Zero Public Option + One Mandate = Disaster

While this bill does seem to provide some relief by getting rid of pre-existing condition clauses, not allowing insurance companies to drop sick people, etc, it also has quite a few gaps.  For example, if someone gets cancer and can't work, the gap between private insurance and medicaid isn't covered.  So, unfortunately, despite all the mandates in this bill, it seems that there will still be quite a few bankruptcies caused by medical expenses.  In that sense it's a failure.

I think that in terms of money, it has been a great victory for the insurance industry.  They have new customers, and have consolidated their position as middlemen.  They may not make that MUCH more, but they have essentially cemented themselves in place.  That's definitely a problem, and I worry that it will make change more difficult going forward.  What isn't talked about much, is what a bill like this says to people about the political process as a viable means towards change.  In that sense, this could be a greater victory for the left in the long run.  

So, we have +'s and -'s:

- Insurance company's position has been consolidated and cemented

- People can still go bankrupt due to medical bills, which should have been one the primary targets of this legislation

+ People get some relief.  The large group of people with pre-existing conditions (such as myself) can now actually get insurance through something other than an employer provided group plan.  People can't get dropped for getting sick.  There are no lifetime limits on policies.  

+ People are witnessing legislation actually getting passed, that may actually benefit them.  This could have a huge effect in the long run.  In a sense, passing nothing may have been a bigger benefit to private insurance, as it would have resulted in an even more jaded, dis-illusioned opponent.

The "public option" was always a scam and the organizations that backed it led a great many well-meaning people into a dead end. Even in the most generous original House version it was projected to cover only 10 million people. Kip Sullivan has written extensively about this and I strongly recommend that everyone read his work.

While the actions of Obama and Congress are highly regrettable, realistically there is no way they are going to support anything, on any issue, unless there are organizations on the ground working for the goal. In the case of single payer the fight was given up before it began by big money organizations like Healthcare for American Now and obviously Organizing for America aka the Obama political machine. They need to be replaced by actual progressive organizations like Healthcare-NOW! and Progressive Democrats of America. Politicians are like little men who stand on the shoulders of giants, with the giants being the collective body of ideas created by society's ruling classes. Unless we direct the giants in the right direction there is absolutely no prospect of influencing the men standing on their shoulders.

A majority of the public almost certainly supports Medicare for All, yet the so-called movement for health care reform failed to take into account their desires. Clearly many of these organizations are simply elitist: they are run by elites who derive their status from maintaing good relationships with those currently in office and therefore deathly afraid of going out on a limb and offending the status quo. The lack of democracy in the movement for health reform and the vapidity and vacuousness of the "public option" concept are directly to blame for the current failure. It is high time we realize this.

It is important that we not get carried away fighting amongst ourselves over the current health care bill because it is not the most important issue. The central question is whether the "left" in America can get its act together on health care and morph into a real left or whether it will continue advocating neoliberal policies like "public option" in deference to an elitist, out-of-touch organizational leadership.

I share the view held here that single payer would be the best solution. I also would prefer to see a public option in the bill. And I consider the Democrats to be about as much in thrall to corporate interests as the Republicans.  Nonetheless, I do consider the proposed legislation to be better than nothing, which is the only real alternative. We have seen how hard it is to line up the Blue Dogs to pass health 'insurance' reform (as Obama took to calling it), much less to gain any Republican votes. Why is fairly obvious: campaign contributions, ideology, the threat of demonization by the right, conservative constituencies, and so on. Regardless, the fact is that the votes are not there for single payer, and the Democrats dealt away the public option to soften corporate resistance, a strategy that appears to have worked. 

The missing element in the discussion here in regard to the individual mandate is any mention of the subsidies people would receive to help pay for mandated insurance. Federal assistance would extend to families as much as 400% above the poverty line. Instead of the right-wing populist backlash posters here anticipate, when the Walmart workers see that they get real health insurance (not AFLAC) almost entirely paid for with a federal subsidy, they might think it is quite a good deal. If the benefits become obvious soon enough, Democrats will have secured those votes for generations to come, with no more desertions to the likes of Ronald Reagan. 

Also missing is recognition that Medicaid would be significantly expanded, to include everyone up to 133% of the federal poverty line. States would be given 100% funding for this at first, with the support declining to 90%, and that is a deal no state legislature will refuse. 

The individual mandate is onerous but necessary. One reason single payer would work so well is it brings everyone in, which is necessary to spread costs properly. The proposed bill is a step in that direction. Yes, to accommodate corporate interests and their friends in Congress, the manner in which it is done is ugly and inefficient, but universality remains a worthwhile goal. Moreover, without the mandate, there is no way to maintain the ban on denial of people with pre-existing conditions. 

It is worth noting that other countries with universal systems are not all single-payer, and some do rely on private insurance companies. They, like Canada, get the better outcomes at lower cost. 

I never thought I would be defending this bill, but I have become persuaded that it is better than nothing and that it is, at this moment, the best that can be had. 

I would suggest, too, that it may be unwarranted to think that we are all locked into buying insurance from the big five companies. New programs can produce new ways of doing things. I don't know what rules would be established to enter the market, but it seems to me that if we don't like for-profit companies, this bill is an open invitation to establish new non-profits. We can get our phone service from companies that serve the progressive community. Why not our health insurance?

The big question is this.  How long will progressive/leftwing voters keep voting for pro-corproate Democrats that put corporate profits ahead of the people?

In the last election, most progressives lined up and supported Obama and the Democrats.  What they were going to do with health care reform wasn't a mystery.  Hillary was talking about mandates back then.  Obama opposed that, but then again he disavowed pretty much every progressive thing he said in the primaries as soon as Hillary conceded, so its no surprise it didn't mean it.  No one other than the Kucinich's of the left was talking single-payer.

So, on health care, in the last election,  a vote for the Democrats was clearly a vote for exactly this sort of health care bill.  Electing Democrats was never going to lead to single-payer.  I think Teddy Kennedy might have been the last major Democratic candidate to support single payer way back when he challenged Carter in the '80 primaries.  Its been very clear for a very long time that a vote for the Democrats was a vote for exactly this sort of bill.

So, what's the left going to do?  Is everyone going to keep voting Democrat with some sort of delusion that they don't serve corporate interests first, last and every moment in between?  If the left keeps on with that incredibly suicidal political strategy, then we'll keep getting this over and over and over again.

Everyone in DC saw the totals next to Nader's name and McKinney's name in the last election.  I'm not sure they got 2% combined.  So, of course no one in DC takes the left seriously.  Spike those numbers up to 5% or 10%, and its a whole different ballgame.

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The people I'm really sick of in this 'debate' are the ones who voted for and supported Obama and the Democrats and who now whine that they don't like what they are getting.  With the sad realization that the same fools will be telling me to vote Democrat again next fall.  

 Norman,

I enjoyed this article.  My only problem is that the American Left--much of which perhaps stopped playing close attention once it (immediately) became obvious that a single-payer system would not have support from Obama and the majority of Dems--will come away seeing this simply as a total cave-in by Dems, including Obama.  The notion that a back-room deal may have been cut between Obama and Big Pharma/Hospital Lobbyists is definitely interesting.  Though, we should remember that the House passed a bill with a public option.  If the somewhat more conservative Senate had done so as well, the present situation could be different--i.e., it would be hard to imagine the two bills going into conference committee with a public option, and coming out with no public option and the president opposed to it.  Secondly, it is difficult not to see how the right-wing scream machine has influenced this debate.  As close and uncertain as the fate of the current legislation is without a public option, it is certainly conceivable that the presence of a public option might simply scare aware too many conservative Dems and only make the Right scream louder.

I do not doubt that many unsavory deals were cut.  As a fellow supporter of single-payer (and thus the public option), I feel your pain.  However, I think placing the blame squarely on the president and a handful of congress members is a bit of an oversimplification.  The ideological composition of Congress matters.  If the house had ten more Weiners and Kuciniches, and ten less Boehners, things would likely be quite different.  Likewise with the Senate (more Sanders and less McConnells).  I have difficulty believing that if Congress had passed a public option, Obama would have suddenly turned against it due to his prior dealmaking.  It is discomforting to see the Dems so quickly back away from the public option, but I tend to feel that it is more out of political pragmatism than some sort of last minute bait and switch scheme.  One cannot get blood from stone.  

Still, the pressure for reforms to this small-scale reform should not stop.  If the legislation passes, we should not see it as crossing the finish line:  It should be understood as the gun firing for the race to start.