This is one way to summarize of the health care reform we got:
At the J.P. Morgan Health Care Conference in San Francisco this week, major health insurers outlined the major expansion opportunities they see in the health reform law.
It is a shame that so many reporters who probably essentially get it, have to play dumb, so as to maintain their mainstream credentials. Call it the health care reform version of:
Did you know that health care reform as we actually got it, is a boon to the health insurance industry, wall street and much of corporate America?
Well if you were following the debate here or even here you did all along. And now if you read the mainstream press, you can learn so again.
As Sarah Kliff of Politico reported it, "Investors see health law's potential":
The Congressional Budget Office estimates 32 million Americans will gain health insurance by 2019 if the law stands. For health insurers, that represents a potential boon for both their individual market business as well as in the Medicaid market, where states regularly contract with private insurers to manage care.
snip
But investors say they’re increasingly optimistic on health insurers’ future for two crucial reasons: regulations released this year have been relatively industry-friendly, increasing stability, and the health reform’s new business opportunities are beginning to look more tangible.
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Numerous other outlets including the always "reasonable liberal" Ezra Klein, Mother Jones and others have been running variations of the story out of that J.P. Morgan Health Care Conference in San Francisco this past week.
But as I will argue at the end, they are mostly missing the point.
While the lobbyists in D.C. do their job, back at that JP Morgan health investors meeting the actual
Health insurers spent barely anytime discussing Republicans’ repeal efforts. Aetna’s Zubretsky touched on the subject briefly only to say that Republicans understand that a rifle shot approach to tearing out specific health reform provisions, particularly the individual mandate, would not bode well for their business.
Zubretsky said Aetna has been in touch with the GOP on the issue and "believe the Republican leaders we’ve been talking to understand the consequences of decoupling the mandate from the guaranteed issue."
As Aaron Carroll reads the tea leaves:
You have often heard those who favor reform complain about the power of the health insurance industry. I think those who favor repeal are about to feel it.
Me... I am shocked, shocked to learn this is going on.
And it is not just the forced new privatized enrollees, much of whose premiums going to the insurance companies are tax payer dollars.
Remember that the Medicaid expansion is at least as big a part of the expansion of health coverage as anything else?
Medicaid also presents serious growth opportunities. The program will expand to cover everyone below 133 percent of the federal poverty line and, as the Wall Street Journal first reported, insurers are actively pursuing contracts with states to manage their Medicaid plans. As Aetna’s Zubretsky put it, "Medicaid is going to be a critical component of our business model with 17 million joining that program."
Molina Healthcare, a company that has a large book of business in Medicaid, listed the millions of Americans who will become newly-eligible for Medicaid as a "health reform growth opportunity" in an investor presentation.
Oh, goody, more chance to skim off tax payer money from actually going to health care.
But it is not just that meeting of insurance companies and wall street.
As Felix Salmon reports, in seeming contrast to the Chamber of Commerce and National Federation of Business lobbyists, the good face of corporate America on health care issues is National Business Group on Health:
...a collection of nearly 300 big employers, President Helen Darling, a former corporate-benefit administrator and Republican Senate staffer, says about executives who call for repeal: "If they really understood it, they wouldn’t."
As David Wessel, concludes in his Wall Street Journal piece:
"Talking about repeal of the health law may be a winning political strategy for Republicans, a rare way to please both workers and business executives. As long as they don't actually succeed in doing it."
NPR and Kaiser News had this earlier:
Republicans made major gains in the midterm election, running vowing to "repeal and replace" the health law passed with solely Democratic votes earlier this year.
But while a large majority of GOP voters told exit pollsters they strongly support the idea of starting from scratch on the health overhaul issue, major players in the health care industry — usually strong Republican allies — are a lot less enthused about the idea.
"No one has said what this bill would be replaced with," said Richard Umbdenstock, president and CEO of the American Hospital Association. "But doing away with this would certainly be the wrong thing. ... People have been gearing up for some time, well before this actual bill got passed,
to make these changes locally, and have invested a lot."
snip
That's not to say that the health care industry loves the law. No segment of the industry got everything it wanted, and everyone is busy lobbying for something to be changed.
"There are plenty of opportunities for improvement, fine-tuning and actually adding some significant enhancements, especially in controlling costs," Darling says.
The health insurance industry, in fact, wants to make more than just fine-tuning changes. It's been among the most outspoken critics of the measure. But even insurers haven't come out in favor of scrapping the whole law and starting over — particularly not when it stands to get millions of new customers.
[duh]
"We're looking forward to working with both parties to minimize coverage disruptions caused by the new law and to make health care coverage more affordable for working families and small businesses," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.
So are Republicans being abandoned by their usual allies in the business community? Not exactly, says Jonathan Oberlander, who teaches health policy at the University of North Carolina, Chapel Hill.
"Usually we think of the health industry as being in alliance with Republicans and opposing more government intervention in the health care system," Oberlander says. But you have to ask why did the industry support the health reform law in the first place?"
He says the reason is that the more people there were without health insurance, the more that threatened the industry financially. In other words, its entire business model was about to fall apart.
"The health care industry needs paying customers and insured customers to make that business model work," he says. "To the extent that Republicans push repeal, they are threatening the bottom line of the health care industry, and I think they're going to find that many elements of the health care industry are going to oppose repeal."
Or you could have read it here two years ago.
As Jonathan Cohn reminds us:
None of this should be surprising. One of the main reasons so many politicians started talking about health care reform in the run-up to the 2008 election was the recognition that everybody in the system was fed up. It wasn't just individual consumers and employees, struggling to pay for their coverage and--when it lapsed--their medical bills. It was employers struggling with the costs of their benefits. Doctors and hospitals struggling with the cost of uncompensated care. And so on. When President Obama began to pursue reform formally in 2009, he and his allies on Capitol Hill reached out to these groups: The result was a plan that embraced their ideas and accommodated their concerns.
I'd be lying if I said I was entirely happy about this. In many though not all cases, what's good for business groups isn't so good for the rest of us. Employers care a lot more about minimizing benefit costs, for example, than they do about making sure benefits are adequate. I also continue to think the pharmaceutical industry ended up with a sweetheart deal.
Meanwhile Wellpoint wants us to know that they are collaborating well with the Obama administration:
Speaking on Monday, CEO Angela Braly framed health reform as a collaborative project with the Obama administration.
"We’re working collaboratively with the administration and intend to continue to do so," she said. "We have brought to them input both from our voice and our consumer advisory group, and they give us a lot of feedback. Our job is to work very carefully with the administration and Sebelius to get the answers to our consumers."
Are you as curious as I am about the real composition and role of this for-profit health insurance stock company's "consumer advisory group."
Conclusion - What all of the above are missing:
This was the script all along.
Can the mainstream reporting please stop pretending that there was ever any intent by corporate America, especially but only the Health Insurance Companies and Wall Street (but I repeat myself), to repeal the individual mandate. Can they please stop pretending that no public option and the individual mandate is what they wanted all along and, surprise, it is what they got.
There is no surprise or discovery or awakening. It is what it was all along. And they (the insurance companies, wall street, corporate America) have known this all along.
The mandate, more of your out of pocket money and tax payer money (the subsidies to buy private insurance, more managed Medicaid, continued managed Medicare) is all a matter of getting more money into the system to go to them. It is also helpful to their profitability, just as Medicare and Medicaid have been all along, to take more of the actual sick (elderly, poor) out the private sector insurance risk pool (by expanding Medicaid; high risk pools, etc.) and shift just them to the public sector risk pool. This is what they wanted, lobbied for, and got all along.
And of course the other game being worked is to make sure that the regulations and implementation are as favorable as they can make them. Compared to the reporting on lobbyist in congress, what is grossly under-reported is the level of lobbying at the agency level. Ezra Klein points this out recently, though of course Don McCanne pointed it out a while ago
The above is the economics and micro-politics of what seems to be going on.
To focus on just the apparent disconnect between the insurance companies wanting the individual mandate, and the right wing campaign against it that is not really going to happen, is to miss the point.
The big picture politics, the real goal is, was, always has been, to make progressive policies look bad, to demonize the left, and to elect politicians who will GIVE THEM ALL THE THINGS THEY REALLY WANT: To cut taxes, reduce regulation they don’t like, and not enforce the regulations that remain. And of course not just health care, but labor rights, environment, all of it. Those tea party republicans who ran on health care repeal, will be there as reliable votes on all the other stuff. Surprise.
A marketing strategy to generate "populist" anger against things that are not actually true (government takeover of health care, death panels, etc.) serves that purpose. So does attacking bad things that are both true and unpopular, such as the individual mandate. So long as it does not actually happen.
At the higher level, Wall Street and big business and the nasty super rich are all the same players, just showing different cards at different times. Sometimes it is the FreedomWorks or the Chamber of Commerce.
But when it is useful, they trot out the reasonable business folks like Ms. Darling when it suites them. And don’t get me wrong, many of the folks at the business roundtable on health care (at least partially) sincere about wanting to improve the health system for their workers. But their parent companies are knowingly playing a double game by also supporting the Chamber of Commerce and FreedomWorks and the rest. What you won't see is the business roundtable on health calling out the right wing lies and playbook before the election. You won't see them supporting real reform like single payer or even a strong public option, when the political fight really mattered two years ago.
At best they are rich selfish ideologues to the extent that they actually believe what they say. But mostly they are rich selfish hypocrites, who just say anything that works for them
Wall Street and Corporate America will get to have its cake and eat it too.
But remember that every dollar of their profit and inefficiency is both one less dollar for care and one more dollar out of your pocket.
They got cake, we got crumbs.
Peace & Health
