1. By all accounts Barack Obama is a decent guy. Smart, caring, compassionate, well-organized, able to hold a range of opposing views. Obama is exactly the kind of guy one would want as President.
2. The evidence suggests that Barack Obama is about to completely throw the American people under the bus by abandoning the public option in the health care bill (if he hasn't bargained it away already). To abandon the public option is a violation of everything he stands for. It would break a campaign pledge. It would abandon the most cherished Democratic Party goal of the last 50 years at precisely the time when it has the best chance of being enacted. And it's completely irrational -- it is impossible to hold down health care costs without a Medicare for All type public option. Most importantly perhaps, it represents a moral failing to protect the most vulnerable in our country from needless suffering and death (as Peter Singer argues, 'If it is within your power to save a life, you also have a moral obligation to do so.')
It would be easy then to collapse this situation down into one pole or the other. Either:
- 'Obama really is a great guy and we just don't understand the complexities of passing a bill'; OR
- 'Obama is a liar who always intended to sell us out.'
One of the fascinating things about the health care bill is how often members of Congress admit openly that if a real public option was attached to the bill, that it would lower costs too much and be the end of private insurance in this country. And they say that like it's a bad thing. At first the notion that private insurers would go out of business seems silly. As Obama argued in his last press conference:
Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical ....
But then, you start to look at the numbers as I did in my last post. Private health insurers make about 30% profit for holding your money in reserve until it is needed to pay for medical bills. As David Waldman pointed out: "Insurers don't provide care. They just finance it. Why are we supposed to be happy paying 30 points on that deal (to private insurers) when Medicare takes just 4?"
And then it all makes sense.
If there were a real public option, private insurers, over time, indeed would go out of business.
I happen to think that's a good thing, a really good thing.
Private insurers provide nothing of value. They don't have the leverage or negotiating power that a Medicare for All government type program would have. And their accountants don't actually look for efficiencies, they just look for technicalities to fuck you so that they can profit from your pain. And for all of that, they pocket 30 cents on the dollar versus the 4 cents on the dollar that Medicare charges for administrative overhead. Private insurance then is a pure mafia-style racket to take money from people in return for "protection services" that are never really provided (or rather the financial services that they provide are marked up an exorbitant 30% over their actual costs).
So if there were real competition, people would naturally chose the fairer program with the larger negotiating power and 4% overhead over the more expensive, less efficient, private plan. Medicare For All would in fact become Medicare for all, a de facto universal health plan just on the basis of the fact that it is A BETTER PRODUCT AT A LOWER COST than the private plans.
Which brings us back to Obama. As Obama himself has argued, the only way to insure competition and lower cost is through a public option. So if it's logical, if it is indeed in the public interest, then why is Obama about to walk away from it?
Because private health insurance is a trillion dollar a year industry (that's trillion with a T). And Obama doesn't have the stomach to take out a trillion dollar a year industry. He just doesn't have it in him. Mr. Consensus is no Huey Long.
So it is true, logical, and rational to argue that a public option was the best way to control costs (which is what Obama did during the campaign). But it is also true that a trillion dollar a year mafia racket can hire a lot of lobbyists and buy a lot of TV time during elections (and everybody in D.C. knows it). Indeed private insurers will spend every last penny they have stolen from us to protect their profitable scheme.
Obama the post modernist wants to have it both ways -- a public option for the American people while preserving the jobs (and profits) of private insurers. The problem is, health care is largely a zero sum game -- what's good for the American people is bad for private insurers and vice-versa. And in trying to have it both ways, Obama's message comes out as convoluted, confused, and lacking in moral authority (because it is).