Friday, January 22, 2010

Cadillac Health Plans

A central means of paying for the US Senate’s version of Obama’s health care plan is a very high tax (40%) on high-cost, so-called Cadillac Plans. The whole debate over that tax goes to the heart of the question of whether health care is a universal right, as it is in every other developed country, or a commodity, thought of the way you purchase a car.

Would you prefer a Caddy or a Chevy? The assumption is that the Caddy, in order to justify its higher cost, has a lot more in the quality and comfort department than a Chevy. The Chevy, however, will get you there just the same so the added cost is entirely in non-essentials. An old rust bucket would also get you there the same… usually, but you might sometimes have to contend with questions of reliability and safety. And some people have no wheels at all so have to get there any way they can. Ultimately, your choice will, with rare safety lapses, or the slightly greater risk of small cars, have little or no bearing on life or death.

Health care, I would think, must be different. It seems axiomatic that every government would want its citizens to be as healthy as possible and yet the excise tax on high-cost health plans could only serve to lower standards of care for large numbers of people.

The idea behind the tax, in addition to raising money, is to get employers to offer lower cost coverage. And just how might those insurance cost reductions be achieved? Doctors taking a pay cut? CEO’s offering to work for less? Stockholders asking management to make less profit so they can have lower dividends?

Probably first would be elimination of dental and eyesight coverage. Next would be increases in deductibles and co-pays. All of which would inevitably lead to a less healthy population.

If health care is a basic right then all would be treated equally – is one person’s health or life less important than another’s? – though if it’s a right and government is thereby necessarily involved, there will always be fiscal restraints. For instance, health care in the UK is absolutely free and available to all but it doesn’t always provide Cadillac quality, so if you need a hearing aid the National Health Service will provide you with a big old style one because they are cheap rather than the tiny little $5000 ones that fit nicely in your ear and are entirely unobtrusive. Seems fair to me. Everybody gets to hear; all have basic coverage. If your vanity can’t deal with big hearing aids you put out your own money for a small high-tech one.

If it’s a commodity then some, who have the wherewithal, will be healthier than others who can’t pony up in the extremely high cost American system. That includes the many who do have insurance but their income is so low and it’s such poor quality coverage that high deductibles keep them from going to the doctor, or they can’t pay for adequate medicine in the one country where drugs are most expensive. Others will have coverage with co-pays that are so high they are forced into bankruptcy even with insurance. The majority of people who file for bankruptcy for medical reasons actually had insurance.

The Senate plan seeks to lower the quality of health care for large numbers of Americans, a counterproductive program if there ever was one. But par for the course for a government owned by industry.

On a related note Democrat Martha Coakley managed to lose an election to fill the late Ted Kennedy’s seat in Massachusetts, one of the most liberal states in the country. It wasn’t easy; she had to be so overconfident that she barely campaigned. The national Democratic Party helped by ignoring her pleas for money. It was, however, easy for the Republican to raise money all over the country to try to make a point of defeating her.

The real culprit though is probably the enthusiasm gap between Republicans and Democrats. When asked if they were certain or very likely to vote 80% of Republicans said yes, 65% of independents replied in the affirmative, but barely more than half of Democrats did. Obama is reportedly angry about the outcome, as well he should, but he has only himself to blame. At least he’s starting to show some emotion; it’d be good if he could get himself fired up about something.

I’m personally glad it happened, now there’s no need to compromise everything good out of the health care bill, or any legislation, just to get a few right wing Dumbs on board to reach the magic sixty vote number. The Repugs have made it clear they have no intention of voting for anything put forward by the Dumbs no matter how reasonable or even conservative it might be. No matter how much Obama coddles the banks, insurance companies or other corporate darlings of the Repugs, he’ll never get a single vote out of the opposition.

So very simple, you throw away the garbage bill voted by the Senate and the better, but still not very good one moving through the House and put forward a Medicare-for-all bill. Everyone in, nobody out. Even right wing morons like their Medicare (for many, because they don’t know it’s actually run by the government otherwise they’d hate it) so let’s throwaway uninspiring words like single-payer and public option and just say MEDICARE. It is liked by seniors and most Americans have a good impression of it.

Even using those dullish words, in every poll I’ve seen a majority of Americans - almost always over 60% - were in favor, so using the word Medicare could only enhance those numbers. It’s not a radical idea, it’s mainstream. It’s what the people want, it’s what they voted for in the last election.

The Dumbs are so steeped in cowardice every time the Repugs only mention the word filibuster, they cave. Majority leader Harry Reid won’t even bother with bringing up legislation if he doesn’t already have 60 votes in his pocket. Well, why not bring it up and let the Repugs actually filibuster, you know, try to talk the bill to death? Let them spend endless hours telling the American people why Medicare-for-all is such a terrible idea. If they managed to defeat the bill, it’d be their downfall in the next election. To repeat, it’s not a radical leftwing idea, it’s what the people have repeatedly said they want.

There’s also a procedure in the Senate for measures that involve the budget called reconciliation which only requires 51 votes for a bill to pass. All the talk about bipartisanship is worthless tripe. You are elected by the majority, you know what they want (and surely remember what you campaigned on) so fight for it. It doesn’t matter if it doesn’t pass the first time, at least the electorate know where you stand when it comes to the next election. Ah, but easy for me to say; the Dumbs, unfortunately, can’t disappoint the fat cats who financed their campaigns; without the bankster money, the pharma cash, where would they be?

I keep hoping that Obama will receive an epiphany, that he’ll suddenly realize how stupid he’s been and start to think of the people first and finally that he should stand for something. He’s such a decent, likeable guy, something is bound to click, to turn him around, to finally point him in the direction he promised to take the country.

I’ve been turned off to the Democratic Party for so long, I harbor only the slightest glimmer of hope that they will do the right thing. But miracles do happen.

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