Health Care Reform: The Ideal vs. the Real—Do We Reject?

By Will Shonbrun

Between the idea
And the reality
Between the motion
And the Act
Falls the Shadow
-T.S. Elliot

A hot topic of debate among progressives regarding health care reform is whether the current Senate bill is worth keeping or should be jettisoned and the whole process started over. What a final Senate bill will look like is anybody’s guess, but it seems pretty certain as of this writing that a public option or an earlier Medicare buy-in at age 55 will not be in it. For some on the left this is a deal killer as has been trumpeted by Howard Dean, Keith Olbermann, insurance CEO whistleblower Wendell Potter, popular blogger Markos and other notables with bully bullhorns. Scrap the damn thing and start all over they say. I disagree, though I surely share their outrage and condemnation of Republican obstructionists, insurance company Senate vassals who eviscerated the House bill and the two Democratic Senate weasels who’ve held the bill’s passage hostage, Nelson and Lieberman. I’ll explain my position momentarily.

A cursory review

Obama ran on a health care reform platform that he insisted had to accomplish three fundamental provisions: insuring most or all of the 45 million now uninsured; reducing the ever-increasing runaway costs of health care; and doing away with private insurance companies being able to refuse coverage because of pre-existing conditions, and arbitrary policy cancellations when people get sick. Much to the dismay of progressives he did not advocate a single payer system or a universal health care system as such provided by all the other industrial and advanced nations of the world. But in order to get progressive backing in the House a plan for single payer was concocted, clumsily titled a public option that would compete with private insurance companies and ostensibly lower premium costs. And now that that third pillar of the Obama reform construct has been dismantled what is there to control rising costs? The answer is, nothing. Obama says insurance must be mandatory so a big chunk of the projected $900 billion cost of the reforms bill will be government subsidies to those unable to pay for the cost of private insurance. What a holy mess!

A primer for botching a bill

The attempt to reform the health care system, so desperately needed in this country now for decades, has been so botched, mishandled and ineptly contrived by the Democrats, and yes, by the President, it’s a wonder the thing is still breathing. It was obvious at the outset that Republicans were going to fight it every step of the way no matter how it was designed, what it contained or didn’t, so any thoughts of bipartisan cooperation were a fantasy. Charging Congress to write the thing was stupefying in extremis. Then relinquishing the progressive drive for a popularly supported single payer system before the bargaining and negotiating even began was a bone-headed decision of astounding proportion, even if it had amounted to no more than a chip in the bartering. Can these Obama chosen political operatives really be the sharpest blades in the pack? Any school kid knows you don’t back off before the fight’s even begun. Head-smacking astounding!

And why were deadlines set to get this or that done according to some schedule? That timetable got shot down in the fall. Health care reform has been discussed and debated for 60 years. Why all of a sudden does some plan have to be signed and sealed by the New Year? Where is that written? Why not make Congress wrestle with it until it’s to the President’s satisfaction? Why put arbitrary time frames on oneself? And if the writing was on the wall that he couldn’t get the 60 votes without giving away the store then screw that and use reconciliation as a club or at least the threat of it. Is the Democratic leadership that stupid or weak-kneed not to know how to or have the guts to play the game?

The deal goes down

In answer to that I have a hunch and it goes like this. Shortly after Obama rode into town on his reforming-health-care horse he met with the insurance honchos. This actually happened, remember? Sort of like Cheney’s secret pow-wow with the energy barons except the Dickster was in league with them, working for and with them in screwing America petro-style. But Obama was playing the good sheriff – gonna clean up the town and show them insurance varmints what fer.

So Marshall Barack meets with the bad guys, let’s them know he’s serious about reforming some of their most egregious shenanigans – denying care and dropping coverage – and the townsfolk, AKA the American public are with him. Even the insurance mafia knows most everyone hates their guts. Obama lets them know that he knows that in their unbridled drive for greater profits and fatter CEO rewards they’re breaking the bank, sending millions into bankruptcy, and effectively condemning 40-50 thousand Americans who can’t afford insurance to death every year. And one way or another he’s going to put a stop to it.

Obama know that what these miscreants fear most is competition; not for profit, government operated competition. He doesn’t even have to say single payer or a Medicare-like system; it’s understood. So they cut a deal and it goes like this: Insurance dudes clean up their act – cover everyone, keep it portable, make it somewhat affordable and discontinue its drop-dead policy – and in return, Obama won’t shove a real competitive system down their greedy gullets. Remember, Obama never drew a line in the sand over the public option. He just paid it a little rhetorical lip service, something he thought was a good idea or some such pablum, but not a mandate.

In addition, Obama promised insurance greed-heads gobs of new customers bankrolled by government bucks, so in the long run they stood to gain by playing ball with him. And in return they wouldn’t put up too much of a fight, i.e., bury him with TV commercials as they did the Clintons.

So they agreed because the reform writing was on the wall anyway as they’d fucked over the American public for so long revolt was in the air. And so the deal went down.

Of course the insurance geeks knew they had enough bought and paid for shills in Congress, most importantly their spineless sock-puppets in the Senate, to carry water for them when it came to squawking opposition in the public forum, so they wouldn’t even have to dirty their hands or reach far into their pockets to put up a fight. They had their elected lackeys and the more moronic fringe in the public to do that. And besides and most important of all to remember is even if a reform bill got passed it would have no real competition agency in it.

The real and the ideal

So back to what I said at the outset of this diatribe: that I disagree with Dean, Olbermann et al., who say drop the current bill and start over. I take this position for two reasons: Starting all over again won’t lead to any new outcome because the deal went down a long time ago, and the bill, whatever its final iteration won’t have what progressives and most of us want – real competition. The second reason is this: The Senate bill will extend coverage to more than 30 million now hanging in health care limbo, of which 45,000 die every year. That’s a lot of grief and suffering for too many of our fellow countrymen/women. In addition the bill will have addressed the most abusive practices of the insurance industry, and as pointed out in a recent article by Ruth Marcus for, it will prevent insurers from refusing to cover individuals with pre-existing conditions, or to charge them more because of poorer health, or cancel their policies once they get sick. “People who lose their jobs, or their insurance, would have a place to turn for coverage through the new insurance exchanges. For the first time, childless adults living in poverty would be guaranteed health care through Medicaid.”

So that’s the deal. Is it a win-win? Hardly, but it’s not a total loss either. Obama is a realist – read his Nobel acceptance speech for proof positive. American politics is the real world; it may stink, but that’s the way it is. If you don’t like it then work to change the system. And that doesn’t mean voting in more Democrats or Republicans at election time. They ARE the system and they’re not about to change it. It means working to change a system run by and for large corporate interests and the military complex that feeds off war and American imperial motivation. It means changing a system where health care is not considered a human right and is managed by companies for profit. It means changing an election system that’s not based on financing from special interests. It means a whole host of things as we claw our way toward a more intelligent evolution.

But for now, see the reality of things as they are, and hope that a health care reform bill gets passed that will at the least right some of the present wrongs.

Editors note: Yesterday, Saturday December 19, Senate majority leader Harry Reid announced he had the 60 votes needed to pass the Senate health care bill, and that the final vote would take place in the coming week. If the Senate bill gets passed it will move back to the House for further negotiations.