When you read the poll numbers indicating that a majority of respondents disapprove of what can now safely be called “Obamacare” (since the President has finally made it clear what he thinks should be passed through reconciliation), it must be remembered that a large portion of that disapproval is coming from the left – from those who would prefer a single-payer, non-commercial health insurance system, often referred to as “Medicare for all”. One of the more articulate spokespersons for this view is Dr. Marcia Angell of the Department of Social Medicine at Harvard University Medical School. I happened to watch part of her latest interview on Bill Moyers’ show last night as I was channel surfing, and was impressed (and depressed) by her analysis of the bill presently being considered by Congress (roughly, the Senate bill plus President Obama’s recommended changes). I recommend that you watch the entire interview (about 15 minutes long), but here’s part of what she said:
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.
The counterargument, of course, is that if you have the framework envisioned by the current bill in place, and costs indeed spiral out of control, then at least it is far easier to add a public option to the mix, and perhaps to eventually move to a single-payer system. Angell isn’t buying that scenario:
MARCIA ANGELL: I think the problem is this, Bill. If this plan is passed, and I think there’s real doubt as to whether it will be, and there’s even more doubt as to whether it would ever be fully implemented, but let’s say that it’s passed. It will begin to unravel almost immediately. And then what will people do? Well, they’ll say, “We tried health reform, and it didn’t work. Better not try that anymore.”
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.
BILL MOYERS: What makes you think it would come back in 16 years or more? What makes you think it will ever be back on the table?
MARCIA ANGELL: Oh, I think it has to be. I mean, I think that this system is unraveling so fast, doing nothing or doing the Obama plan, so fast, that something will have to be done. Unless we want to, you know, explicitly be a third world country. So I don’t think it’s going to wait. But if we pass this plan, it’s going to delay.
Like I said: depressing.