So I have given this post a somewhat hyperbolic title. But not as much as you would think. The Senate Finance Committee voted down the public plan today, and because I was driving around Maricopa County Arizona (all 9200 square miles of it) for a good part of the morning, I heard the good, the bad, and the ugly about the debate. Snippets that I caught included:
"There is no competition among insurance plans in 95% of the states. Two insurers rule the market."
"The doctors, at least the ones I've talked to, don't want to be paid Medicare rates."
"Medicare has a $37 trillion unfunded liability. Does anyone even know how much money that is?"
""A public option won't mean government run health care this year, or maybe even next, but just wait until 2013 or 2014."
A few hardy Democrats tried to say the people wanted a public plan, but they were beaten back by one Senator saying
"I don't even think these people shopping for a public plan or a private plan even know what they're buying."
And someone else said, "the person whose doctor says get an MRI is in no position to judge whether he needs iit or not. He has to trust the doctor."
These snippets tell me we are nowhere near a consensus on what health care should be like in America, much less how to get there.
Eons ago, Steve Gillmor told me that if we got nothing out of reform but an end fo rejecting people for pre-existing conditions, we would have achieved a lot. At the time, I thought that was nothing. I now totally agree with him, and believe that in the current climate, the Democrats are lucky to escape with their shirts.
The lack of a coherent plan that people could rally around has left Obama in the dubious position of violating his own dictum: "Strategy first, then resources." If that's good enough for Afghanistan, it should be good enough for health care. If we pass reform this year, we will be throwing resources at a non-strategy.
You can tell I'm a registered Independent, or as that is translated in Arizona, "no political party." Having a choice of Republican, Democrat, Green or Libertarian, I opt out.
I agree that there is no competition among health plans. I remember when there was, and no one could get enough traction to justify the expenses of operating, so different plans gradually withdrew from certain states, other companies merged and acquired and consolidated, and now we have what we have.
I also agree that Americans cannot have everything and pay nothing, and that rationing is a part of every health care system and should be brought out into the open and discussed. It's not the province of the public plan; in fact, one reason that Medicare has so much financial trouble is that Medicare rations much less viciously than private plans.
We've had almost a year of debate based on half truths, circumlocutions, slogans, and bull-oney. Now we're here. No matter what happens henceforth, the Democrats will lose in 2010, probably Obama will lose in 2012, and health care costs will continue to rise. We have wasted an entire year of lobbyist time, company money, and consumer trepidation for nothing. All we've done is show that on the health care side our government is as broken as it is on the banking side.
Is your credit card interest rate 29.99% Is your house under water? Can you get in to see a doctor? Is your doctor happy with his or her occupation?
Money wins. Doctors and patients lose. And I am disappointed because I really thought Obama was talking change.
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