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Why Obamacare Sucks

Re-POST of 1/18/11

So the interest in repealing Obamacare means some strident Republicans claim it is too unfair to corporations and want to eliminate the pathetically limited protections it offers the citizenry.

It is chock full of citizen pitfalls and corporate aggrandizements but that is not enough for the corporate overlords who want the last molecule of profit-making they can on the backs of American citizens or the Republican kabuki artists who wail just to wail because that is how they play the game.

The tepid media response from those who now pass as "progressives" (since real progressives have been disenfranchised long ago by the Obama administration and the corporate media) is Obamacare must be defended. Tepid, because it is hard to get passionate about a Trojan Horse law that aids and abets the profit-making of the insurance industry vendors. That blocked a universal health care system that would have been the tide that raised all citizens' boats in these dark times. That would have cost us all a hell of a lot less, 6% out of our payroll taxes, wasn’t it? That would have saved us and our families the upcoming economic and physical slings and arrows -- expensive and possibly critical (as in gratuitous suffering and death) ambushes -- those realists among us are having nightmares about.

But the disinformation campaigns of both parties aided by a craven corporate media worked their evil magic on a citizenry that got played, played, played. That turned on each other and lost the benefit of universal health care that most every other industrialized nation enjoys, while paying a lot less for it. Listening to Keith Olbermann and Howard Dean last night express impatience with the “repealers” rang hollow for me when it was the Obama administration and a Congress on both sides of the aisle that aided and abetted the collective screwing of the citizenry in terms of affordable health care. Along with the lemming mentality of the obtuse tea partiers on one side and the public option pragmatists on the other.

In July of last year Dr. John Geyman in pnhp (Physicians for a National Health Program) did a concise assessment of the Orwellian-named “Patient Protection and Affordable Care Act of 2010” (PPACA). The healthcare legislation investment will be $1 trillion over the next 10 years, ensuring the health of the health insurance industry far more than average Americans.

Here are first the profound negatives and then a few positives according to Geyman's analysis:

On the negative side of the ledger, however, these are some of the reasons that the PPACA will fall so far short of needed health care reform that it is not much better than nothing:

• Surging health care costs will not be contained as cost-sharing increases for patients and their families.

• Uncontrolled costs of health care and insurance will make them unaffordable for a large and growing part of the population.

• At least 23 million Americans will still be uninsured in 2019, with tens of millions more underinsured.

• Quality of care for the U. S. population is not likely to improve.

• Insurance “reforms” are so incomplete that the industry can easily continue to game the system.

• New layers of waste and bureaucracy, without added value, will further fragment the system.

• With its lack of price controls, the PPACA will prove to be a bonanza for corporate stakeholders in the medical-industrial complex.

• Perverse incentives within a minimally-regulated market-based system will still lead to overtreatment with inappropriate and unnecessary care even as millions of Americans forego necessary care because of cost.

• The “reformed” system is not sustainable and will require more fundamental reform sooner than later to rein in the excesses of the market.

Geyman examines why the reform effort got so offtrack:

• The issues and policy options were framed as the political process was hijacked by the very interests that are largely responsible for today’s cost, access and quality problems in health care. As examples, the drug industry lobbied successfully to avoid any price controls of drugs, as the VA does so well; the insurance industry avoided real rate controls over their premiums and ended up with other loopholes to game the new system; and all of the corporate stakeholders will gain subsidized new markets without significant regulation of the market.

• The quest for bipartisanship was futile as reform got run over in the middle of the road. The big questions cannot be answered in the political center, such as whether health care should be a right or a privilege, or whether health care resources should be allocated based on ability to pay or medical need.

• Market failure was not recognized as the wellspring of our system problems. When it was agreed to “build on the strengths of the present system” instead of more fundamental reform, corporate stakeholders and their lobbyists found willing legislators to craft centrist “remedies” which could be sold to the public as  reform. But the various incremental tweaks of our existing system, such as employer and individual mandates, have failed over the last 20 or 30 years to remedy cost, access and quality problems. 

In the absence of real health care reform, we can now expect these kinds of unfavorable outcomes in coming years:

• soaring costs without effective price controls throughout the system.

• managed care fails to control costs or improve quality.

• persistent financial and other access barriers for many millions of Americans.

• growing backlash by physicians and consumers.

• gaming of private plans and adverse selection in public plans.

• consolidation among hospitals sustaining high prices.

• increased cost-sharing for employees as employers cut back benefits.

• continued high levels of inappropriate and unnecessary care.

• added bureaucracy and waste in an even more fragmented and dysfunctional system.

Geyman gives the devils their due on the postiive side of the ledger. Good as far as they go, but way too few, limited and/or belated:

• Will extend health insurance to 32 million more people by 2019.

• Provides subsidies to help many lower-income Americans afford health insurance.

• Starting in 2014, expands Medicaid to cover 16 million more lower-income people.

• Provides new funding for community health centers that could enable them to double their current capacity.

• Eliminates cost-sharing for many preventive services.

• Phases out the “doughnut hole” coverage gap for the Medicare prescription drug benefit.

• Will create a new national insurance plan for long-term services: Community Living Assistance Services and Supports (CLASS) program.

• Will establish a nonprofit Patient-Centered Outcomes Research Institute to assess the relative outcomes, effectiveness and appropriateness of different treatments.

• Initiates some limited reforms of the insurance industry, such as prohibiting exclusions based on pre-existing conditions and banning of annual and lifetime limits.

• Contains some provisions to improve reimbursement for primary care physicians and expand the primary care workforce.

Thank God for these, but again, the negatives vastly outweigh the positives.

Geyman points out that most industrialized nations have learned many years ago that free-marketing health insurance programs perpetuate overwhelming health care burdens for a population. These more pro-citizen nations (as opposed to our present anti-empathy US government) at the same time spend a lot less on health care than we do in spite of this protective and regulating role of government. Why would a working government be regarded as evil when it exercises its capacity to ensure sustainable and better quality of care for ALL citizens. When it puts people over profits -- over gratuitously massive profit-making? When did most of our citizenry get so mean-spirited they lost all sensibility of a “common good”? Why are so many so short-sighted they confuse any government action with "bad" government action? They -- we -- got played, played, played by corporate overlords, pimped politicians, and a corporate-owned media.

Geyman writes:

There is a fix in plain sight for our problems — single-payer financing coupled with a private delivery system. The private insurance industry has outlived its usefulness, and is only being kept alive by government subsidies, whether by overpayments of private Medicare plans or this latest provision in the PPACA to pay out nearly half of a trillion dollars in subsidized premiums for their inadequate coverage.

When will we have the political will to face up to our real problems in health care and show that the democratic process can still work?

When will the political will happen, indeed, Doctor. Code name for the intelligent citizens who fathom the universal health care answer in America is “Rumplestiltskin”. You know, like that fairy tale character. The media, Obama, both legacy parties refuse to utter our name and undemocratically crush our political will. Including the so-called progressive media now "tching, tching" the present repealers, pretending that Obamacare ever seriously cared. I hope future generations get it and are not as obtuse as the majority in this one was.

The good news for Obama and those stupid enough to think that support for Obama is a substantial support for any of us is that he will get his corporate payoffs, as will also those back-stabbing Congresspeople on both sides of the aisle, for the elections of 2012.

Oh goody. More kabuki and betrayal. More ebbing tides for the citizenry.

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Geyman's article at pnhp from “Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform,” 2010, with permission of the publisher Common Courage Press. http://commoncouragepress.com/index.cfm?action=book&bookid=402

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malagodi's picture
Submitted by malagodi on

Gotta agree completely.

Geyman's point that "The “reformed” system is not sustainable and will require more fundamental reform sooner than later to rein in the excesses of the market" is essentially what Rick Ungar at Forbes is saying; that some ACA measures like the medical loss ratio and underwriting provisions, coupled with the inability of ACA to address all the negative points Geyman makes will lead to the end of the present private health insurance industry as we know it.

Ungar believes that smart money will abandon the industry, leaving the government, perhaps by extending Medicare for All, as the only source with capital enough willing to be in the business. In this way ACA may be the pathway to universal care, not because it was designed well, but because it wasn't.

I'm not sure I share his confidence in the straightforward road ahead, but I do think that we'll actually be in a better position to advance single-payer as the limitations and outright failures of ACA become more apparent.

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