Just last month I went for a routine physical examination followed up by routine blood tests and a bone density scan. According to my health insurance plan, all these were supposed to be fully covered. Of course, being a veteran of the bureaucratic health care system in the US, I know that nothing is ‘routine’ here and so before I did any of these things I had to spend some time making sure that I was going to a doctor covered by my insurance plan and that the blood-testing laboratory and the bone-density measuring facility were also covered procedures done by approved facilities.
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(My latest book God vs. Darwin: The War Between Evolution and Creationism in the Classroom has just been released and is now available through the usual outlets. You can order it from Amazon, Barnes and Noble, the publishers Rowman & Littlefield, and also through your local bookstores. For more on the book, see here. You can also listen to the podcast of the interview on WCPN 90.3 about the book.)

So after much drama, the health care bill finally became law. If anything demonstrated the fecklessness of Obama and the Democratic Party and their willingness to sell out of their supporters in order to appease their corporate overlords, it is the way that the health care bill was constructed and passed.

There is no question, as Robert Weissman writes, and which I have repeatedly pointed out, that a single payer system, the system of choice for almost every other country in the industrialized world, is more humane and more efficient than what the US currently has. (See here for all my previous posts on health care.) Even candidate Obama conceded as much during his presidential campaign. T. R. Reid’s new book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care also debunks the myths of the alleged superiority of America’s health care system. Even Sarah Palin admits that when she was a child, her parents took advantage of Canada’s system, saying, “we used to hustle on over the border for health care”, adding “I think isn’t that ironic now.” Yes it is, Sarah, yes it is.

The pressure for health care reform comes largely from the fact that the private, profit-seeking entities that dominate the system (insurance and drug companies and hospitals and specialist doctors) are driving up the costs and employers want to shed themselves of this burden. (Also see another comparison of costs.)

The logical thing would have been to go to a government-run single-payer system that would be cheaper because it would spread the costs over the entire population, have the power to negotiate lower prices, reduce bureaucratic duplication, and eliminate the profit element that plagues the current system and results in such horrors as the rescission of coverage after one receives a diagnosis of a disease. The despicable insurance companies also find sleazy ways to drop coverage for people who discover they have breast cancer:

They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.

Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information.

Of course, Congress and the Obama administration will not do anything to harm the interests of these companies since these very organizations that profit greatly from sick people are major contributors to their coffers. And so what we finally ended up with was a mere tweaking of the existing system.

It is not that there are no good features at all in the bill. There are, such as expanding coverage and restricting some of the worst industry abuses. But these were the bones that were tossed to the Democratic Party supporters to mask the fact that the resulting plan has internal contradictions that will eventually wreck it. The Democratic party deliberately sabotaged the one big chance the country had to enact the kind of reforms that are necessary to prevent the looming catastrophe that will occur because the basic causes of cost increases have not been addressed. As Marcia Angell, former editor of the New England Journal of Medicine, says:

What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they’re regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they’ll do that.

Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies’ products for whatever they charge. Now that’s a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster.

Glenn Greenwald quotes a Kaiser Health News report that “details the massive benefits each industry [Doctors, Hospitals, Insurers, Pharma] receives (compared to their mild costs), the success they had in killing any real competition and reform in the bill (i.e., the public option, Medicare expansion, drug-reimportation, bulk price negotiations, and an end to the insurers’ anti-trust exemption)” and that the bill was enacted by “invoking and strengthening precisely the same corrupt, sleazy practices that have long driven Washington.”

There have been many analyses detailing how the Democrats sold out on health care, calling the Obama strategy essentially a scam on the American people. Angell says of Obama that, “He gave away the store at the very beginning by compromising. Not just compromising, but caving in to the commercial insurance industry and the pharmaceutical industry.” Glenn Greenwald and Norman Solomon lay out in detail exactly how the scam by Obama and the Democratic Party was executed. It was the shocking loss of Ted Kennedy’s Senate seat in Massachusetts to Republican Scott Brown that exposed the scam for all the world to see, while paradoxically hastening the passage of the final bill.

While the Democrats still had sixty votes in the Senate, they could play out this charade that they really and truly wanted real reform as represented by a single-payer system or Medicare for all (or at least expanded) or a public option, but that they had to overcome this darned filibuster threat by the Republicans, which meant that they had to appease the most reactionary elements in their own party in order to hold on to every one of their sixty party members and thus were forced to give up on the more ambitious plans. Oh, but they were so sad that they had to compromise their ideals like this.

But as Greenwald says,

[A]dvocates of the public option kept arguing that the public option could be accomplished by reconciliation — where only 50 votes, not 60, would be required — but Obama loyalists scorned that reconciliation proposal, insisting (at least before the Senate passed a bill with 60 votes) that using reconciliation was Unserious, naive, procedurally impossible, and politically disastrous.

But the win by Scott Brown meant that they could not overcome the filibuster after all because of the unanimous opposition of the 41 Republicans. Faced with the possibility that they might not get any health reform bill at all through the Congress, which would have meant political disaster for them, they suddenly decided that they would use the reconciliation path to passage after all. So given how much they had said about their desire for more sweeping reform plans, you would think that now they would bring back all those elements they so ardently desired and spoke so passionately about. But no. They went with the health-insurance industry friendly bill, thus exposing that this was the bill they had really wanted all along and that everything they had said suggesting otherwise were nothing but lies. If one needed any more proof, along the way it was revealed that Obama had made a secret deal early on with the pharmaceutical industry to kill the public option, thus confirming the existence of the scam.

It should have been clear to the dimmest bulb that the health care bill that Obama and the Democrats finally passed was what would have been considered in the old days a Republican plan, one whose main goal was to leave untouched (and even enhance) the interests of big business and the wealthy. It is no coincidence that it is similar in philosophy and structure to the plan introduced in Massachusetts by Mitt Romney when he was governor. He now has the unenviable task of disowning his own plan in order to appease the crazies who now running the Republican party.

What has happened in American politics is that the Democratic party has become the Republican party and the Republican Party has gone nuts.

POST SCRIPT: The ignorance of health care opponents

The party groups that demonstrated on April 15 to denounce the health care bill, among other things, as part of some socialistic takeover of America’s economy are remarkably ignorant of the reality of American politics but are driven by some inchoate sense of frustration and impotence that makes them succumb to paranoia. They pose a real danger to the Republican party, risking making it into a fringe and nutty cabal.

Cartoonist Tom Tomorrow describes how detached from reality health reform opponents really are.

(See part 1, part 2, and part 3.)

What is interesting about my experience is that even physicians whom I know personally and to whom I have told this story are surprised that whether I am charged for a colonoscopy depends on whether any polyps are found.

I also spoke about my experience at a health care panel a couple of years ago. Another panelist, a professor at another university, said that he thought that it was perfectly reasonable for us to treat health care like any other commodity and that consumers should shop around for the best deal. I responded that this was absurd. Health care is not a commodity to be compared like buying detergent. People often confront the health system in situations where they are deeply troubled or their plight is urgent or where they have few choices.
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(See part 1 and part 2.)

By now I am fed up with all this back and forth and decide that I will schedule the colonoscopy anyway and deal with being charged afterwards. I call the doctor’s billing office again to get the final ok and learn something new. They say that the colonoscopy is considered ‘routine’ and thus free not only if there were no prior indications of cancer but also only if the doctor finds absolutely nothing. If the doctor finds even a single benign polyp (which is not uncommon), then it ceases to be routine (and free) and I have to pay the full amount, which is about $1,500. The insurance company had not told me this piece of interesting news nor is it spelled out in their policy. So whether I pay nothing or whether I pay about $1,500 depends not on the procedure itself but on what they find during the procedure! In other words, I have no idea going in what it is going to cost me coming out.
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In my first post in this four-part series, I pointed out that the choice of doctors and hospitals is very limited in the US. But as I continue to look further into my ‘free’ colonoscopy I discover more pitfalls.

I know that insurance companies try to find ways to avoid paying so I analyze my policy carefully and call the insurance company and ask what the word ‘routine’ means, since only those kinds of colonoscopies are free. I am told that the colonoscopy is considered routine if it is done as part of a regular check-up and not because of any symptoms that might suggest that I may actually have colon cancer.

This strikes me as bizarre, that the procedure is free only if there are no indications at all that I have any problem. The slightest hint of a symptom and bang, I am on the hook for well over a thousand dollars, the cost of the procedure.
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(For previous posts on the issue of health care, see here.)

In anticipation of Obama’s speech on health care this week and as a coda to my long series on health care, in a four-part series I am going to write about a recent experience I had with the bureaucracy of the health care system in the US, not for any serious illness, but to get a ‘routine’ colonoscopy.

I recount my story in detail not because it is tragic (it isn’t) but to show how even seemingly simple things are made enormously complicated because of the private profit-seeking system that we have. The absurdity of it is that what I went through is so common in the US that people think that it is the only way to do things, unaware that in other developed countries, people do not have to go through this nonsense.
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(For previous posts on the issue of health care, see here.)

In this last post in this series, I want to look at the way the health care ‘debate’ has progressed because it provides a classic example of how Congress and the president, supposedly meant to represent the ‘will of the people’ who elected them, maneuver to actually do the will of the business interests.

Polls have repeatedly shown that people are highly dissatisfied with the current system of employer-based health care in this country in which the private, profit-seeking insurance companies exert such a stranglehold. As Paul Street writes in the September 2009 issue of Z Magazine (not online), 73 percent feel that health care is either in a “state of crisis” or has “major problems” (Gallup, November 2007), and 71 percent feel that we need “fundamental changes” or have the US health system “completely re-built,” compared to just 24 percent who wish only for “minor changes” (Pew Research Center, 2009).
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(For previous posts on the issue of health care, see here.)

In this post in this series, I want to look at the political gamesmanship that is going on in health care.

As I have said repeatedly, the US is a pro-war/pro-business one party state with two factions that differ on some social issues. However, people would revolt if they realized the extent to which so many of their elected representatives of both parties are the servants of corporate interests. In order to disguise this fact, whenever an issue that involves corporate interests arises, one sees an elaborate Kabuki theater performance in which the elected officials play assigned roles, one of which involves pretending to have a major fight over some peripheral issue, while the final outcome is never in doubt.

The massive bailout to Wall Street interests was a case in point. Remember the big fuss over bonuses? Regulations? Corporate jets and other perks? That was pure Kabuki theater, the equivalent of the circuses that Roman emperors put on to amuse the people and appease their blood lust. Once a few executives had been excoriated in public and made their public penance, once the media spotlight shifted to other things, the looting of the public resumed. The big Wall Street banking interests were ultimately left alone to make huge profits and hand out big bonuses, which is exactly what is happening right now.

It is the same with health industry reform. Matt Taibbi of Rolling Stone argues persuasively that Obama was, from the beginning, in the tank with the health insurance/drug/physician/hospital industries and was never serious about making the kinds of far-ranging changes that would improve health care, if those measures went against the interests of those industries. Jonathan Cohn already had pointed out that Obama cut a deal with the drug industry not to seek lower prices. But he did want to create an image of himself as a serious reformer and use fixing the health care system, which is obviously broken, as a vote getter. So he played his Kabuki role.

Obama started out on the campaign trail talking about the virtues of the single-payer system and then falsely asserting, without any argument, that because the employer-based system was already in place, single payer cannot be implemented now in the US, despite evidence to the contrary. This enables him to rule out, right at the beginning, single payer systems as one among the mix of options to be discussed in his health care reform panels.

Then later he says that what is most important to him is not getting good health care reform passed but that it must be bipartisan. Why on earth should bipartisan acceptance be more important than good policy? That statement was the confirmation of my suspicions that Obama was not serious, because that appeal to bipartisanship immediately put him at the mercy of the Republican Party and those in his own party who were never interested in any reform, who then went on to play their Kabuki roles of objecting to any meaningful reform proposals. Obama of course had to know that they would do this. He is not stupid. This predictable opposition enables him to act as if he is being forced to compromise more than he wants to, thus preserving his reformist credentials while abjectly serving the interests of the health industry. As Glenn Greenwald says, “There is one principal reason that Blue Dogs and “centrists” exert such dominance within the Party: because the Party leadership, led by the Obama White House, wants it that way and works hard to ensure it continues.”

Then Obama starts signaling that he is willing to abandon even the limited public option. All this is to lead up to the final scene of the Kabuki theater in which he finally agrees to a system that the health industry would love, such as mandating that everyone buy insurance from the private, profit-seeking health insurance industry with the government paying the premiums of those who can’t afford it, while the insurance companies are given the freedom to continue the treatment-denying policies that is at the heart of their business model.

Greenwald continues:

White House threats that “you’ll never hear from us again” are issued to defiant progressives only. Not only are such threats never issued to “centrists” and Blue Dogs who are supposedly impeding the President’s health care agenda, but the White House does everything it can to protect those ostensible obstructionists and further entrench them in power. Isn’t all of this fairly strong evidence that the White House knew, accepted and likely even desired from the start that — despite the President’s public assurances to progressives — the “public option,” understandably despised by the insurance industry, would be dropped from bill?
…
The very idea that Obama is valiantly struggling to cleanse the party of its corporate and centrist dominance, yet is just haplessly and helplessly unable to do so, is ludicrous beyond words.

Former insurance industry insider Wendell Potter also sees quite clearly how Obama playing his role in this Kabuki play.

Not only is Obama clearly ready to throw the public option overboard, he is embracing the requirement that we all be forced to buy insurance from private insurers. That means your tax dollars and mine will be used to pay subsidies to the big insurers to provide coverage to people who can’t afford to buy their policies, because the big insurers charge far more than they should because Wall Street investors demand that they do.
…
During his speech in Montana, Obama talked a lot of trash about the insurance industry. Don’t be fooled by that tough talk. It’s all part of a strategy to try get us to believe we’ll get the reform he promised during the campaign. Industry leaders are in fact delighted he’s denouncing their behavior, because they believe most of his supporters — who were hopeful the stars might finally have aligned for real reform — will be fooled into thinking the reform bill that reaches his desk will benefit them more than the special interests with their armies of lobbyists.

That final scene hasn’t been arrived at yet because there is one group that is not playing its designated role and is thus threatening to disrupt the performance. These are the progressives in Congress whose role is to be cheerleaders for Obama because he is allegedly one of them. There are hopeful signs that the progressive members of the public and Congress are seeing through this charade. They are getting angry at this sell-out on a fundamental campaign issue and they are warning Obama that they will revolt if he abandons meaningful reform.

I hope they are successful in pushing back against Obama’s sell-out.

POST SCRIPT: The Onion on health reform deadlock

As usual, it is the comedians and parodists, not the news media, that sees through the Kabuki façade.

After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care.

“Both parties understand that the current system is broken,” House Speaker Nancy Pelosi told reporters Monday. “But what we can’t seem to agree upon is how to best keep it broken, while still ensuring that no elected official takes any political risk whatsoever. It’s a very complicated issue.”

“Ultimately, though, it’s our responsibility as lawmakers to put these differences aside and focus on refusing Americans the health care they deserve,” Pelosi added.

The legislative stalemate largely stems from competing ideologies deeply rooted along party lines. Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

That is about as succinct a presentation of how the pro-business one party state in the US works as you will find anywhere.

(For previous posts on the issue of health care, see here.)

Some of the supporters of the current health system have a somewhat naïve view of capitalism. They seem to have bought into the myth that the ‘invisible hand’ of the market will always result in good quality goods and services being provided at lower costs. That model works in some situations when there is competition among many suppliers and when the consumer has the option of not buying a product at all if they are not satisfied with the price or quality of the offerings, say as with the purchase of specific foods or a new car or a washing machine.

But it ceases to be true when people are in dire need and their options are limited. This is why one finds price gouging in essential supplies like water, food, blankets, and power generators in the immediate aftermath of a disaster like a hurricane or earthquake, when callous merchants take advantage of the misery of people to rake in huge profits. It would be insane for the government not to intervene and provide people with necessary supplies and services at those times. Look at how George Bush got hammered for the government’s slow response to Hurricane Katrina.

Since health care is one of those situations in which people do not have the option of not obtaining services, and usually have to seek it in emergency situations, it is closer to the hurricane situation than that of buying a new car, which is why a strong government role is essential.

But the private, profit-seeking health insurance industry wants to go in the opposite direction. As Wendell Potter, who used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies, says in an interview with Bill Moyers, “The industry doesn’t want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don’t want any more competition period. They certainly don’t want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so”, compared to the health insurance industry’s 20%.

Potter explains to Moyers the brutal calculations that go into increasing profits by denying treatment.

WENDELL POTTER: …[T]here’s a measure of profitability that investors look to, and it’s called a medical loss ratio. And it’s unique to the health insurance industry. And by medical loss ratio, I mean that it’s a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry’s been dominated by, or become dominated by for-profit insurance companies. Back in the early ’90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they’ll punish them. Investors will start leaving in droves.

I’ve seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street’s expectations with this medical loss ratio.

For example, if one company’s medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that’s ridiculous. And it’s horrible.

BILL MOYERS: That they’re spending more money for medical claims.

WENDELL POTTER: Yeah.

BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that’s what– that is what happens, what these companies do, to make sure that they satisfy Wall Street’s expectations with the medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That’s one thing. And that was that issue in the Nataline Sarkisyan case.

Many of the people who oppose single-payer and other comprehensive attempts at health care reform may be doing so out of a sense of smug complacency. They may think they are healthy and have good coverage from their current employer and so life is good. Why mess with something what seems to be working so well for them? In fact, one of the most disgusting arguments that I have heard recently from opponents of health reform is that by adding the 40 million or so currently uninsured to the rolls, there would necessarily be increased waiting times to obtain medical services. In other words, in order to save a little time for them, they would like to see others have no access to health care.

The fact that so many other people suffer from either inadequate coverage or no coverage at all may not be sufficient to move those who think they have good coverage now to embrace reform. What they do not realize is that their seemingly comfortable situation could change practically overnight through no fault of their own. All it would take is for one or two of their fellow employees to get a serious illness for them to lose their own coverage. Potter explains how this happens as a result of deliberate policy by the health insurance companies:

But another way is to purge employer accounts, that– if a small business has an employee, for example, who suddenly has [to] have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That’ll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they’ll say, “We need to jack up the rates here, because the experience was,” when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they’ll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They’ll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes. (emphasis added)

Potter warns people who resist reform attempts that the very things they say they fear about single payer or socialized systems or even the public option are actually more likely to occur under the present employer-based system.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don’t want the government to take away your choice of a health plan. It’s more likely that your employer and your insurer is going to switch you from a plan that you’re in now to one that you don’t want. You might be in the plan you like now. But chances are, pretty soon, you’re going to be enrolled in one of these high deductible plans in which you’re going to find that much more of the cost is being shifted to you than you ever imagined. (my emphasis)

The private, profit-seeking health industry is a cold-blooded and ruthless business in which meeting the needs of sick people is at the very bottom of their list of priorities, while making profits for their shareholders and paying for their executives’ luxurious lifestyles is right at the top. Why anybody would want to preserve that system can only be explained either by their ignorance of how it actually works or because the politicians have been bribed by the industry.

POST SCRIPT: Billionaires for Wealthcare speak out

“If god loved the poor people, he wouldn’t let them get sick.” So true.

(For previous posts on the issue of health care, see here.)

Wendell Potter used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies. That position gave him a special insight into how the health insurance industry actually works and the very different way they present themselves to the public. At some point the contradictions became unbearable for him. He could not take it anymore and left his position and since then he has been spilling the beans about how the insurance companies really operate, how they put profits before any other consideration, and make money from the misery of sick people by denying them care in their time of need.
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