First, there was Hillarycare. Then, there was Obamacare. Now, weve reached the bottom of the barrel, scraped it, and come up with the answer to no ones health-reform dreams. Are you ready? Democrats, with a 79-vote majority in the House, a 20-seat majority in the Senate, and the White House securely in hand, have labored mightily and brought forth a mouse. Theyre on the verge of enacting something that can only be called Baucuscare, after the DINO (Democrat in name only) Montana senator and Finance Committee chairman who has fathered this bastardized version of a health plan.
The key to Baucuscares tentative provisions is that, for all intents and purposes, it has no provisions at least of the sort most Americans, and especially Democrats, thought they were getting. Almost the entire sorry spectacle called the American health-care system its really a non-system will remain intact. The minimalist reform envisioned is likely to include something about preexisting conditions and portability, as well as a big, fat individual mandate (but no employer mandate) requiring the uninsured to get privately insured at their own expense, with a few niggardly subsidies thrown in for the poorest among them. Baucuscare will include no public option, however, and therefore little in the way of price competition for the private insurers, who have individual quasi- monopolies in many states.
The Finance Committee bill, which has become by common consent the Senate bill, carries the imprimatur conferred by bipartisanship. That makes tinkering with it, or substituting something else for it, taboo in the eyes of the punditocracy and, it appears, the Obama administration. This bipartisan fetish means the final Democratic health-care legislation will have been written by a coalition of conservative Democrats and Republicans, specifically the so-called Gang of Six of lore and legend. The senatorial Gang of Six (sounds like something out of Maos China) includes Democratic Blue Dogs Baucus, Kent Conrad of North Dakota, and Jeff Bingaman of New Mexico, himself a heavy investor in the healthcare industry with $150,000 in stock holdings. On the Republican side are Chuck Grassley of Iowa, the committees ranking minority member, Mike Enzi of Wyoming, and Olympia Snowe of Maine. Virtually all are skeptics of direct government involvement in health care.
Grassley, Baucus alter ego, is on record against any public option, especially if based on Medicare, which he evidently despises. Snowe wants a moratorium on the public option pending future health-insurer misfeasance or malfeasance. Chairman Baucus set the tone for the proceedings by declaring the single-payer approach out of bounds from the start and expressing his own public-option doubts. And Conrad has surfaced as the author of a cooperative alternative to the government-run public option, the latest effort to avoid facing health-care reality.
Knowledgeable non-politicians who have thought seriously about health-care coverage know that a federally run single-payer system is what is really needed and what, sooner or later, will have to be adopted; nothing less will reverse the downward momentum of a profit-ridden system dominated by insurance companies, which is rapidly spiraling out of control. In the meantime, however, the political class, wedded to the corporate model and dependent on health-industry campaign funding, will twist itself into a knot to avoid doing what obviously needs to be done, resisting even the stopgap public option.
The fact that former congressional staffers are among those lobbying their former bosses on the health-care issue is playing a prominent role here. Five of the Gang of Six, for example, have former aides working the halls of the Senate on behalf of pharmaceutical firms, HMOs, hospital chains, and other health-care companies; they include two former Baucus chiefs of staff and health-policy advisors to both Grassley and Enzi. This is undoubtedly why the Baucus gang has seized so enthusiastically upon the cooperative notions of its charter member Conrad, whose nongovernmental solution offers one last opportunity to preserve the dominance of corporate for- profit medicine while appearing to do something constructive for the public in the way of a nonprofit health option.
Since their creation in Great Britain in the mid-19th century, cooperatives (enterprises owned, supported, and operated by those using their services) have had a somewhat checkered past. Theyve been quite successful on a relatively small scale, especially in producer activities like agriculture and rural electricity, less so as larger mutual entities in fields such as banking and insurance. Co-ops tend, by their nature, to be localized operations, springing up spontaneously to address local problems and conditions (farm prices, for instance) and tending therefore to be limited in scope; they cant be readily imposed from above.
Health cooperatives would almost certainly be intrastate or regional enterprises unlikely to compete effectively with the giant Aetnas and UnitedHealth Groups of the world. Conrad himself admits that a viable health co-op would need a minimum of 500,000 members to negotiate lower rates with medical providers. And the whole start-up process remains vague and uncertain, dependent on local initiative and an infusion of federal seed money ($3 billion has been proposed), much like sponsored experiments in alternative energy. The bottom line: Americans have little experience with health co-ops; their establishment would be a crapshoot.
Nevertheless, Senate Blue Dogs like the idea of cooperatives because they are not government-run and pose little potential impact on either the federal deficit or the $260 billion nationwide health-insurance industry, which would eat the co-ops and their tiny market share for lunch. Even should they increase in size, health co-ops would remain malleable and subject to market forces. Nonprofits can easily evolve into investor-owned companies; numerous credit unions (a form of cooperative) have done so since the late 1990s, as have many mutual banks and insurance companies. There is also a distressing tendency for co-ops to diverge from cooperative principles and lose touch with their members as they become larger and more remote, thereby defeating their very purpose and undermining their competitive stance versus the for-profits.
None of this disturbs the Senate Blue Dogs, secretly formulating Baucuscare inside their exclusive kennel while other Democratic Finance Committee members, as offended West Virginia Senator John D. Rockefeller IV has revealed, cool their heels outside. Something smells here, perhaps because a Blue Dog is really nothing more than a skunk with blue fur.
Wayne OLeary is a writer in Orono, Maine.
From The Progressive Populist, October 1, 2009
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