Krugman's Health Care Sell-Out: The Health Care `Reform'
Bill is Worse than Nothing
29 December 2009By Dave Lindorff
Paul Krugman, one of the few liberal columnists
writing for the New York Times, claims that at some
point in the hoary past when he “began writing a lot
about health care,” he was in favor of a
Canadian-style single-payer health care system. He
adds that even today if he thought there was “any
chance of creating Medicare for All any time in the
next decade,” he would be “pushing for single-payer
now.”
But on Christmas, Krugman threw in the towel, calling
on progressives to support the Senate’s version of
health care legislation. Suggesting that the so-called
Senate Health Reform Bill, if it had been the law back
in Dickens’ time in England, would have saved Tiny Tim
without any need for the belated charitable
intervention of Ebenezer Scrooge, Krugman says
progressives should recognize that the Senate bill is
the best they can hope for, and that they need to
accept that politics is “the art of the possible.”
Krugman goes on to say that despite some “flaws and
limitations,” which he leaves unexplained, the Senate
bill is “a big win” for progressives--"and for
America.”
But is it?
Certainly the Senate bill, and the only slightly less
cruddy House version, with which it must be reconciled
(let’s be clear here that the ultimate act, when
passed, will much more closely hew to the Senate
version than the House version, given the number of
conservative Democrats in the Senate), does a few good
things, such as increasing funding for community
health clinics, expanding Medicaid, the health
insurance system for the poor, and banning the current
insurance industry practice of denying coverage to
people with pre-existing medical conditions. But these
small positive steps pale in comparison to the truly
noxious things this bill does, and the things it fails
to do.
The most outrageous thing the health “reform” bill
does is further consolidate the death grip that the
insurance industry has over health care access and
delivery in America. It does this by mandating that
everyone buy health insurance, on pain of being
slapped with a heavy fine by the IRS. Since most of
the 47 million Americans without health insurance are
younger and healthier than average (63% of them are
under the age of 34 and 21% are under 18), what this
measure does is hand the private insurance industry a
huge captive customer population who will be stuck
with high-cost, low-benefit insurance that will
generate huge profits for the industry. The industry
will be further enriched by nearly half a trillion
dollars in subsidies needed to help low-income people
or small businesses buy their mandated health
insurance--subsidies which will end up going directly
to insurance companies, which will be offering in
return wretched bare-bones plans that will only cover
some 60% of actual medical costs. (And that's not
counting the inevitable proliferation of scam
insurance policies that, as with mandated auto
insurance plans, will really be simply dummy plans
offering no real coverage, but only a piece of paper
to allow people to dodge government fines for
non-coverage.)
Supporters say that mandating that everyone have
health insurance is akin to mandating that every
driver of a car buy liability insurance, but there
actually is a huge difference. Driving is a matter of
choice. If a person doesn’t want to buy car insurance,
she or he can decide not to own a car. That reality at
least forces auto insurers to compete in offering
low-cost minimal insurance plans. Nobody can decide
not to buy health insurance under this plan though. It
is a historic first: a law requiring American citizens
to buy a service from a private company.
Adding insult to injury, the bill does almost nothing
to limit costs. This is why doctors, hospital and drug
companies and the insurance industry, all of which
spend millions of dollars lobbying for this law, love
it (health insurance company shares jumped on word of
Senate passage). Indeed, the government’s own Center
for Medicare and Medicaid Services (CMS), predicts
that the law, if enacted, will cause US health care
costs--already the highest in the world on a per
capita basis and as a share of GDP by a factor of
almost two--to rise faster than ever. Furthermore, to
keep the projected costs of this bill at an alleged
$871 billion over ten years, a huge amount of money is
stolen from important existing programs, including $43
billion from payments to safety-net hospitals (mostly
public institutions in urban centers which serve poor
populations), and from cuts in Medicare funding that
could for the first time lead significant numbers of
physicians to stop seeing elderly patients on
Medicare.
The reform plan is terrible for other important
reasons too. In order to sell it to one lone hold-out
Democrat, Sen. Ben Nelson of Nebraska, Senate leaders
allowed strict limits to be put into the bill making
it almost impossible for low-income women or families
to buy insurance that includes payments for abortions.
The bill also undermines trade unions by taxing, at a
rate of as much as 40%, those health plans which,
through years of negotiations, offered quality care to
workers. As the group Physicians for a National Health
Program (PNHP) points out, group health insurance
costs are also largely driven by geographical and
demographic considerations, and thus this penalty tax
actually targets workplaces that employ more women, or
that have older workers, or which are located in
higher-cost regions such as New York or California.
But surely the worst thing about this bill is that far
from putting the US on a course towards some eventual
humane national health system like those that exist in
the rest of the developed world, and even in many
countries in the less developed world, it actually
locks in the power of the insurance industry even more
solidly, making achieving true health reform an even
more difficult challenge than it has been.
Krugman is wrong. If the health plan envisioned by
Congress had been the law of the land in Dickens’
time, Tiny Tim’s survival would still have been
dependent upon Scrooge’s largesse. If his parents did
manage to buy some subsidized insurance policy (and
under the Senate version, over 20 million Americans
would still be left uninsured!), the deductibles and
co-pays would be so high that they still would not be
able to get him treated for his deadly disease, and
the dark future predicted by the Ghost of Christmas
Yet to Come would still have befallen him and his
family.
Krugman is also profoundly wrong in his gloomy
prediction that there is no chance for true health
care reform (as defined by expanding Medicare to cover
everyone in America), any time in the next ten years.
As the insurance industry continues to rake in obscene
profits, as America’s health statistics continue to
plummet, and most importantly, as the huge population
of baby boomers hits retirement age and sees their
health coverage under Medicare gutted and their
children and grandchildren struggling to pay for care,
the stage will be set for a radical political
realignment, with socialized medicine as one of its
key demands.
The liberal attitude expressed by Krugman, of urging
progressives to accept a tenth of a loaf, only works
to push off the day of that political revolution.
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