Sam Smith
The pending health care legislation is as corrupt, cynical and contemptuous of simple decency as any bill I've seen in over a half century of covering national politics. Which still leaves the question of what to do about it.
After all, living in the Mafia neighborhood that contemporary America has become, survival can easily, and wisely, take precedence over principle.
For example the Institute of Medicine estimates that around 18,000 Americans die because of a lack of health insurance. A study in the December issue of American Journal of Public Health puts the figure for those 18-64 at 45,000 lives lost a year. Does one ignore such numbers in order to stand on principle against an indefensible payoff to the health insurance industry?
Or consider these assets of the pending legislation as outlined by Joshua Holland for Alternet:
[] According to the Congressional Budget Office, Medicaid expansion alone would offer public insurance to more than 10 million low-income Americans who would otherwise be without. . . More than nine in ten people who lack insurance in America fall beneath 400 percent of the poverty line, and every one of them will get some help getting coverage. . .
"The House legislation is a watered-down bill that would do little to contain America's overall health-care costs, but would help contain the family health-care expenses of tens of millions of real working people, while covering 36 million who would otherwise be uninsured." []
But now look at another side of the story. How many people will die or become ill because of provisions in the measure?
For example, the Medicare cost-cutting raises a serious threat to elderly. How big a threat one can't tell right now, but you can get a sense of the problem by considering the recent report favoring a drastic reduction in mammograms. Thanks to the strength of the women's movement, this suggestion was quickly squashed, but what about similar cuts in examinations or services to those under Medicare who are less likely to cause a fuss?
Further, we are looking at a system in which the standards for care will be judged for both health benefit and budgetary efficiency by the same government agencies. The conflict of interest is enormous and will especially affect those whose illnesses and response do not match the government-approved average. How many people will die or suffer continued bad health as a result? To what degree is there a submerged bias in the bills against older patients suffering what might be called statistical deficit disorder? What will be the death rate as a result of seniors giving up Medicare Advantage? What will be the health effects of the mandatory mandate on a family that is about to have their house foreclosed and simultaneously faces criminal charges for not paying protection money to the insurance industry? We seem to have forgotten that beyond the poor are a huge number who need only be slightly pushed to go over the edge.
It is useful to recall that Obama's original point man in this sick game was Tom Daschle who said that health care reform "will not be pain free" and that seniors should accept more of that pain rather than treating it.
Daschle pushed for a federal review body modeled after the one in Britain that distinguished itself by such things as a rule that elderly patients couldn't get an expensive eye drug until one of their eyes went blind. It took three years of protest to reverse that decision.
Now, quietly snuck into the stimulus package, we have something called the Federal Coordinating Council for Comparative Effectiveness Research, which consists of 15 government officials and no outside experts. This body will be making purportedly unbiased evaluations of treatments but every official on it will be actually serving two gods: health and the budget.
In short, we are moving from a de facto triage system based on income to one based on appropriations.
And on age.
The silent and widespread acceptance of huge cuts in Medicare as part of "health reform" is an indicator of where the elderly really stand in current political priorities. As Cecil Connolly of the Washington Post noted last summer, "It appears seniors are the net losers under bills" then pending in the House.
No small part of the reason for this is that our health "reform" is being designed on an economic rather than a medical or moral basis. Since seniors are less productive than younger people, their lifespan simply isn't that important to a government so fiscally obsessed.
You can get a sense of how this works from an article in the Boston Globe by Linda Bilmes of the Harvard Kennedy School and Rosemarie Day of Massaschusetts' health insurance authority:
"The premature death of thousands of Americans can be translated into monetary terms using the economic "value of a statistical life.'' . . . A recent study by Stanford economists has demonstrated that the average economic value of a year of human life is about $129,000. Most insurance companies, and many countries around the world, already use a variant of this concept. They implicitly ascribe the value of an additional year of human life at $50,000 by setting that as the threshold for approving treatments. (Any treatment that costs $50,000 will be reimbursed if it is predicted to add another year of life for the patient)."
Significantly, no figures were given for the elderly, retired or infirm but it is clear from the subtext of the current debate that those in charge know whose lives they want to save and it ain't your grandmother.
There are other problems lurking behind the teleprompters. For example, the National Committee to Preserve Medicare and Social Security notes:
[] The health care reform bills now before Congress contain an unpleasant surprise for older Americans: Age-based increases in health insurance premiums for those under 65. This is nothing more than a giveaway to the private insurance industry.
At first blush, it might appear that this is justified assuming that as we age, we cost the health care system more. In fact, age is far from an entirely reliable predictor of health care costs, accounting for less than 20% of the variation in costs across age groups. A healthy 55-year-old may well consume fewer health care dollars than a 35-year-old who is obese or has diabetes.
Both the House and Senate bills include provisions to eliminate coverage for pre-existing conditions, which clearly serves the public interest.
Permitting premiums to rise with age contradicts the intent, if not the letter, of that regulation as aging can reasonably be considered an immutable, pre-existing condition. Moreover, the new regulation disproportionately affects Americans between 55 and 64, who already shoulder a financial burden for health care that is higher than any other age group, regardless of insurance status. . .
Here's a question for policymakers and the public to consider: Will the proposed age-rating of premiums, coupled with the absence of a robust, affordable public option, push more older Americans into the pool of people unable to afford health coverage?. . .
A recent Harvard study published in the American Journal of Public Health found that American adults under 65 who lack health insurance have a 40 percent higher risk of death than those who have coverage. Ailing and uninsured people in their 50s and 60s will likely add to the strain on Medicare's budget as they seek care for neglected health problems as soon as they become eligible for this entitlement.
The private insurance industry stands to make big profits from the millions of new customers it will pick up through health care reform. Adding to its bounty by putting the squeeze on the finances of older Americans is not only unjust, it is poor economic policy. []
Add to this the efforts by a powerful coalition that wishes to gut both Social Security and Medicare, epitomized by the insidious Concord Coalition and Peterson Foundation, as well as a development reported recently by Chris Bowers in Open Left:
"Of all the various blocs and gangs that have been formed in Congress this year, Senators Bayh, Conrad, Feinstein, Lieberman and Warner have managed to form the most regressive one yet. Currently, these five Democrats are demanding that Speaker Pelosi hand over all relevant Congressional power to an independent commission that will be allowed to slash and partially privatize Social Security and Medicare, or else they will allow the United States to default on its debt."
Writing in Global Research, Shamus Cooke gives rare attention to still other hidden ills of the healthcare legislation:
[] And although the final bill has yet to be crafted, there exists general agreements as to what the end version will look like. Americans will be forced to buy shoddy corporate insurance with no limit to the cost, no guarantee of quality, with large premiums and other tricks to further gouge consumers. If a public option emerges in the final bill - by no means a guarantee - it will be shrunken enough to insure very few people (2 percent of the U.S. population).
But it gets worse. How this health care "reform" will be paid for has implications that dwarf the above atrocities. . .
The two biggest cost saving schemes are the most damaging. The first is the enormous attack on Medicare. Since its inception, the corporate elite wanted this program struck down. Now they have their man for the job - a Republican could never get away with such obvious treachery. . .
One way that both Congressional health care bills will gut Medicare is referred to as "forced productivity gains" - cost saving measures essentially; trimming the fat.
What are these savings? The most mentioned device - by politicians and media alike - is the reduction of "wasteful tests" and procedures that doctors routinely perform, an idea that the health care mega-corporations love. It will save them billions, while having catastrophic effects on the health care of millions of people. . .
Another piece of Medicare that's being trimmed is Medicare Advantage, a favorite program of the elderly because of its comprehensive services. . .
Finally, The Senate health care bill attacks Medicare by reducing payments to doctors by 25 percent. If doctors receive such a drastic reduction in pay, they will simply refuse to see Medicare or Medicaid patients; people will thus be insured only on paper. The newly insured Medicaid patients under any new congressional bill will be sorely disappointed.
Once Medicare is undermined in the above ways, the corporate sponsored right-wing will make a very convincing argument that "Medicare doesn't work", leading to future cuts that will further destroy the program.
The second hidden disaster in financing a congressional health care bill is the tax on so-called "gold-plated" or "Cadillac" health insurance policies that some employers offer their workers. This tax is supposedly meant to apply to the health care policies that "elite" employees receive. . .
As it turns out, many, if not most workers in unions will be included in this tax, which, under the Senate version, will include any plan worth more than $8,000 for individuals and $21,000 for families. Hardly elite, considering the still-soaring costs for health care.
If this provision were to pass - and it's very popular in Congress - the immediate reaction would be very predictable: employers would immediately drop their health care plans, forcing workers into the now-forced purchasing of inadequate health care. . . []
But facts have never been important in this debate. For example, the Democrats have done their best to conceal how long it will be before provisions actually go into effect - such as the much touted ban on denial due to preexisting provisions. Nor will anyone admit the truth that a real advantage of the mandatory mandate is that the administration can claim - dishonestly to be sure - that it is not raising taxes. It is. The affected are just sending their checks to an insurance company rather than to the IRS.
In the end, the legislation will save lives while simultaneously causing other deaths. Not only does no one know the real numbers, but no one that I can find has even tried to come up with such figures. How do the saved uninsured match up against those driven out of existing plans (such as Medicare Advantage and so-called "Cadillac" programs) and how many seniors will die prematurely because of added costs or efficiency measures that claim their tests to treatment aren't worth it? I suspect there will be a net saving of life but that's not what all of us being created equal and with inalienable rights was meant to be about. None of our founders mentioned cost effectiveness as a precondition of human decency.
It's all a sad example of America's cultural and political collapse. This crowd - from Obama on down - could never have gotten Social Security, a minimum wage or Medicare passed. And it probably wouldn't have bothered them all that much, since today's politics has no higher goal than next quarter's campaign contributions.
Still, in reacting to it, this is a different situation than, say, being a conscientious objector in which one refuses to join in the killing and where virtue and effect are in sync. If, as I suppose, more lives will be saved than lost under the healthcare bill, then it is worth backing however cruel the choice - because you can't stand on principle in this instance without contributing to the damage. It seem that we have to pay the protection money to the insurance mob, save some lives and then turn to fighting the struggle on better ground.
