Tuesday, 6 October 2009

Why Obama's health care reforms are mere tokenism

On Friday, CNN reported that the Senate Finance Committee "finished its work [on the public health care bill] at 2:18 a.m. and plans to vote next week, after the bill's final language has been made public and the Congressional Budget Office has provided final cost figures." The version of the Bill that emerged from the committee, the Baucus Plan, "would not create a government program to provide health insurance to all Americans." However, Barack Obama has said that he is "confident" that he "will get reform passed this year."

On Tuesday, the broadcaster told how many doctors - including Obama's personal physician - "desire to see the nation adopt a single-payer system like the ones in Canada and Europe," and have "argue[d that] the president's plan doesn't go far enough." Obama has responded that he would support this notion if he were "designing a system from scratch," but that "the concept is not practical in the United States."

In reality, it is only impractical because of the fierce opposition it faces from hard line "free"-marketeers and social conservatives, who have drummed up irrational fears to justify their opposition to health coverage for the poor. Hence, we have Sarah Palin's reactionary comments about "death panels," and the utterly idiotic claim from Investor's Business Daily that "people such as [British-born, NHS-treated] scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless." I very quickly decimated these myths back in August, but it would seem that even Obama remains in thrall to them.

Despite "castigating political opponents for spreading distortions about his plan," he remains quick to insist that "doctors wouldn't support a reform agenda if they believed it would lead to government interference in the doctor-patient relationship." His support for the "tireless efforts" of the Senate Financial Committee in drafting the Baucus Plan are also telling.

In their final white paper, Call to Action: Health Reform 2009, the committee declared its commitment to "meaningful health reform legislation that achieves coverage for every American while also addressing the underlying problems in our health system." However, within the paper, they propose $377 billion in cuts to Medicare, $200 billion of which would be cut by lowering payments to hospitals, nursing homes and other providers, $113 billion in cuts to the Medicare Advantage (MA) programs that provide health care to over 10 million elderly people, and the rationing of care through "comparative effectiveness research" (CER). This would, among other things, create an Independent Medicare Commission "that would develop and submit proposals to Congress aimed at extending the solvency of Medicare, slowing Medicare cost-growth, and improving the quality of care delivered to Medicare beneficiaries" by reducing "excess cost growth" in line with the consumer Price Index (CPI). As such, it is the old private enterprise trick of "improving quality" through cuts to services.

Also of importance is the fact that, like all prior proposals, the Baucus plan would make the purchase of insurance mandatory. Though there are exemptions, such as for those who cannot find coverage for less than 8% of their income, such a plan is not akin to the National Insurance system in the UK, but rather a legal enforcement of private profits for insurance companies.

One positive is that, whilst not mandatory, the bill does allow for individual states to set up their own public health option. However, rather than basing payments on Medicare reimbursement rates, states would have to negotiate costs directly with private providers, and would be funded by tax credits that would have gone to individuals.

Likewise, the restrictions on insurers denying coverage due to preexisting conditions (a particularly acute controversy in the United states) are full of loopholes. As the Washington Post reports;
If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.
Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.
And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School.
By itself, a ban on discrimination would not eliminate the economic pressure to discriminate.
"It would probably increase the incentive for cherry-picking," Pauly said. "I'm strongly motivated to try to avoid you if I'm not allowed to charge you extra."
What the bill offers, then, is a sop towards social democracy. Dressed up in fancy rhetoric, the Baucus Plan claims to offer Americans the health care system they so desperately need in a country where roughly 18,000 people die per year simply through lack of coverage. As with most of Barack Obama's initiatives for "change," though, the appearance is superficial, with only as much reform as the power-centric political spectrum will allow.

On camera, he has beaten back the privileged reactionaries demanding either the status quo or even less health provision for the poor. On the streets of America, he has silenced those whose very living conditions are a protest against the current system, producing a more liberal version of free-market health care only so that he need not face the demand for truly socialised medicine.