We've been had! The healthcare reform bill is an abomination that doesn't seem worth saving. In fact, it's a disaster in the making and really should be killed.

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Yesterday I raised the question progressives are left to grapple with: Is the Senate health care reform bill-in-the-making worse than nothing?I noticed that the NYT reporter referred to this legislative farrago, not as "health care reform," but as "health overhaul." This is certainly more accurate but is still awfully euphemistic. Not only isn't there much "reform" left in the bill, but it really doesn't have much to do with "health."I never did have the heart to return to the subject yesterday, but Howie sure made clear where he stands in his post last night My inclination has been negative for a disrespectably long while now -- long before Sunday's methodical stripping out of what remained of a public option as well as the Medicare buy-in that had been incorporated as an interesting complement or substitute. Back in July I was quoting Howard Dean : "Don't pretend you're going to do health-insurance reform unless you're really going to change the system," and proposing KenInNY's Health Care Legislation Rule: "From now on, no one should be allowed to participate in any way in the drafting of health care legislation without proving that they have read Dr. Dean's book. Proof that they've understood it would be nice too, but that may be beyond the reach of proof."Of course no one paid attention, and now the thing has taken its course, and we are where we are. Certainly I wasn't cheered by the position Governor Dean took Tuesday, and Marcy Wheeler's excellent post, to which our friend Jimmy the Saint directed me in a comment on my post yesterday, has both led the way and reflected a growing sentiment this week among shell-shocked progressives.Marcy was especially helpful in focusing on the devastating economic impact of the individual mandate built into the package, which she suggests formalizes a new "feudal" relationship between already-struggling American families and the insurance companies, whereby the government establishes us as serfs who are compelled to turn over to our new masters, the insurance companies, a chunk of our earnings.The political fallout from just this provision is incalculable, or perhaps just calculable if we calculate that no American family afflicted by this new quasi-tax burden (it has the feel of a tax but truly isn't one, since the money is going, not to the government, but directly into the coffers of private enterprise) can be reasonably expected to vote for a Democrat in the foreseeable future. Is that Master Rahm a master strategist or what?I originally intended just to highlight the impressions that are my takeaways from the bill as it has developed, but since I sketched them out, they have become pretty general sounding points for shocked and angry progressives. Nevertheless, these are the central points to which my mind wanders when I think of the "reform" package:The big insurance companies are looking to see a rich reward for all the money they've poured into the street fight against meaningful health care reform, which would have more or less begun with a close look at how our health care is delivered and how we pay for it. Once again they went into the fight way better-prepared than the proponents of health care reform, and they've converted the Congress they invested so heavily in into their pimps.* While it's true that a mandate provision is probably essential in any truly universal system of health insurance, so that everyone is paying in, that's far from the same thing as simply strong-arming everybody into buying whatever crap policies the insurers come up with to satisfy the government's new requirements, which almost completely fail to curb the industry's traditional abuses and all but invite new ones. Yes, the plan includes subsidies to those whose incomes fall catastrophically short of being able to afford individual insurance, but even setting aside the damage caused by what the plan may do to pay for those subsidies, they're clearly inadequate to protect most of the affected from irreparable economic harm.Marcy set out some sample numbers in her post, but I think we can easily enough imagine the catastrophic effect of suddenly forcing a family, even one with what seems like a reasonable income of, say, $65, to have to dig into empty pockets to find an "extra" $6K or $8K to shell out for insurance from which they are likely to received hardly any immediate benefits. There would be essentially no controls on the insurance companies. For every remaining attempt to establish limits, regulation, or merely oversight, there's a loophole to render it meaningless.* Can you imagine how the coalition of the Just Say No Republicans, the Movement Conservatives, and the Teabaggers is salivating? They won't even have to lie, or at least not lie too much. Just tell Americans what's in this misbegotten bill, and who in his right mind is going to vote for any of the pols who brought this on them? I'm not just talking about "independents" and "undecideds," although the hit there will be horrific -- as colleagues point out, as far as the public is concerned, Democrats who pulled for health care reform will own every kink and defect in the system. What I'm really talking about, though, is the withdrawal from the electoral fray of, above all the progressive base that worked so hard to make sure the Bush regime couldn't succeed itself in 2008, on the promise of change we could believe in.Do the people in Congress and the White House really not understand what they are doing to? No, we're not going to vote Republican, and in the end many of us, however unhappily, will trudge to the polls and vote for Democrats. But don't these master strategists get that a lot of people who voted with determination and hope for congressional Dems in 2006 and 2008 and a Democratic president in 2008 are just going to sit on their hands? Did they learn nothing from this year's Virginia gubernatorial debacle? (Answer: So it appears.). . . is to strip the individual mandate out of the bill, on the ground that it can no longer be justified without any reasonable alternative for buyers under compulsion to buy from the insurance companies that have vowed to rape and plunder them. Leave the rest, and key in on making sure that there is rigorous enforcement at the attempts to limit the damage the insurance companies can do as they implement the new requirements.This would leave the way open for some real structural reform of the health care delivery system along the lines outlined by Dr. Dean in his book.

Labels: health care reform, Howard Dean, Rahm Emanuel