All Life Is Problem Solving

The Democratic Party will be the first to tell you that it’s the Party of the people, especially working people and the middle class. Change we’re supposed to believe in is change from a society moving in the direction of the wealthy, to one that is clearly moving in a direction to restore the American Dream for all. Well, we’re coming to a critical test of the propositions that the Democrats represent working people and the middle class, and that the Party is capable of delivering change we can believe in. That test is its actions, and not its words, on health care reform. There are various bills on the table in the sense that they have been introduced in Congress. They can be divided into four categories. There are expensive bills that give many concessions to the insurance industry, expand the number of people covered, but do nothing to cut rising costs and profits, or to protect people from bankruptcy and foreclosures due to out of control medical bills. There are other bills that include a public health care option that retain the present role of the insurance companies, but provide a voluntary public plan similar to Medicare to compete with them. There are still others that claim to offer a public option, but that structure it in such a way that it could not compete very successfully with private insurance companies, and would not have much effect on health-related cost increases. There is even one lone bill based on a single payer plan idea introduced by Sen. Bernie Sanders (I – Vermont), that provides for a health insurance plan that would severely curtail the activities of the health insurance industry in providing basic care by funding health care with tax revenue, providing payments to medical practitioners and private organizations that actually perform services, and setting prices to hold down cost increases.

When you consider the costs of these alternative types of bills, it’s clear that the most expensive bills, the ones that are worst for the national economy and the taxpayers, are the “no public option” plans, closely followed in expense by the emasculated public option plans. These plans will probably increase deficits by 1.3 to 1.6 trillion dollars over a ten year period. The public option plans may yet come in at a deficit increase of $1 trillion dollars over ten years. The only plan that promises to deliver a deficit neutral solution over 10 years is Sen. Sanders’ single payer plan.

Given the differences in costs among these proposals, the first thing one might ask is whether the more expensive plans are likely to deliver better quality health care than the single payer plan? In considering this question, it is important to recognize that there is not a shred of empirical evidence to suggest that the American Medical System run by today’s health insurance companies can deliver better medical care than a single payer plan. The comparative performance of health care systems across national boundaries is a touchy one, and it is hard to draw the clear conclusion that medical care in countries using single payer plans is better across the board than the system in the United States. However, a few things are not a matter of dispute: 1) the level of care in other major industrial nations is at least as good and may be better depending on the measures one uses; 2) it is better if we use life expectancy and infant mortality statistics as the primary measures of health care quality (The performance of the American system on these measures is abysmal, and compared to nations like Canada, the expected cost to Americans of being born here rather than in Canada is three years off their life span); 3) single payer is better if we take into account its impact in ending medical expense-induced bankruptcies and foreclosures; and 4) in spite of not getting better results than citizens of other nations, the US spends at least 60%, and often 100%, more for our health care system, than other so-called “advanced” nations. So, even if the overall output of the American system health wise is comparable to outputs in other nations, its benefit per unit or productivity is at least 38%, sometimes 50%, less than we find in other systems, and also its spillover impact into other areas of the economy is far greater and more baleful than we see in other nations.

So here’s where we are. We have four groupings of alternatives for health care plans. In order of expected productivity per dollar spent, we have single payer plan, strong public option, emasculated public option, and no public option. In order of cost, we have no public option, emasculated public option, strong public option, and single payer plan. The single payer plan is the least expensive, highest productivity alternative. The Democrats control Congress. But they’re not representing middle class and working class interests by pushing the single payer plan. In fact, from the beginning of the current debate, they’ve insisted that single payer is off the table, because, even though a majority of Americans favor it based on surveys, it’s politically unfeasible, and that they want a vigorous public option instead. Now we’ve reached the point where the Republicans and conservative Democrats are talking about the high cost of public option plans, and the unacceptability of one that would subject the private insurance companies to vigorous competition from the public option, while at the same time they advocate “reform” in the form of a plan that will provide no public option at all, at an even higher cost. All the while, they tell us that a single payer plan is “off the table,” because it is “socialized medicine,” and at the same time they reject a strong public option because they see it as “a stalking horse” which will, inevitably result in a single payer system over time.

Republicans and conservative Democrats have crafted a web of alternatives designed to persuade the public that they can’t pay for health care without increasing the deficit, and also that any public option won’t be materially less expensive than a plan dominated by the private sector, while over time such a plan would destroy the private sector plans and take ‘choice” away from them. They’ve been enabled in this opinion-molding effort by the Obama Administration’s leadership and complicity in taking single payer off the table. By doing this, the Administration has so far prevented the debate from centering around the issue of whether single payer plans can provide more choice than Americans have now at a lower cost. And Republicans and Conservative Democrats have been enabled in raising the false issue of disappearing choice, by framing it in terms of the eventual disappearance of private insurance companies.

Today, Ruth Marcus devoted a column in the Washington Post to making the point that public option plans can only be successful if they’re strong enough to be able to set prices and “require providers to participate if they want to remain eligible to accept Medicare patients.” Since she thinks that such a bill cannot emerge from the present Congress, her conclusion is that those interested in “effective reform” should spend less time worrying about the shape of the public option, and much more time on the makeup of the regulatory structure and the new market exchange that are supposed to ensure cost containment.

I think this is bad advice. It is bad advice because it guarantees that reform legislation will not serve the interests of middle and working class people, but will only demonstrate to them that Democrats are no better than Republicans when it comes to crafting health care legislation that enriches the private sector at the expense of taxpayers. Any health care reform that mandates coverage and provides subsidies for those in need without absolutely guaranteeing cost reductions in health care services is just more “lemon socialism” for the rich. Much better advice is for Democrats to begin representing the interests of their historic constituencies, and reducing the inequality that has become so characteristic of American society over the past 35 years or so.

Democrats can do that by changing their legislative strategy, deciding to place single payer health care back on the table, and fighting for that bill. If they can’t pass it, then they ought to run on it in 2010. But they need to acknowledge now that a public option is not a better alternative than a single payer system, and that they formulated it only because they were hoping for a bipartisan health care reform bill that would be at least somewhat effective, and also widely supported. Since the Republicans, have indicated in no uncertain terms that any kind of public option is unacceptable to them, Democrats have to make the choice between representing their supporters and bipartisanship. Of course, they have to choose representation, and they may as well withdraw the inferior public option alternative from consideration, since it won’t win any Republican support anyway, and just go for the best alternative, a single payer plan. If they do, they’ll have a helluva lot easier time explaining the plan to people. They can explain easily enough that while single payer removes the choice of insurance company from people, it will most probably, for most Americans, provide much greater choice of providers, hospitals, and services than they have now. In fact, Democratic legislators can even use their own Congressional health care plans as a model of the kind of choice working and middle class people would have under the new single payer plan the Democrats might favor. Stories like that would be effective in persuading people that single payer would provide more rather than less choice. At the same time enough stories like these would make it very difficult for ordinary citizens to forget that their Congressmen and Senators already have such a tax payer-financed plan, and it would be correspondingly more difficult for Republicans and conservative Democrats to vote against the idea of providing their constituents with the same health care plan that they enjoy.

Finally, in taking part in a process of whittling down the public option (a compromise from single payer in the first place) into an emasculated public option that won’t control costs, the Democrats are proving to everyone that they don’t represent middle and working class interests, but prioritize other things above providing affordable and secure health care to every American. Democrats are trying to hide this behind a welter of complex detail underlying the various alternatives under consideration. These alternatives are indeed complex; but the origin of the complexity is not the problem of providing effective, affordable, and secure health care to all Americans. It is to do some semblance of this, while still seeing to it that the insurance company system survives and prospers. Unfortunately, this last is not an American interest, or a Democratic Party interest. It is only a vested interest. It is nothing the Democratic Party was elected to do. And if it continues to sacrifice what it was elected to do in the interests of covering the health care insurers, the Democratic Party will lose its majorities in 2010 anyway, because they will have shown that those majorities make no difference when it comes to representing the people. Democrats need to wake up. It’s not beyond the realm of possibility that middle and working class Americans will lose patience with both major parties, and will decide to raise up a new political party that does not seek, and will not take, contributions from the health insurance, energy, pharmaceutical, and financial industries. What good to us is a Democratic Party that is so solicitous of Banksters, Wall Street manipulators, globalizing interests, energy companies, and health insurers? Why should we care about such a Party? Why should we vote for it again?