March 24, 2010

LAST SUNDAY night around 10 p.m., I was finishing up the next day's edition of SocialistWorker.org when my e-mail inbox started filling up like a casino slot machine finally paying off.

The subject lines all had the same theme: "Historic legislation..." "Monumental effort..." "Accomplishment on a scale with Social Security..." "Salute this landmark achievement..."

The House had finally voted in favor of health care legislation, passed by the Senate and supported by the White House, and now liberal organizations were celebrating a long-delayed triumph on the issue that dominated the first year of the Obama presidency. Every pro-Democratic and progressive list-serve I'm on came alive.

Ding-ding-ding-ding-ding-ding!

Barack Obama e-mailed to thank me for my tireless efforts and for not listening to the people who said it couldn't be done. His adviser David Plouffe even invited me to co-sign "this historic legislation." On the BarackObama.com Web site, though--not actually in the East Room of the White House.

Barack Obama signs health care legislation in front of Democratic lawmakers in the East Room of the White House (Lawrence Jackson)

The enthusiasm extended beyond elected officials. "The health care reform bill passed by Congress and signed into law today by President Barack Obama is progressive reform at its finest--conceptually farsighted in design and pragmatically far reaching in scope," wrote John Podesta of the liberal Center for American Progress.

Also weighing in were groups and figures who previously had criticized the legislation--people who protested the exclusion of voices advocating single-payer health care from the discussion; who warned that a bill without at least a strong "public option" for the uninsured was a disaster in the making; who opposed the so-called "Cadillac tax" on employer-provided insurance plans with halfway decent coverage.

One surprise came from Michael Moore, director of the excellent documentary Sicko about the health care crisis in the U.S. and a bitter opponent of both Republican smears of reform and Democratic concessions to the health care industry.

Moore's initial statement was couched as an "open letter to Republicans," which allowed him to make fun of the fanatical right-wingers who opposed every proposal for health care reform as a communist plot.

Moore did say that he was "going to get busy trying to improve upon this bill so that all Americans are covered." But mostly, he emphasized all the good the legislation would do. Instead of focusing on the Democrats' concessions, he called on "my Republican friends" to "be happy for your country. We're doing better."

On Wednesday, though, Moore delivered a much tougher assessment of the legislation in an interview with Democracy Now!:

This bill was never about universal health care. It did a couple of good things that could have been done any time, I guess--like ending the pre-existing condition rule for children. It doesn't end it for adults for four years, so you can rack up another 20,000 to 40,000 deaths in the meantime from people who otherwise would have received help had we truly gotten rid of pre-existing conditions for all citizens... The larger picture here is that the private insurance companies are still the ones in charge. They're still going to call the shots. And if anything, they've just been given another big handout by the government by guaranteeing customers.

THE DEMOCRACY Now! Moore got it right. As leading members of Physicians for a National Health Program (PNHP) wrote in a damning indictment of the legislation:

Instead of eliminating the root of the problem--the profit-driven, private health insurance industry--this costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers' defective products, and turn over to them vast amounts of public money. The hype surrounding the new health bill is belied by the facts: About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering. Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income, but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles. Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it, their ability to block future reform. The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured. People with employer-based coverage will be locked into their plan's limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows. Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates. The much-vaunted insurance regulations--e.g., ending denials on the basis of pre-existing conditions--are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017. Women's reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

IT'S UNDERSTANDABLE why many people would look for reasons to celebrate the passage of health care legislation.

For one thing, the Republicans finally didn't get their way on something in Congress. That's become a rare event, especially on the health care issue, even though the Democrats have the biggest majority for either party in both houses in a generation.

The gathering of tea party fanatics outside the Capitol that spewed racial and anti-gay slurs at Democrats like former civil rights leader John Lewis and openly gay congressman Barney Frank exposed the ugly reason that the right wing opposed the health care legislation: racism and bigotry.

So the Republicans lost. But the problem is that the Democrats won--and in this case, that means the passage of a piece of legislation that will do more harm than good for most people in the U.S.

If you followed the media coverage about health care in the last few days, you've heard one person after another point out that some 30 million people will be covered by health insurance as a result of this law. That sounds like a step forward, but the real question is how much they'll have to pay, and what they'll get for their money. There's nothing to guarantee that the insurance they'll have to obtain will be affordable or adequate.

America's health care crisis isn't limited to the fact that 50 million people have no insurance in the U.S.--as appalling as that is in the richest country in the world. The other side of the crisis is that tens of millions more people are covered by insurance that does them little good if they actually get sick or suffer an injury.

If you saw Michael Moore's Sicko, you'll remember the startling fact about the health care horror stories portrayed in the film: Every one of the victims had insurance, at least when they got sick or injured.

Now, under the law signed by Barack Obama, millions more people will be forced--under the threat of an annual penalty of $750--to buy what PNHP leaders rightly call the "private insurers' defective products."

The legislation does provide for subsidies to help the poor get insurance. But to pay for the subsidies, the legislation requires cuts in spending and benefits in the Medicare program for the elderly--and a new tax on employer-based health insurance plans that provide decent benefits.

The bill will do nothing to reverse the downward pressure on whatever decent health insurance plans people still have today, as employers continue to shift costs to workers. The shoddy policies that insurance companies will peddle to the uninsured will lower the standards for everyone.

In short, while it may take some years to become clear, Obama's "reform" law signals a new era of rationing for health care.

What a twisted outcome to the opportunity that greeted Barack Obama and the Democrats a year ago--massive public sentiment in favor of transforming the dysfunctional health care system.

Another effect that will play out in the years to come is the discrediting of proposals for reform. Just in the past few months, Republicans were able to portray the health care legislation as "big government" run amok by exploiting legitimate disgust with the backroom deals used to bribe Democratic holdouts. Imagine what the GOP will do when ordinary people are forced by the federal government to spend hard-earned money on insurance policies that are worse than useless.

People will continue to hate the insurance company parasites--but they'll also despise even more a political system where the interests of corporations come before everything else.

Even the small steps forward in the health care legislation are mixed--the new regulations on the insurance company practices are outweighed by provisions that give the medical-pharmaceutical-insurance complex more power than ever over the fate of ordinary people.

These facts have to be stated outright. On Democracy Now! Michael Moore said that progressives were "too afraid of going too far. But frankly, if not us, who? If we don't stand up against this, if we don't say this is wrong, if we don't speak out against it--then who's going to do it?"

The need for real health care reform--to remove the drive for profit at the heart of the crisis--will only grow more urgent as the Democrats' legislation takes effect over the coming years. The job of organizing for an alternative will be best served by being clear about Barack Obama's "historic achievement"--it's not a cause for celebration.