Democrats on Crack

First, the supposedly good things about the bill seem more akin to promises than requirements. We're told that the bill, for example, will require private health insurers to accept new clients with pre-existing conditions. Great! But what does that mean, exactly, and what penalties might be imposed (and by whom) for non-compliance? In all the discussion I've read I haven't seen anything — not a single word — about enforcement. A bill with no teeth is, well, toothless, and will be observed only in the breach. Given the larger context of Washington's give-aways to the corporate system it makes no sense for a mature adult American to believe that in this case compliance by the health industry can be expected to happen on a purely voluntary basis. (I would've liked a round-trip airplane ticket to Kathmandu for Christmas but, alas, I didn't get one.) Everything supposedly good about the bill is a fudged promise: it's a measure of how desperate people are to have something — anything — in the way of health care relief provided by the government that they're willing to suspend normal, reasonable skepticism for such obviously empty promises.

Second, there's nothing in the Senate bill that I have heard of that has to do with cost controls. The bill hands the health insurance corporations a blank check. It would, again, be very un-adult of us to expect these corporations not to raise prices as fast as ever they can. If the Senate bill were enacted into law it's fair to predict that it will result in a speeding up (perhaps dramatically) of the rate of increase of health care costs.

Third, the bill has many obscure provisions that haven't been debated in Congress, that remain unknown to 99% of the public, but that might well turn out to be extremely problematic. To take just one example — and I can't find a recent analysis of this or I'd provide a link — the bill seems to set up a "fast-track" system for future Senate votes on Medicare cost increases, a provision likely intended, and likely to be used, for severe cuts in Medicare. Jamming a six hundred page plus bill through the Senate, a bill that's written mainly by lobbyists, doesn't really do anybody but the lobbyists any good.

Which gets to the fourth point. Who do the Democrats think they're kidding?? Having fully prostituted themselves to health insurance and pharmaceutical lobbyists, do they really think that their "compromises" are going to "improve" health care delivery? And if they don't think so, do they really believe that nobody's going to notice that their "reform" is nothing but a miserable failure?

The subtext of this point has to do with the argument that if any bill is passed then later on it can be improved. Proponents point to civil rights legislation, social security, or other essentially desirable public policies that have grown stronger over time. A more apt precedent, however, may well be the sort of anemic welfare programs that have bounced over the years from agency to agency while being systematically dismantled on a bipartisan basis. Does anybody remember President Clinton's welfare "reforms" (which prompted the resignations of Peter Edelman, Mary Jo Bane, and others)?

And this brings up a final point. It's not a good idea to make "the market" the foundation for health care policy. By further institutionalizing "market" mechanisms this bill, if it were to become law, would make real reform much more difficult to accomplish and would, I believe, significantly delay the inevitable adoption of the kind of system that all other civilized countries have long had.

Odds are the Democrats will get their wish. Having bought off the supposed liberals Bernie Sanders and Russ Feingold in the Senate, the liberal pipsqueaks in the House should be a piece of cake. OK. The Democrats, to partly mix metaphors, will reap what they sow. I have no pity to spare for when the furious public backlash hits them and I'm pretty sure that this one will be a doozy.

Hopefully the Republicans will successfully contest the constitutionality of the mandate. Possibly — hopefully — some liberals will join with them. Jane Hamsher has already started down that path and more power to her!

[Update: It's not easy to find the final text of the Senate bill. The Thomas search engine hasn't got it yet but several news outlets have copies. Here's the one from CNN (.pdf). The file is searchable. If you look, for example, for the word "fine" it doesn't appear often — only once, that I could see (excluding words the search produces such as de-"fine"), in the context of a fine for individuals who misreport their status. Same thing for "penalty," another word whose absence is quite astonishing. "Penalties," plural, occurs three times, once benignly and ambiguously for corporate over-charging on drugs, twice harshly (once as a criminal penalty) for individual non-compliance. The beneficial "requirements" imposed on corporations that the press is talking about seem virtually nonexistent.]