March 8, 2010


(Watch the video here)

Honestly, at this point, I don't even care whether or not this crappy healthcare bill passes. I see so many serious problems with it, and I simply do not have any trust in the integrity of the Obama administration and the commercially-sponsored Congress to fix them.

The only reason I can see for supporting the bill is political - and no, I don't think that's an insignificant reason. (I'd guess it's the only reason Wendell Potter still supports it.) However, as Dr. Marcia Angell points out, the bill is such a confusing mess, what are the odds that its passage will work in the Democrats' favor? It's a complete and utter crap shoot, and for that, I blame the consistent lack of leadership from the top. I have never been so disgusted with the political process in my entire life:

From Bill Moyers Journal:

BILL MOYERS: So, has President Obama been fighting as hard as you wished?

MARCIA ANGELL: 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.

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.

BILL MOYERS: But given that, why have the insurance companies, health insurance companies been fighting reform so hard?

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.

BILL MOYERS: But this is all about politics now. It's not about pure health care reform. So given that reality, what would you have the President do?

MARCIA ANGELL: Well, I think you really do have to separate the policy analysis from the political analysis and I'm looking at it as policy. And it fails as policy. Moreover, a lot of people say, "Let's hold our nose and pass it, because it's a step in the right direction." And I say it's a step in the wrong direction.

You're right. Politics is different and there are a lot of people who say, "Look, it's a terrible bill. Even a step in the wrong direction as policy goes. But we need to get Obama elected again and we need to continue with the Democratic majority in Congress. And so we need to give Obama and the Democrats a win. If we don't, the Republicans will come in and take over Congress in the fall, and then the White House in 2012. But the problem with a political analysis is sometimes you're right and sometimes you're wrong. And Democrats and particularly liberals have a history of outsmarting themselves.

And I'm not so sure that if this bill goes down, it's going to make it any harder for them politically. So I think it's difficult times for the President and for the Democrats. But if you look at it as a matter of policy, the President's absolutely right that the status quo is awful. If we do nothing, costs will continue to go up. People will continue to lose their coverage. Employers are dropping health benefits. Things will get very bad. The issue is will this bill make them better or worse? And I believe it will make it worse.

BILL MOYERS: The President, with all due respect, would disagree with you. Let me show you something he said--


BILL MOYERS: --in his speech on Wednesday.


PRESIDENT BARACK OBAMA: My proposal would bring down the cost of health care for millions, families, businesses, and the federal government. Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people's premiums and brings down our deficit by up to one trillion dollars over the next two decades. Brings down our deficit. Those aren't my numbers. Those are the savings determined by the Congressional Budget Office, which is the Washington acronym for the nonpartisan, independent referee of Congress.

BILL MOYERS: Not good enough for you?

MARCIA ANGELL: Well, first of all, you have to look at what the CBO is looking at.

BILL MOYERS: Congressional Budget Office.

MARCIA ANGELL: Yes. They're not looking at the cost to the system as a whole, to the larger system. They're not looking at the private system. They're simply looking at the federal budget as a budgetary item.

BILL MOYERS: Right. They look at the government--

MARCIA ANGELL: The government part of that. 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. So that's the first thing. The second thing is the CBO has to build in assumptions. And those assumptions are arguable, to put it mildly.

And as far as cost-cutting, there are sort of promissory notes. ˜We'll get a committee to look at the cost of effectiveness, of various medical procedures.'

BILL MOYERS: Well, you remind me 45 thousand people, as Wendell Potter said earlier, die every year for lack of health insurance. That should be-- they're--

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.

BILL MOYERS: But, the very poor do get Medicaid.

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.

BILL MOYERS: Is there anything else in there you like, in the Obama plan?

MARCIA ANGELL: Oh yeah. I mean--


MARCIA ANGELL: First of all, the intention is very good. The expansion of Medicaid is very good. Raising the age of dependents to 26, and saying that they have to be covered under parents' plans. I think that's very good. Looking at the cost-effectiveness of various procedures is a good thing to do in its own right.

So yes, there are things in it. But the bill as a whole, the more I look at it, the worse it gets. It's going to increase costs, not decrease them. And it's going to increase the rate of growth. It's not going to bend the curve, except in Medicare.

I think in order to look at a reform and to measure a reform, you have to look at the problem it's designed to answer. You have to look at what's wrong with our system, in order to evaluate a reform. You have to ask yourself, "Why is it that we spent over twice as much per person on health care and yet don't manage to cover everyone?"

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