Getting thrown under the bus by a really nice guy

Okay I really want to break this down because I think it's an important case study in how our political system really works.

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:

1. 'Obama really is a great guy and we just don't understand the complexities of passing a bill'; OR
   
2. 'Obama is a liar who always intended to sell us out.'

But let's walk through the implications of the health care bill for a second.

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).

The Life You Can Save: the moral politics of the health care debate

Imagine: Barack Obama and a group of Republican lawmakers are having a beer summit to talk about health care....

But let's say there had been a lot of rain recently and so a small lake formed on the White House lawn. And suddenly the participants in the beer summit look over and see a little girl drowning in the lake that formed on the White House lawn.

They have a moral obligation to save her life, correct? Obvious, right?

That's the point that moral philosopher Peter Singer makes in his book, “The Life You Can Save." Singer makes a series of points -- the logic of which is ironclad:

First premise: Suffering and death from lack of food, shelter and medical care are bad.

Second premise: If it is in your power to prevent something bad from happening, without sacrificing anything nearly as important, it is wrong not to do so.

Third premise: By donating to aid agencies, you can prevent suffering and death from lack of food, shelter and medical care, without sacrificing anything nearly as important.

Conclusion: Therefore, if you do not donate to aid agencies, you are doing something wrong.

Singer is talking about international aid, but his points could easily be applied to the health care debate in the United States.

So let's go back to the beer summit analogy: Let's suppose that instead of being 50 feet away, the girl drowning in the lake is 500 feet away -- let's say she's across the street. But if the people at the beer summit get up from their table -- there is still time to save her. They have a moral obligation to save her correct? Again, the moral obligation of the situation is obvious to the point of being ridiculous.

Now imagine that she's not 500 feet away -- she's 500 miles away, and she's not drowning in a small lake, she's drowning because she has cystic fibrosis and her lungs are filling with fluid and she has no health care. But if the people at the beer summit act immediately -- they can still save her life. Again, they obviously have a moral obligation to save her life.

See that's the thing, Republicans (and Blue Dog Democrats) see the girl drowning in the lake, it's in their power to save her, and they walk right on by. In fact Republicans make a virtue out of letting people drown, of letting people suffer and die because they lack health insurance. Because Republicans worship the false idol of Laissez-Faire Capitalism -- the moral calculus that the rest of us follow ("if it is within your power to save a human life you have a moral obligation to do so") -- falls on deaf ears with them.

[And don't give me any BS about how 'Republicans really like health care they just want the market to provide it.' We have a market based system right now and 48 million Americans don't have health insurance. Republicans are fine with that because the Strict Father Model worldview they subscribe to says that poor people deserve to suffer and deserve to be punished in this way -- in order to teach them important moral lessons. Applied to the current health care crisis in our country the strict father model is sociopathic but Republicans seem incapable of seeing the world any other way.]

So just to be clear, let me translate Peter Singer's 3 points above as they apply to the current health care debate:

First premise: Suffering and death from lack of medical care is bad.

Second premise: If it is in within Congress's power to prevent something bad from happening, without sacrificing anything nearly as important, it is wrong not to do so.

Third premise: By approving legislation to create universal health care, the U.S. Congress can prevent suffering and death from lack of medical care, without sacrificing anything nearly as important.

Conclusion: Therefore, if Congress fails to pass universal health care, they are doing something wrong.

The health care debate in Congress is not just a piece of legislation, it's a moral test of our nation. Failure to pass universal health care at this point is a moral evil, akin to letting others drown whom we have the power to save.

Providing Health Care is Like Building a House

Atul Gawande, has an article titled "The Cost Conundrum: What a Texas Town Can Teach Us About Health Care" in the June 1, 2009 edition of The New Yorker. The article is a must read for anyone hoping to understand the importance and complexities of health care reform in the United States. Gawande, author of Better: A Surgeon's Note on Performance, is increasingly becoming the Malcolm Gladwell of health care writing. Like every New Yorker article, it's really damn long, but if you only read 2 paragraphs, read these:

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

[Full article available here.]

How about just nationalizing all health insurance companies

Isn't the other option in the health insurance debate -- to just nationalize all of the health insurance companies? Bam! overnight, single payer national health insurance!

I get that there would need to be political considerations. But if you nationalize the health insurance industry don't you also own all of their assets and lobbyists too? Ta da -- no more money for Harry and Louise ads!!!

If we can nationalize GM because they are bankrupt -- why not nationalize Blue Shield, Kaiser, Aetna etc.? I think a strong case could be made that the health insurance industry is bankrupting our nation and so there is a compelling national security interest in nationalizing the industry (a recent study showed that 60% of U.S. bankruptcies are due to medical bills).

Again it may be politically unfeasible. But if health insurance companies believed, even just a little bit, that nationalization was on the table -- don't you think they'd cooperate a little bit more in the crafting of a national health insurance plan that works for everyone?