[Update 12/17/09: In the weeks since posting this, following the complete collapse of the public option and the rejection of the expansion of Medicare, I’ve begun to hear some politicians start to make my point about insurance companies collecting up to 27% of a worker’s income, with such payments required by law and enforceable by the IRS. But I’d like to hear more.]
Bloviation warning: I’m getting some opinions off my chest below, in the form of a disjointed series of rants. <political bias>
Everywhere in the air today is a swirl of comment about health care reform: insurance, individual mandate, employer mandate, public option, yadda yadda — these buzzwords are all over the airwaves. A couple of nights ago the House passed a bill, and now debate goes back to the Senate. It’s time for this blogger to put in his highly inflatable $.02.
Opponents of comprehensive reform worry about a government takeover: that the “public option” is merely the first step toward a “single payer” plan. Progressives, looking at Canadian and European models, agree, and some are willing to settle for a public option, this year, because it is a first step toward their goal. I lean heavily toward the latter camp. Let me unpack some of the rhetoric I have heard and try to explain why the individual mandate without at least a public option is the worst of all possible worlds.
One complaint is that a public option will have to be paid for with taxes, or, more directly, that the premiums paid toward such a plan amount to a tax. Sure. But at least those tax dollars go to the government, which is ultimately responsible, however unwieldy our system is, to the people. I can vote the decision-makers in and out of office, raise a public outcry to persuade people to join such a cause. Clearly Congress has the power, constitutionally, to raise taxes. But does Congress have the power to require people to put money directly in the pockets of private corporations? Money that is required by law to be paid out of people’s incomes is a tax, any way you cut it. Why should my tax dollars go, not to my government, run (however imperfectly) by people I can vote for or against, but to a company, whose primary motivation is profit, which has every incentive to provide denial of service to its customer (me), and which lives in a culture that thinks it is just fine to pay its executives millions or billions of dollars, and feels it must do so in order to retain such “talent”?
Directly taxing the people in order to enrich corporations is fascism. That’s what an individual mandate without a public option would give us.
Now, of course, it won’t be called a tax, it will be called a premium. I think that’s kind of funny, really. If it’s a payment required by law, it’s a tax, and if it’s a tax, it should go to the government. If instead of going to the government it goes to a private corporation, what does that say about who is really in charge here?
Never mind about government taking over healthcare: is anyone worried about a corporate takeover of government?
And by the way, to those who worry about a government bureaucrat making decisions about what health care procedures will be paid for: in what way is this worse than an unaccountable, faceless, nameless corporate bureaucrat making such decisions, which is exactly what happens now?
I got an “explanation of benefits” from the insurance company just the other day. The medical procedure involved happened early last February. The payment was processed, according to this statement, at the end of October. The insurance company owed the hospital that money for nearly ten months. Did they pay any interest? I think not. Is the insurance company’s credit score adversely affected because they delayed so long in paying their obligations? Nonsense. These fictional persons, corporations, exist by different rules than living, breathing persons such as you and me. By the way, this is not the longest delay in payment I’ve seen; it’s fairly typical. I’m told that the turnaround time for payment of Medicare claims is much shorter. So much for private business being more efficient than government bureaucracy.
I wish we were seeing more about the streamlining of billing procedures, the standardization of claim forms across companies, the digitization of medical records, and similar technological improvements that have the very real potential to squeeze billions of dollars worth of inefficiencies out of the health care system, and the related industry, health care payment systems. I wish we were hearing more debate and discussion about the ratio of premiums collected to claims paid, with efficiency ratings of companies being made public, so it could be seen how much of the insurance industry consists of a self-perpetuating administrative inefficiency machine. But most of all, I’d like my friend who put off going to the doctor for three weeks because he couldn’t afford both that and his house payment, and then ended up in the emergency room, to have had other, better, more rational options. His ER visit will be paid for, eventually (your tax dollars — and excess insurance premiums— at work), but that’s an awfully inefficient and expensive way for “we the people” who are supposed to be running this show to be subsidizing — what, his house payment? Aaargh.
I’d say, let’s cut out the middleman, but then I remember that the French word for “middleman” is “entrepreneur” – a between-taker — the hero of American capitalism. Funny how we idolize a person whose only product is profit, while everybody else does the work and pays the bills.
Finally, having lately heard someone claim to read from the Preamble to the Constitution (he was actually quoting the Declaration of Independence), I thought I would go ahead and review the actual Preamble, as follows, to remind us of the purpose of the Constitutional system we have, according to the founding fathers who wrote and signed that document. There are six purposes listed, which I will bullet for the reader’s convenience.
We the People of the United States,
In order to [that means “for the purpose of”]
1. Form a more perfect Union, [remember Obama’s brilliant speech highlighting this term?]
2. Establish Justice, [meaning “fairness” and “due process” among other things]
3. Insure Domestic Tranquility,
4. Provide for the Common Defense,
5. Promote the General Welfare;
6. and Secure the Blessings of Liberty to Ourselves and our Posterity,
do ordain and establish this Constitution for the United States of America.
I just wanted to point out that the people who think the only legitimate purpose of Government is #4 on this list, are flat out wrong. Arguably, providing for the health of the people also meets the goals of #1, #2, #3, #5 (which conservatives have wished away ever since Ronald Reagan sold them a myth about “welfare queens”), and #6. </political bias>
P.S. Senator Bernie Sanders of Vermont is now hinting at a threat to filibuster any bill that does not include a public option. I remember Bernie Sanders from when I was living in northern Vermont and he was running for mayor of Burlington. (In those days his issue was affordable housing; I couldn’t vote in that election because I wasn’t able to afford the kind of rent I would have had to pay within city limits; we lived in a place waay out in the country.) Makes me just a wee tad proud.