The progressives who have been pushing for eight long years to throw off the yoke of Bush Republicanism reached a variance in perspective in this last election. Those who backed third party candidates hoping to build support for a specific leftist agenda failed to win a significant number of voters to their cause. On the other hand millions of people who undoubtedly believe in that agenda decided that every last vote was needed to ensure Obama's win and that any pre-election pressure that they exerted would only handicap him in the pre-eminent task of defeating the Republicans.The call is now going out to begin exerting post-election pressure. The operating belief among Obama progressives is that the leftist position is now stronger because all of these empowered voters will demand specific policies.
Nowhere will this strategy be put to a greater test than in the battle to reform the nation's healthcare system, sure to be one of the foremost initiatives in Obama's first hundred days. That is because nowhere will the centrist paradigm of getting elected come into greater conflict with the desires of progressives to have effective reform. The middle way on healthcare reform, which Obama used to parry and parrot Hillary Clinton's plan in the Democratic primaries, is premised on the idea that the power of the health insurance lobby is too strong to be assailed head on. Therefore the most expeditious approach to providing healthcare for all is to give the insurance companies what they want: continued control of the system and access to more business, paid for out of the Federal Treasury. These concessions will then open the door for fairness provisions--requirement to insure pre-existing conditions, tax credits to pay for insurance, expanded Medicaid and S-CHIP, pooling mechanisms and a limited public plan.
Powerful forces within the Democratic Party and the liberal media are already marshalling to push this initiative early. Senator Max Baucus of Montana is introducing the legislation. The lavishly funded HCAN organization is ubiquitous. Hillary Clinton is expected to weigh in forcefully. The internal conflict among Democrats is already being framed as: will buying insurance be mandatory or voluntary?
The real story on healthcare reform is less apparent and much more alarming.The newly empowered centrist faction of the Democratic Party may well be pushing a plan that is destined to fail, and in so doing they may sabotage reform for a generation. Passing legislation and having it signed by the president may be the least of their problems. Much more central to the discussion is: will the middle way prescription realistically work? Here's what the Obama plan won't do: save the country any money. The modus operandi of all politicians, whether Democratic or Republican, is to defer to the powerful and rely on the largesse of the Federal Treasury. The last thing that the Democratic leadership wants to admit is that their acquiescence on the $850 billion Wall Street bailout has seriously crippled their ability to expand spending on social programs, especially ones that represent burgeoning outlays into the future.
The working model of the Obama/Baucus plan of mixed private and public coverage is the Massachusetts universal care program. Passed under Republican Mitt Romney and implemented by Democrat Deval Patrick, its effect on public spending is unequivocal. The Boston Globe reports,
The subsidized insurance program at the heart of the state's healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.
Massachusetts is now turning to the federal government for help in making up the difference. They will be joining the queue behind AIG, Lockheed-Martin and Kellog, Brown and Root.
If reducing the cost of healthcare was easy it would already have been taken care of by now. But the afore-mentioned political realities have kept key considerations off the table. Namely, that roughly 30% of every healthcare dollar goes to maintaining the for-profit insurance infrastructure--administrative costs, advertising, promotions, lobbying, CEO salaries and profits. This is potential savings that the Democratic conciliatory approach is not attempting to reach. Instead the cost-containment mechanisms in the Obama/Baucus plan are so generic that they are nearly identical to those in John McCain's plan and are likely to be implemented by the industry irregardless of government action. These include improvements in information technology and a greater emphasis on maintaining good health.
Another aspect of rising healthcare costs which gets little attention is the reliance of Wall Street on private healthcare companies as a growth industry. Certainly a legitimate part of a capitalist economy, it nonetheless creates perverse incentives within the fee-for-service structure to provide the kind of care that keeps the stock prices of these companies rising, i.e. late stage treatment over prevention and countless unnecessary tests, treatments and hospitalizations. In both of these components of the private system--for significant savings to ever be realized--someone is going to have to cut off the cash cow to these corporations.That makes the centrist impulse of leaving the private structure intact almost the same as no action at all. If the level of public debt that we are now facing proves to be unsustainable, then even liberal initiatives like H-CHIP and Medicaid may be threatene--let alone the new spending this plan entails. If the economy continues on its current trajectory, the Obama plan (like the Massachusetts model) will be headed for the dust heap of history.
The activist community needs to come to terms with how formidable their task is. In healthcare, as in scores of other issues, no change will take place until there is an actual confrontation with entrenched power. The reallocation of public resources to the needs of the people will never happen unless those resources are wrested from the clutches of the military/industrial complex and the corporate welfare state. The private insurance industry is not fearful of Obama's plan--rather they welcome it. Their stock values have plateau-ed and they are anticipating a huge influx of cash as the uninsured are added to their roles, paid for with taxpayer dollars. They have given substantial contributions to both Obama and the Democrats, outstripping their support to their former allies in the Republican Party.