Interesting Op-Ed by Ezekial Emanuel this morning in the NYT. Yes, that Zeke Emanuel, often described by the media as the White House's top health care adviser and liaison during the crafting of the ACA.
Perhaps "interesting" is not the correct adjective. Please read the opinion piece yourself and then join me past the squiggle for some discussion.
What We Give Up For Health Care
Let's just begin with the first few sentences:
WHEN it comes to health care, most liberals are committed above all to ensuring that every American has insurance. In their view, the greatest achievement of the health care reform act passed under President Obama is to finally erase the moral stain of the United States’ being the only major developed country without universal coverage. But we also hold the questionable distinction of having the world’s most expensive health care system — what about cost control? For many liberals, that just sounds like a cover for heartless conservatives who care only about cutting benefits and not about helping people in need.
Question - Why is this entire opinion piece directed at "Liberals" in the first place?
To address Emanuel's observations point by point:
I don't think the majority of people who wanted healthcare reform were committed to having "insurance" - they were committed to having the actual healthcare itself, which is why so many were so enamored of the idea of a "public option" that bypassed the traditional insurance companies that have been screwing us so well for so long.
We have the world's most expensive healthcare? Really? You're just noticing that now? Yes, what about cost control? Wouldn't that have been something to think about and address while you guys were crafting the f!@king reform?
Person after person and writer after writer made the point ad nauseum that the ACA did not address the core issue of cost control. The public option which would have provided lower costs through government control and negotiation and low overhead which would have provided COMPETITION (something free marketers supposedly love) was about the only concrete, immediate way to drive down costs.
One assumes the public option would have negotiated prescription costs like the VA does and which Medicare does not - which was ANOTHER plank of the Obama health care plan that he campaigned on and then discarded. You must remember that, right Zeke? Drug negotiation for Medicare and also drug re-importation, which the White House also killed with some arm twisting when Dorgan's bill looked like it was going to pass? That might have lowered some COSTS for everyone.
Many argued that the Medical Loss Ratio of 80-85% would control costs. (This means that 80-85% of all dollars taken in by the insurers has to be spent on actual care or the excess is rebated to consumers) Just as many others argued that it would not and in fact provided a perverse incentive for insurers to secretly hope that costs go UP as that means the percentage of what the insurers get to keep goes up. ( Example - if your procedure costs 10K the insurers get to keep 2K. If your procedure costs 20K the insurer gets to keep 4K. Do you think the insurer would rather keep 2K or 4K?)
Another point that gets lost in the shuffle is that the ACA did nothing to actually lower the costs of insurance premiums - it just shared the costs between the individual and the government in the form of a subsidy. If your premium was 1000K a month your individual out-of pocket will go down appreciably because of the subsidy, and perhaps you will spend 500 and the government will spend 500. Great for you and me, but in the big picture sense, no cost cutting was achieved at all. Within the ACA is a provision that provides for automatic review for premium increases of over 10% a year. Whoopdy doo, folks. Will you be surprised when premiums go up annually at 9.9999%? Me neither.
Why is Emanuel only concerned NOW that we have the world's most expensive healthcare system? Does he ever talk to his brother who boasted that one of the signature achievements of the Obama administration was "preserving private delivery of healthcare"? (translation - we beat off the public option) Does preserving that private delivery system have anything to do with costs?
Question -Why does Emauel advance the false straw man from this first paragraph that "Liberals" don't care about cutting costs? Just more old-fashioned Emanuel family hippy punching? Boy, they never tire of it do they?
Now for paragraph #2
But liberals are wrong to ignore costs. The more we spend on health care, the less we can spend on other things we value. If liberals care about middle-class salaries, public education and other state-funded services, then they need to care about controlling health care costs every bit as much as conservatives do.
Wow! His thesis restated yet again - Liberals ignore costs. Did you know that? I didn't know that. As someone who pays over 12K a year out of pocket for my family health insurance I for one am very surprised that I don't care about costs. And it means I can't spend my money on other things? Really, you sanctimonious !@##$$
Further into the piece we finally get the admission that so many critics of the ACA have said from the getgo
But even with subsidies, some Americans will find rising premiums unaffordable and will be forced to opt out and pay the penalty for not having insurance.
Again no surprise to many but at least here Mr. White House Healthcare expert finally admits it.
I don't have the energy to go further with this. The entire piece is that 'liberals' don't care about cutting healthcare costs and they should because then we will have money for education and better wages. (gee, do ya think?) I have never read such a piece of straw man tripe in my entire life. I would just like to remind people that Zeke Emanuel is the father of the concept of voucherized Medicare, which is the darling central concept for Paul Ryan and the austerity mongers. It's a poorly disguised effort to dismantle and privatize and profitize the one sector of healthcare that actually works in this country.
Will you be surprised when that happens, pushed along smartly by the White House and Dinos in the spirit of bi-partisan sacrifice sharing? Me neither.
What do you think of Zeke Emanuel using a New York Times Op Ed piece to trumpet and further a lie that "Liberals" don't care about healthcare costs?