Health Care Reform: The End Is Nigh

Lost progressive causes don't die -- they just fade away with barely a sigh marking their expiration. Health care reform has been terminally ill ever since Barack Obama exhausted his shallow pool of conviction about a serious recasting of America's patchwork of arrangements that we generously call a 'system.' Discriminatory, unethical and ruinously expensive, its very existence has been an affront to those with a capacity for moral outrage or a sense of social responsibility. Lacking either one or the other in sufficient quantity, Obama early on abandoned his pledges to his voters. Instead, he substituted a calculated strategy of devolving the job of doing something (or anything) onto the very people in government and outside it who had a stake in protecting the status quo. Floating above the fray, Obama contented himself with vague platitudes that left friend and foe alike persuaded that his sole concern was to have a signing ceremony. To this day, he has not pronounced exactly what he wants.

Symptoms of the invalid's painful and debilitating decline have punctuated the path to its demise. It hasn't been a pretty picture. Empowerment of the Gang of Six from Nowheresville, America; the coronation of Queen Olympia; the mindless relegation of the public option to a "sliver" in the master builder's not so grand design; the open-White House welcome to 545 visits by health industry lobbyists counter-posed to one belated invitation to progressive Democrats from the House; the underhanded maneuverings by Rahm Emmanuel that Obama never dared either endorse or disown in public; the wanderlust that never quite left time to make the powerful ethical case for meaningful reform; the readiness to slash home care for the disabled elderly so as to trim a few bucks from the bill; the shameless placing of the burden to marshal Senate Democrats on the slight shoulders of Harry Reid. If Lyndon Johnson had been as diffident and lackadaisical in dealing with civil rights legislation, the Obama family might still be sitting in the back of the bus whenever they ventured south of the Mason-Dixon line.

So now health care reform lies prostrate -- a shadow of its once promising self. Its distorted features compose the face of its near antithesis. Big Pharma, the semi-monopolistic insurance giants, and the privileged providers still rule the roost. Under the table deals instead of transparent regulation and true competition. Mandates without options that will swell the income of the vested interests. A permission slip to compensate for an end to the pre-existing condition scandal by charging heavy premiums on policies written for those who most need health care. Yes, there are very small subsidies for the working very poor -- to be paid for not by levies on the rich but by imposing 40% excise taxes on many policies of the middle class. A woman earning $48,000 may find herself tapped for a couple of thousand in taxes because she is fortunate enough to have an employer who provides genuine health insurance rather than the barebones version that leaves patients to the mercies of profit driven HMOs.

This hodge-podge of disconnected measures will do nothing to reduce the health industry's drain on the country's finances. Currently at 16% of GDP, it can only go up. That is the simple arithmetic of adding the 50 million uninsured to the ranks of the insured -- and care seeking. The only prospective cost-cutting changes are those that will implicitly ration care for those who buy their own insurance or will receive lower Medicare benefits (by roughly $450 billion) once the Finance Committee's plan to empower a benefit/price setting oversight board kicks in. All the rest goes on as before: the legions of pointless paper pushers, the profiteers, the overwhelmed government agencies barely able to keep track of whom they are paying what. Budget neutral? Unlikely. National cost neutral? Impossible. Taxing middle income earners to cover the costs of doing a bit for the poor? For sure. A perfect Republican formula.

The skewed costs and benefits help to explain why most provisions won't take hold until 2113, 2117 or 2119. A decade. That's how long it took Alexander to conquer all the known world, and then lose back a large chunk of it. By then, our two term former president will be into the second year of a 30 year comfortable retirement doing what alumni of the White House do: shuttling among snazzy golf clubs; presiding over his Obama Foundation for Responsible Change; raking in big bucks for uplifting speeches; and being toasted all across the non-Muslim world. Meeting the health needs of Americans without bankrupting the economy will be left awaiting the next Saviour somewhere over the horizon.

Who cares? Who dares care?