost controls in the Senate bill are mostly non-existent. So the end result will be continuing high medical care costs and continuing high profits for the medical-industrial establishment, no improvement in medical outcomes, and a huge black eye for the Democrats. We won't get any real medical care reform until the system we now have collapses from its own weight.