Health Reform Hangs in the Balance

Battle lines are now firmly drawn over the fate of the health care initiative. Republican and industry opposition has coalesced. The unity moment in the White House featuring President Obama and moguls from insurance, HMOs and pharmaceuticals is revealed for the cover-providing photo-op it was. When congress reconvenes in September the nation will find out whether these allies will be successful again as they were in 1994. By shooting down health care the Republicans would stop the Obama administration in its tracks and likely set themselves up for good gains in the 2010 midterm election. For the industry's part, doing so would likely put a health overhaul on the back burner for another 15 years as it did after their last victory.

The industry lobbyists, in their joint appearance with Obama, were careful to announce they supported the president's idea that everyone should have health coverage-actually, that everyone should be required to buy it, guaranteeing them more customers. As it turns out of course, they disagree on everything else associated with the issue. They want to be able to pick and choose their customers. They want to be able to rescind coverage when people get too sick. They don't want cheaper drugs used. They want to be able to determine what will be covered and what will not. They do not want to have to compete with other private providers within regions or with a public alternative program.

The current strategy is to slow things down and raise questions about cost and "government control." Their greatest fear is that any program, once in place, will prove overwhelmingly popular with the public and hold the industry up to a tougher standard of competition. Look at the earlier public service agencies. Franklin Roosevelt and the New Deal Congress instituted Social Security in 1935, and Republicans have been trying to end it ever since. Senator Robert Taft during the Eisenhower years, President Reagan in the 1980s and President Bush 43 in the 2000s attempted to discontinue, water down or privatize it. All ran into buzz saws of senior and general public opposition and were stymied. Social Security has become known as the "third rail of American politics." Like the electrified central rail of a subway system, touch it and you die.

President Johnson and the Great Society Congress passed Medicare in 1965. Ever since, all senior citizens have had medical coverage paid by the government that allows them to choose their own physicians and has minimal intrusion into the doctor-patient relationship. President Obama joked the other day that he gets letters, calls and emails every day now from senior citizens who plead with him to do two things: not institute a "government health plan" and also not to touch their medicare. The irony makes clear how pathetically they are being duped by the industry and its water carriers.

There is certainly a good deal of hypocrisy going on. Congress, of course, has long voted to cover itself with a government-provided health plan which allows each Member to choose his or her own physicians. And even neoconservative intellectual Bill Kristol, speaking on the Daily Show with John Stewart last week, said that the government-run health system for the military was superior to the civilian system and deserved because they were defending the country. Not much support for the argument of the alleged inferiority of taxpayer-funded health in either case. And, as Obama has been saying for two years, everyone who has private insurance and wants to keep it will be able to do so. These arguments do not stand up. They are transparent efforts to sow fear and protect profits.

Another consistent theme is the "what's the rush?" canard. The rush is that this idea was first proposed 62 years ago by President Truman, that the U.S ranks 37th in health care, just after Slovenia, that we spend 17% of GDP on health while the rest of the advanced world spends 11%, and that despite this their longevity and infant mortality are pulling away from ours. Another part of the rush is that when the Clinton health initiative was defeated in 1994 there were 38 million uninsured and 5% of health industry revenues went to overhead while today it is 49 million uninsured and 20% to overhead. The system continues to deteriorate. If the US spent just 11% of its $13 trillion GDP on health it would save $780 billion a year for other, more productive purposes.

To put things in perspective, on March 31, 2009 PBS Frontline reported that approximately 20,000 Americans die every year because they lack or have inadequate health coverage. When 3,000 died on 9/11 we suspended large portions of the Constitution and invaded Iraq. The health crisis is equivalent to more than six 9/11's every year. Yet the mantra of the comfortably ensconced is, "what's the rush?"

While congressional Republicans are ideologically in step with industry and largely bought by their campaign cash in any event, there are Democrats in their pay as well. With Democratic majorities of 80 in the House and 20 in the Senate, the fact that health care reform may be in trouble makes it plain that a number of them are drinking the kool aid too. See an ad here that crystallizes the issue with Nebraska's Democratic Senator Ben Nelson from the perspective of a small businessman. It also gives you an opportunity to help.

Eight months into the Obama presidency will either cement his place in history as one of the most successful of new administrations or will find him dead in the water, apparently impotent, and his political foes gleefully triumphant. Meanwhile the lives of thousands and the competitiveness of the American system hang in the balance. It will be a suspenseful few weeks.