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When Pelosi was asked on July 31st if she was worried that progressives in the House would yank their support of the bill because of the sellout to conservatives, she literally laughed out loud. "Are the progressives going to take down universal, quality, affordable health care for all Americans?" she said, chuckling heartily to reporters. "I don't think so."
The laugh said everything about what the mainstream Democratic Party is all about. It finds the notion that it has to pay anything more than lip service to its professed values funny. "It's a joke," complains one Democratic aide. "This is all a game to these people -- and they're good at it."
The concession to the Blue Dogs comes at a potentially disastrous price: Without a public option that drives down prices, the cost of other health care reforms being considered by Congress will almost certainly skyrocket. The trade-off with conservatives might be understandable, if those other reforms were actually useful. But this is Congress we're talking about.
STEP THREE: PACK IT WITH LOOPHOLES
Given that five different committees are weighing five different and often competing paths to reform, it's not surprising that all sorts of bizarre crap winds up buried in their bills, stuff no one could possibly have expected to be in there.
Under bill HR 3200, employers must provide "essential benefits" to workers or face a stiff penalty. "Essential benefits" includes elements often missing in the fly-by-night plans offered by big employers: drug benefits, outpatient care, hospitalization, mental health, the works. If your employer does not offer acceptable coverage, you then have the right to go into one of the state-run insurance "exchanges," where you can select from a number of insurance plans, including the public option.
There's a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance "exchange." In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their lousy plans protected by a grandfather clause. Which means: "If you have coverage you like, you can keep it," says Sen. Sanders. "But if you have coverage you don't like, you gotta keep it."
This grandfather clause has potentially wide-ranging consequences. One of the biggest health care problems we have in this country is the technique used by large employers -- Walmart is the most notorious example -- of offering inadequate, bare-bones health insurance that forces employees to take on steep co-pays and other massive charges. Low-wage workers currently offered these plans often reject them and join Medicaid, effectively shifting the health care burden for Walmart employees on to the taxpayer. If the HELP committee's grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart's insurance-in-name-only employer plan and taking the comparatively awesome insurance offered via Medicaid, will now be rebuffed by the state and forced to take the crappy Walmart offering.
This works out well for the states, who will get to purge all those Walmart workers from their Medicaid rolls. It also works great for Walmart, since any new competitors who appear on the horizon will be forced to offer genuine and more expensive health insurance -- giving Walmart a clear competitive advantage. This little "glitch" is the essence of the health care reform effort: It changes things in a way that works for everyone except actual sick people.
Veteran legislators speak of this horrific loophole as if it were an accident -- something that just sort of happened, while no one was looking. Sen. Ron Wyden of Oregon was looking at an early version of the bill several months ago, when he suddenly realized that it was going to leave people stuck with their employer insurance. "I woke up one morning and was like, 'Whoa, people aren't going to have choices,'" he recalls.
As a means of correcting the problem, Wyden wrote up a thing called the Free Choice Act, which like many of the prematurely sidelined ideas in this health care mess is actually quite sensible. The bill would open up the insurance "exchanges" to all consumers, regardless of who is offered employer-based insurance and who isn't. But Wyden has little hope of having his proposal included in later versions of the bill. Like Sanders, who hopes to correct the committee's giveaway to drugmakers, Wyden won't get a real shot at having an impact until the House and Senate meet to hammer out differences between their final bills. In a legislative sense, the bad ideas are already in the barn, and the solutions are fenced off in the fields, hoping to get in.
STEP FOUR: PROVIDE NO LEADERSHIP
The only major reform with teeth would be the one forcing everyone to buy some form of private insurance, no matter how crappy, or suffer a tax penalty. If the public option is the sine qua non for progressives, then the "individual mandate" is the counterpart must-have requirement for the insurance industry.
The so-called "individual mandate" is currently included in four of the five bills before Congress. The most likely version to survive into the final measure resembles the system in Massachusetts designed by Mitt Romney, who imposed tax penalties on citizens who did not buy insurance. Several of Romney's former advisers are involved in the writing of Obamacare, including a key aide to Ted Kennedy who was instrumental in designing the HELP committee legislation. The federal version of the Massachusetts plan would slap the uninsured with a hefty tax penalty -- making the barring of people from opting out of their employer-provided plan that much more outrageous.
If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that has already been proven not to work. "The IRS and the government will force people to buy a defective product," says Woolhandler. "We know it's defective because three-quarters of all people who file for bankruptcy because of medical reasons have insurance when they get sick -- and they're bankrupted anyway."
STEP FIVE: BLOW THE MATH
