Rather than serious consideration of how to provide health care access to all, discussion of U.S. health care reform has frequently been reduced to political calculation, driven by big-money stakeholders.
Insuring Americans "is not the issue," declared Senate Minority Leader Mitch McConnell when asked on Fox News how Republicans will insure the numbers insured by Obamacare if they repeal it.
McConnell had previously described Republican priorities: "The single most important thing we want to achieve" is to limit President Obama to one term.
In the unreality show that is Washington, Republicans hold that the for-profit corporate health insurance model is a "government takeover of health care." In no other realm of reality is huge tax subsidization of insurance and pharmaceutical companies called a public "entitlement" -- Louisiana Gov. Bobby Jindal's description.
Speaker John Boehner defined President Obama's health care reform as the "government takeover of the entire health insurance industry" -- ostensibly objecting to any regulation of private insurances. Declared Boehner, "Obamacare will bankrupt our country and ruin the best health care delivery system in the world." Citing medical malpractice as "one of the big cost drivers in health care," Boehner disregards the one health care model that would eliminate litigation of future health care costs, while also controlling defensive medicine costs -- Medicare-for-All.
So fearful are Republicans of government doing anything well -- e.g., Medicare that maintains low overhead costs of about 3 percent, contrasted with private insurers' 30 percent administrative costs -- that they are willing to sabotage Medicare, or even President Obama's less efficient Affordable Care Act, at the cost of millions going without health care. Republicans hate the idea of subsidizing sustainable, cost-effective single-risk-pool health care like Medicare, but do not hesitate to funnel hundreds of billions of dollars of taxpayer-subsidized corporate welfare to the insurance and pharmaceutical industries -- a key element of so-called Medicare Part D Prescription Drug Reform, which also forbade Medicare from negotiating bulk drug rates with pharmaceutical companies (guaranteeing that Americans pay higher costs for medicines than other countries and the VA, which negotiates bulk rates).
Under the guise of so-called "market-driven" health care, Republicans who hyperventilate about alleged government involvement in health care willingly hold people hostage to corporate-controlled health insurance steered by "denial managers" who inflate their bottom line by denial of health care to the insured. Even as the "Denial Management" industry adds a reported $20 billion annually to health care costs, the private insurance industry are obstructors of health care for many, including 45,000 (a growing number) who die annually for lack of health care access.
Republican philosophy holds that health care is not a right for all, but a privilege for the few who can pay outright. Theirs is health care policy modeled on Wall St. economic policy that privatizes profit and socializes risk.
Unfortunately, the Democratic congressional leadership has followed President Obama's lead in capitulating to Republican hostage-takers in various negotiations over the previous year, by offering to deal away social programs, including Medicare and Social Security. At least $400 billion in cuts to Medicare benefits and reimbursements have been offered, as well as proposed increase of the eligibility age for Medicare and Social Security. Having been proffered, these proposals remain on the table for future negotiations. See Republicans (& Some Democrats) Killing Medicare to 'Save It'.
At the end of March, House Minority Leader Nancy Pelosi did an about-face, expressing support for the Simpson-Bowles proposal of the previous year, which was never voted out of committee. The plan that she originally called "simply unacceptable" for its cuts to social spending, Medicare and Social Security, she came to describe as "very bold" in March of 2012. Pelosi had moved to support even larger social spending cuts during the 2011 manufactured debt-ceiling crisis when the president offered Republicans just $800 billion in tax increases in return for the balance of a $4 trillion "grand bargain" to be achieved by social spending cuts.
Boehner and Republicans invoke the false mantra of "choice" around private insurance benefits, providers and hospitals. In reality, a single-payer or a single-risk-pool model like Medicare or improved Medicare-for-All offers full choice of providers and facilities, contrasted with private insurers that each maintain a limited network of providers and hospitals from which to choose. A "choice" of insurances, whether across state lines or not, does not equate to health care access. Due to high overhead costs, private commercial health insurance has increasingly become a choice of under-insurance with rising costs and decreasing benefits.
The focus on a mandate to purchase insurance is one more distraction from the serious discussion about how to achieve true universal health care for all while controlling costs. Washington denial runs deep as they disregard more than 20 federal and state studies of a single-payer, Medicare-for-All model since 1990: annual federal savings are $400 billion or more, with provision of health care for all. Even with passage of the Affordable Care Act, the Congressional Budget Office has estimated that 23 million in the U.S. will remain uninsured in 2019.
Health care policy is yet another vehicle with which Republicans seek to advance their 30-year goal to shift wealth upward while decimating social programs like Medicare, Medicaid and Social Security, as well as democracy itself. As Doctor of Political Economy Jack Rasmus explains in "The $4 Trillion Income Shift", the Washington consensus has sought to shift $4 trillion of wealth upward in the form of tax cuts for the rich over the previous decade, to be paid for by $4 trillion in budget cuts disproportionately taken from programs benefiting the working/poor over the next decade. Democratic leadership has abetted the wealth shift by failing to stand for the working class, and offering to compromise away social programs in which working people are invested, like Medicare and Social Security.
Like much of election-year dialogue, the rhetoric around health care has more to do with obfuscation than reality, as entrenched wealth and corporate interests dominate both major parties. Both parties have abandoned working people, creating what some describe as a "vacuum in U.S. politics."
Presidential debates, too, are engineered by the Republican-Democratic Party duopoly, which formed the Presidential Debate Commission to replace the independent role of the League of Women Voters, and control all aspects of debates, from format to venue to who participates. Democratic participation has been further compromised by reduced ballot access for candidates in many states. Corporate media profit from huge sums of money invested in inane 30-second political ads intended to distract rather than inform. Sorely needed is expanded dialogue and free media that engages all serious candidates in honest debate. Rocky Anderson of the Justice Party and Green Party candidate, Dr. Jill Stein would bring a perspective that has been missing, and doing what the media has failed to do -- keep the discussion honest. The media should be held to a standard that serves the people rather than basely extorting every last bit of cash from a broken electoral system.