Dr. Marcia Angell, a single-payer advocate, doesn't think there's much in the President's plan to feel good about.
Her interview on Bill Moyers Journal last night was a must see for those doubting their own suspicions that this 'reform' will just make a bad situation worse. I've pull quoted some of the key points into the body of this diary. But I strongly recommend that you just click through to watch the whole video.
Link to Video (approx 20 mins) and transcript
So what are the fundamental problems with the bill? Read on.
Note: Bold text is diarist emphasis.
First, The Fundamental Problem.
MARCIA ANGELL: What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they'll do that.
Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster.
Should Obama's fixes and this current bill pass?
MARCIA ANGELL: (Obama has been) Fighting for the wrong things and too little, too late. He gave away the store at the very beginning by compromising. Not just compromising, but caving in to the commercial insurance industry and the pharmaceutical industry. And then he stood back for months while the thing just fell apart. Now he's fighting, but he's fighting for something that shouldn't pass. Won't pass and shouldn't pass.
So what will happen if this bill dies now?
MARCIA ANGELL:... It'll be like what happened after the Clinton plan failed. There'll be another 16 years before anybody comes up with the courage to try that again. People say, "Too expensive. Just can't have universal care. Tried that, did that, didn't work, good-bye." Whereas if the bill dies now, people can say, "This bill died because it was a bad bill." And the problem is still on the front burner. And then one can hope that we get some version of Medicare for all. And that we don't have to wait 16 years.
But as Friedman preached, 'Free Markets' will automatically seek the correct price levels. Oh yeah, I forgot that insurance companies have that anti-trust exemption.
MARCIA ANGELL: Well, if you get-- I think it was Senator Rockefeller who said, I mean, that was a wonderful comment he made in the summit last week. Senator Rockefeller referred to the private insurance companies as rapacious, rapacious, and said, "Like sharks, they swim under the water, and you don't know they're there until you feel their teeth." Now there are not many people in America who would disagree with that description and so what this plan does is says, "This is a terrible industry, so let's force people to buy their commercial products. And let's subsidize it and put a lot of money into it."
On the age penalty (for older people, 40 and up).
MARCIA ANGELL:
They allow for insurance companies to charge three times as much for older people as for younger people.
...
So this sets up a situation which probably all plans, for 55-year-olds, are high priced. So they can't afford to buy it, or if they do buy it, they have to pay an excise tax on it. This is a real poison pill for these older people. It's a gift for the insurance industry.
On the mandate windfall and premium costs control (or lack thereof).
MARCIA ANGELL:
... And what do you think they're going to do? If you were an insurance company, you would say, "Well, thank you, Santa Claus. I've got all of these captive customers. Young ones are healthy. They probably won't even use the insurance. There's nothing to stop me from raising my premiums. I have all of these subsidies coming in." Don't you think that the prices would go up? I think it would be remarkable if they didn't.
But wait, Obama wants to expand Medicaid. That's a good thing, right?
MARCIA ANGELL: Yes, yes. And one of the things about the Obama plan that I do like is that it expands Medicaid up to 133 percent of the federal poverty level and that's fine. The problem is that could have been a stand alone measure. You didn't need to have it incorporated in this massive Rube Goldberg apparatus.
We're getting the Miracle from Massachusetts plan. How's it working in Mass?
MARCIA ANGELL: It's not lack of health insurance. It's lack of health care. There is a difference between health insurance and health care. You can have insurance offered that is too expensive to buy or too expensive to use. What good does it do? And what happens when this occurs, is that what you see is instead of improvements, look at my state of Massachusetts.
Instead of seeing improvements, you see it shredded even further. You see more people denied access anyway. Now they're about, I think over 60 thousand people in my state who are exempted from the plan for financial hardship and this is also in the Obama plan. If you're really poor, you don't have to participate, and these are the very people who should be in a plan to cover them.
Obama says it will "Brings down our deficit." So how will Medicare fare if this bill passes? Not good.
MARCIA ANGELL: ...So if they can save money in Medicare, then they come out ahead, no matter what happens out in the private sector. And so that's what he's talking about. It will take money out of Medicare and put it into the private sector. Medicare is the source for a lot of the funds that are going to go to subsidize the private health insurance industry.
But if Big Insurance is fighting this bill, that should mean it's a winner for consumers right?
MARCIA ANGELL: ...Oh, they haven't fought it very hard, Bill. They really haven't fought it very hard. What they're fighting for is the individual mandate. And if they get that mandate, if everyone does have to buy their commercial products, then they're going to be extremely happy with it.
Your turn. Tell me why she is wrong -- because I just don't see how this bill can be good news.
Footnote:
Marcia Angell Bio:
In 1999, Dr. Marcia Angell became the first woman to serve as editor-in-chief of the NEW ENGLAND JOURNAL OF MEDICINE, the premier journal of medical science in the United States. She has also written for a general audience on the relationships between medicine, ethics, and the law.