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Sunday, March 21, 2010

Myopia

Slightly edited comment I put on a major blog in response to a broadside with the time-worn arguments of sell-out, etc., on the health reform bill.

Blah, blah, blah. We've all heard all these great arguments, and most of us have decided that, on balance, while we sympathize with them very much, we would like to see the best deal that is politically feasible now passed into law. That's partly because we recognize that the sole focus should be on what the bill actually does for people and how it can be used in the future, and that whether or not insurance companies and drug manufacturers like it or not is totally irrelevant -- the tail wagging the dog.

It is totally beyond my comprehension how anyone claiming to be a progressive would be willing to kill legislation that will:

(1) end some of the worst insurance company abuses, including denial of coverage for pre-existing conditions (including rescissions after the claim for insurance coverage is activated by treatment) and lifetime benefits caps;

(2) move closer than ever to universal coverage and reduce bankruptcies due to high medical expenses;

(3) set Federal minimum standards for acceptable health insurance;

(4) set up a marketplace in which insurance companies will have to compete on an apples-to-apples basis, making it easier for buyers to make direct price comparisons of the same basic coverage;

(5) require more companies to provide their employees with health insurance and provides tax credits to help the smaller ones to do so;

(6) require insurance companies to pay out no less than a set percentage of premiums on actual medical claims;

(7) require the Federal agency that negotiates plans for Federal employees to establish at least one national non-profit plan that will be made available in the exchanges, and enable state exchanges (or groups of states) to set up additional non-profit co-operative plans that are owned by their customers and have the legal duty to make decisions to the benefit of those customers;

(8) make several million more Americans eligible for Medicaid;

(9) improve Medicare finances by virtually ending the insurance company gravy train from diverting tax dollars to subsidize companies offering plans under the Republican-generated Medicare Advantage (Medicare privatization) program;

(10) create hundreds of new low-cost Federally-supported clinics for extending primary care to lower income Americans;

(11) provide significant tax credits to reduce insurance premiums for the majority of middle class and lower income Americans who need to buy insurance through the exchanges;

(12) by guaranteeing affordable insurance through the exchanges, enable employees who are hanging on to jobs by their fingernails for the benefits to have less fear of losing a job or taking a chance on an entrepreneurial idea, thereby reducing job lock and beefing up Republican-depleted consumer confidence that is essential to a thriving economy;

(13) incorporate cost controls, including enlarging the pool of insureds, that a large group of economists who are generally considered to be progressive consider to include, save one important idea, every cost-control idea that's ever been identified; and, finally,

(14) create the exchanges and thereby set up the regulatory structure into which a public option may be inserted long before the exchanges go into operation -- that is, if progressives, instead of taking their marbles and going home to pout, have done their job of continuing to promote public support of this already-popular concept, and forcing the issue at a more opportune moment after it is allowed to stand alone unencumbered by the other controversial elements of the main bill.

That's 14 very worthwhile things this legislation does. Most of the canards from the left – most notably, that it forces people to buy from for-profit insurance companies – are just that, canards that misrepresent the actual bill. Just as I would like to see Republicans tell us which if any of these are an idea they oppose -- they cannot do that because their opposition has zero to do with substance -- I would ask the recalcitrant progressives to identify exactly which of these elements of the bill are either worthless or make the problems in the current non-system worse.

I know, I know, it's not good enough, because it does not guarantee that insurance companies and drug manufacturers will suffer -- and that, after all, is what's most important. If we hold out now, we might be able to get single-payer within 10 years or so. For the 450,000 people who die for lack of insurance in that period (per New England Journal of Medicine article's estimate of annual deaths), you hard-line “progressives” can make their families feel better by instructing them on the eggs-omelet metaphor.

It's time for some of the left-side Kill-Bill adherents to look in the mirror and ask why only a handful of liberals or progressives are still holding out. Most of them (outside of Congress anyway) would have preferred single-payer, and virtually all supported the public option in its absence. Is it not possible they have a better grasp of the present and future dynamics? Perhaps it has come to the point, however, where narcissism and the inability to admit a mistake have rendered such reflection impossible.

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