Wednesday, September 9, 2009

What We're Not Getting

Just a couple of observations from President Obama's speech on health care "reform", and then I think I'll go read a book or something.

Basically, it tells us what we're not getting single payer:

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's -- (applause) -- where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.

I've said -- I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch.

Transcript: Obama's Health Care Speech

The part I've emphasized is a rhetorical strategy known as a strawman. Single-payer is a way of paying for health care. It's not the whole system. That Obama would lie like this is the first indication of where this speech is going, but it gets worse.

To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. (Applause.) The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

Transcript: Obama's Health Care Speech

Translation: You're not getting a public option, either.

Why do I say that? Simple. Once again, Obama is distorting the facts. The public option was a compromise position from single-payer, which is a much more efficient way of providing health care. What the public option does, though is allow people still want to be covered by their own private insurance to continue to do so. Those of us who don't, either because we just don't trust insurance companies, or because we can't afford them, or because we're being excluded for one reason or another, then we have an option. That's what it means, as Obama did explain in the speech prior to this quotation.

So, this was already a compromise, and now we progressives are asked to compromise again. Insurance companies are not asked to compromise, nor are drug companies. No, they're not. Insurance companies are getting a captive market in exchange for some regulations that, in all likelihood given our government's record of enforcing law in the financial sector, aren't going to happen. Drug companies are not giving up anything.

What's more, House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid, and President Obama all spent much of yesterday explaining that they didn't think a public option would happen. So it's not going to happen. We knew that yesterday, if not before, but today was the memorial service.

The first clue that this wasn't going to happen, though, was that months ago, instead of coming up with the obvious strategy to sell a public option, Obama and Congress came up with a hodge-podge that wouldn't work for anyone. Josh Marshall explained what they could have done:

It also points back to the question (a frustratingly good one) of why the advocates of a public option and just reform in general have not simply explained this as allowing people to buy into Medicare at any age. Because, essentially, that's what it is. And I think I could pretty much guarantee you that if the question in the public mind was "Would you like the option of buying into Medicare before you turn 65?" the opposition would be vastly diminished.

This isn't just rhetoric. This is the most accurate and graspable explanation of what's being proposed. Indeed, the big secret not many people are discussing is that in the current iterations of the 'public option' in most of the bills in committee that 'option' isn't given as an option to many people. Most people aren't allowed to access it. And it's designed that way in order to put a crimp on any competition it might provide to private sector insurers.

Adventures in the Rabbit Hole

I noted a month ago that Ian Welsh had come up with the same idea. I'd guess you could probably find dozens of people who have suggested it. I certainly wondered why this wasn't the plan all along.

Why would the Obama White House want to do this, you might ask? Jane Hamsher filled in that blank a few days ago:

On May 11, "stakeholders" including the AMA, PhRMA, the hospitals and the device manufacturers delivered proposals to the White House promising to "voluntarily" reduce cost increases over the next 10 years. In an effort to keep them "at the table," Baucus's Chief of Staff Jon Selib and Finance Committee staffer Russell Sullivan told stakeholders at a May 20 meeting that their participation in the process of crafting a health care bill was contingent on them "holding their fire":
The goal of keeping stakeholders at the table was threefold:

1. Keep them from advertising against the White House plan
2. Keep them from torpedoing vulnerable Democrats in 2010 so there isn't a repeat of 1994
3. Keep their money out of GOP coffers

You can see the fingerprints in the deals that they made: the $150 million PhRMA was spending on ads for health care reform, the $2.5 million they spent helping vulnerable freshmen, and the total fury that Boehner has unleashed on PhRMA and other stakeholders for making deals with the White House.

The Baucus Caucus: PhRMA, Insurance, Hospitals and Rahm

So, what's left is for the progressives to either stand up and say there will be no health care bill, which would be preferable at this point, or for them to lie down and take their screwing like they always have before. I'm betting on the latter, but you never know. Maybe they've finally had enough.

Either way, there's no public option this year.

I just checked back to see the first time I referred to Barack Obama as a con artist. It appears to be February of 2008, when I wrote this:

Ordinarily, I'd say that it's wonderful that we have widened the talent pool for viable Presidential candidates to include women and black people. That would be great news, if only we hadn't managed to pick a con artist and a crazy man as the candidates. The Age of American Unreason really has arrived.

Obama Now Ahead For Real

He can do a bait and switch with the best of them. And folks, given all the shit I took for calling him a con artist, I'm happy to say I told you so.


Dana Hunter said...

Afraid I can't be as pessimistic as you on this one.

Cujo359 said...

Just wait.

The truth is that Obama has put himself in a bind. Assuming the progressives in Congress actually stand up and do the right thing, he either has to break whatever deal he made with the insurance and drug companies, and say goodbye to hundreds of millions of dollars in campaign cash, or screw the rest of us. My money's on the latter. The reason is that he's never once done anything else.