Monday, September 14, 2009

the reality that democrats are in fact ideological cowards, their principles mostly worthless

Some comments on Taibii's health care article here. For the record I agree with Dave and share Jodi's cynicism.

The depressing article itself seems essential reading in its entirety:

"It's a dirty deal[...]" "The administration told them, 'Single-payer is off the table. In exchange, we want you on board.'" In August, the Pharmaceutical Research and Manufacturers of America announced that the industry would contribute an estimated $150 million to campaign for Obamacare.[...]

For a while, the public option looked like it might have a real chance at passing. In the House, both the ways and means committee and the labor committee passed draft bills that contained a genuine public option. But then conservative opponents of the plan, the so-called Blue Dog Democrats, mounted their counterattack. A powerful bloc composed primarily of drawling Southerners in ill-fitting suits, the Blue Dogs — a gang of puffed-up political mulattos hired by the DNC to pass as almost-Republicans in red-state battlegrounds — present themselves as a quasi-religious order, worshipping at the sacred altar of "fiscal responsibility" and "deficit reduction." On July 9th, in a harmless-sounding letter to Pelosi, 40 Blue Dogs expressed concern that doctors in the public option "must be fairly reimbursed at negotiated rates, and their participation must be voluntary." Paying doctors "using Medicare's below-market rates," they added, "would seriously weaken the financial stability of our local hospitals."

The letter was an amazing end run around the political problem posed by the public option — i.e., its unassailable status as a more efficient and cheaper health care alternative. The Blue Dogs were demanding that the very thing that makes the public option work — curbing costs to taxpayers by reimbursing doctors at Medicare rates plus five percent — be scrapped. Instead, the Blue Dogs wanted compensation rates for doctors to be jacked up, on the government's tab. The very Democrats who make a point of boasting about their unwavering commitment to fiscal conservatism were lobbying, in essence, for a big fat piece of government pork for doctors. "Cost should be the number-one concern to the Blue Dogs," grouses Rep. Woolsey. "That's why they're Blue Dogs."

In the end, the Blue Dogs won. When the House commerce committee passed its bill, the public option no longer paid Medicare-plus-five-percent. Instead, it required the government to negotiate rates with providers, ensuring that costs would be dramatically higher. According to one Democratic aide, the concession would bump the price of the public option by $1,800 a year for the average family of four.

In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, "about the same as what we have now,"
as one Senate aide puts it. This was the worst of both worlds, the kind of take-the-fork-in-the-road nonsolution that has been the peculiar specialty of Democrats ever since Bill Clinton invented a new way to smoke weed. The party could now sell voters on the idea that it was offering a "public option" without technically lying, while at the same time reassuring health care providers that the public option it was passing would not imperil the industry's market share.[...]

For those looking to fuck up health care reform — or to load it up with goodies for their rich pals — the tedium actually serves a broader purpose. Given that five different committees are weighing five different and often competing paths to reform, it's not surprising that all sorts of bizarre crap winds up buried in their bills, stuff no one could possibly have expected to be in there. The most glaring example, passed by Ted Kennedy's HELP committee, would allow the makers of complex drugs known as "biologics" to keep their formulas from being copied by rivals for 12 years — twice as long as the protection for ordinary pharmaceuticals.


If the HELP committee's grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart's crap employer plan and taking the comparatively awesome insurance offered via Medicaid will now be rebuffed by the state and forced to take the dogshit Walmart offering.

This works out well for the states, who will get to purge all those Walmart workers from their Medicaid rolls. It also works great for Walmart, since any new competitors who appear on the horizon will be forced to offer genuine and more expensive health insurance — giving Walmart a clear competitive advantage. This little "glitch" is the essence of the health care reform effort: It changes things in a way that works for everyone except actual sick people.

Veteran legislators speak of this horrific loophole as if it were an accident — something that just sort of happened, while no one was looking.


Like Sanders, who hopes to correct the committee's giveaway to drugmakers, Wyden won't get a real shot at having an impact until the House and Senate meet to hammer out differences between their final bills. In a legislative sense, the bad ideas are already in the barn, and the solutions are fenced off in the fields, hoping to get in.


One of the reasons for this chaos was the bizarre decision by the administration to provide absolutely no real oversight of the reform effort. From the start, Obama acted like a man still running for president, not someone already sitting in the White House, armed with 60 seats in the Senate. He spoke in generalities, offering as "guiding principles" the kind of I'm-for-puppies-and-sunshine platitudes we got used to on the campaign trail[...]

This White House makes a serial vacillator like Bill Clinton look like Patton crossing the Rhine. Veterans from the Clinton White House, in fact, jumped on Obama. "The president may have overlearned the lesson of the Clinton health care plan fiasco, which was: Don't deliver a package to the Hill, let the Hill take ownership," said Robert Reich, who served as labor secretary under Clinton. There were now so many competing ideas about how to pay for the plan and what kind of mandates to include that even after the five bills are completed, Congress will not be much closer to reform than it was at the beginning. "The president has got to go in there and give it coherence," Reich concluded.

But Reich's comment assumes that Obama wants to give the bill coherence. In many ways, the lily-livered method that Obama chose to push health care into being is a crystal-clear example of how the Democratic Party likes to act — showering a real problem with a blizzard of ineffectual decisions and verbose nonsense, then stepping aside at the last minute to reveal the true plan that all along was being forged off-camera in the furnace of moneyed interests and insider inertia. While the White House publicly eschewed any concrete "guiding principles," the People Who Mattered, it appeared, had already long ago settled on theirs. Those principles seem to have been: no single-payer system, no meaningful public option, no meaningful employer mandates and a very meaningful mandate for individual consumers. In other words, the only major reform with teeth would be the one forcing everyone to buy some form of private insurance, no matter how crappy, or suffer a tax penalty. If the public option is the sine qua non for progressives, then the "individual mandate" is the counterpart must-have requirement for the insurance industry...

If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that has already been proved not to work. "The IRS and the government will force people to buy a defective product," says Woolhandler. "We know it's defective because three-quarters of all people who file for bankruptcy because of medical reasons have insurance when they get sick — and they're bankrupted anyway."


So what's left? Well, the bills do keep alive the so-called employer mandate, requiring companies to provide insurance to their employees. A good idea — except that the Blue Dogs managed to exempt employers with annual payrolls below $500,000, meaning that 87 percent of all businesses will be allowed to opt out of the best and toughest reform measure left. Thanks to Harry Reid, Nancy Pelosi and Barack Obama, we can now be assured that the 19 or 20 employers in America with payrolls above $500,000 who do not already provide insurance will be required to offer good solid health coverage. Hurray!

Or will they? At the end of July, word leaked out that the Senate Finance Committee, in addition to likely spiking the public option, had also decided to ditch the employer mandate.


The much-ballyhooed right-wing scare campaign, with its teabagger holdovers ridiculously disrupting town-hall meetings with their belligerent protests and their stoneheaded memes (the sign raised at a town hall held by Rep. Rick Larson of Washington — keep the guvmint out of my medicare — is destined to become a classic of conservative propaganda), has proved to be almost totally irrelevant to the entire enterprise. Aside from lowering even further the general level of civility (teabaggers urged Sen. Chris Dodd to off himself with painkillers; Rep. Brad Miller had his life threatened), the Limbaugh minions have accomplished nothing at all, except to look like morons for protesting as creeping socialism a reform effort designed specifically to change as little as possible and to preserve at all costs our malfunctioning system of private health care.

All that's left of health care reform is a collection of piece-of-shit, weakling proposals that are preposterously expensive and contain almost nothing meaningful — and that set of proposals, meanwhile, is being negotiated down even further by the endlessly negating Group of Six. It is a fight to the finish now between Really Bad and Even Worse. And it's virtually guaranteed to sour the public on reform efforts for years to come.

From Matt Taibbi's article here.

Update: Obama hears the music but will he dance...

Update II: The deal Obama denied striking with Big Pharma is clearly evident, point for point, in the long-awaiting Baucus bill.

All of which is not to say there aren't still some principles worth fighting to keep alive, despite the process. Even if they're just a cautious, very modest starting point and do very little to address the major issues.

This country has been fucked since Reagan, and Clinton's "third way" geneticist/market solution has been nothing but disaster.

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