Thursday, November 21, 2013

Left opposition to Obamacare

It is partly true that Obamacare is a Republican plan or "Republican-inspired" plan, but that insult -- and I am guilty myself at times -- obscures some very significant differences that are worth noting before we take off advocating, "The best thing that could happen would be a quick and total collapse," -- which is reckless and inhumane, besides being juvenile.

Here's a historical fact: When Massachusetts passed "Romneycare" it was Democrats who dominated the legislature and overrode several Romney vetoes of aspects like the employer mandate to provide insurance.  Romney also advocated that nobody, no matter how poor, should get health care for no cost at all and instead promoted the idea of a small premium for the very poorest, but the Democratic legislature overrode him.  Obamacare includes both a strong employer mandate (with all its problems) and an enormous expansion of Medicaid -- which is much better than Medicare anyway, as people who have been on both (like my mother) can attest.

Not that the 'who's-idea-was-it' debate makes much difference to the question of whether it's a good idea, but please also note that Romneycare was passed in 2006, reprising an earlier Massachusetts law passed (again by Democrats) in 1996.  When was the notorious "Hillarycare" (let's call it Clintoncare, I mean really) -- decried at the time as nothing more than a windfall for insurance companies -- trotted out, friends?  1993 (i.e. Democrats). 

Back to the differences, the original Democrats' idea was an employer mandate.  The Republican *response* (as Gingrich now says it was only) was the individual mandate.  Both are incorporated in Romneycare and in Obamacare, although Romney opposed the employer mandate and Obama originally opposed the individual mandate.  The Republicans tended to favor "tax credits" for the poor (which do nothing at all for the poorest, since the main taxes they pay are sales taxes and the tax credits don't help with that), while Democrats put in government subsidies and expanded Medicaid, which are a significant benefit to people up to 138% of the poverty line and for retirees or people with no employer-offered healthcare plans (e.g. self-employed people who may have been paying almost $1000 a month and who now pay $50-100 for coverage).

It is true that insurance companies make money from subsidies (as well as mandates), just as agribusiness makes buttloads from food stamps.  Always have.  Are they profiting on the public dime all over the place?  Yes, and if that's new to you, where have you been, like, forever? 

Not to make light of the public trough, corporations actually started as government contracts with businesspeople to serve a (perceived) public interest, and critics of runaway corporate power are always reminding us that they have sadly gotten away from that.  Fine.  I do think we can say, "Reign in corporate power," while acknowledging that the *public* sector has ALWAYS been run by the rich and powerful, whether kings or country clubs.  Let's come back to that in a minute. 

Then we must ask, I think we can agree, "Who benefits?"

Now we get to separating sheep from goats.  If your first and only thought in answer to that question regarding Obamacare is "insurance companies benefit," then you have not been looking objectively at the whole picture.  Do the blood-suckers make money?  Well, duh.  (Newsflash: they make money on EVERYTHING.  It's what they do.  They make money on LOSING MONEY!  ...more on that another time.) 

But the other beneficiaries (the ones I care more about, frankly, and the ones who will be left out in the cold -- possibly to die -- in the case of a "quick and total collapse") are cancer patients or other people who get very sick who had or would have been denied coverage or kicked off, people who need mammograms or colonoscopies or other preventive care, and the many lower-income people who weren't eligible for Medicaid before but are now, and so on. 

Here's a short quiz: Who benefits when you get a job?  If you answer, the employer class, you're right.  But don't you benefit from eating and having a roof over your head, too?  Would you suffer from not having them?  We know the deck is stacked against us, but we still have to survive.  That does not mean don't fight for better wages and working conditions, etc.  It does mean we don't abolish jobs -- at least until something better comes along (and I don't mean a better *idea* but a better *reality*).  It's an analogy.

These are real people, not hypothetical future people who WOULD (presumably) benefit IF we could get single-payer or some form of universal or national health care.

It's a giant 'IF,' and by no means certain.  We should all be for single-payer or national health.  And we should never give up.  But we also have to consider the length of time that would realistically take -- if ever -- and what happens to actual living human beings in the meantime.

It's not that we can't get single-payer introduced into Congress.  Conyers has introduced the "Expanded and Improved Medicare for All" bill every congress since 2003, and eventually went from 25 cosponsors up to 88 in 2009.  Bernie Sanders tried in 2010, and he and McDermott tried it again in 2011, and the AFL-CIO supported it.  These bills simply haven't been successful (yet), but what is significant is the gains, and losses, along the way. 

Clintoncare, for all its faults, raised the national debate to a new level.  Vermont passed single-payer legislation (or close to it -- private insurance is still allowed), but every other state has so far failed.  (Massachusetts actually passed  it in 1986, but it was repealed before it ever went into effect.  Romneycare came later.)  It was passed and vetoed twice in California (by Schwarzenegger).  Montana tried it, and went for a waiver under Obamacare, but never was able to do it -- but they did increase coverage for lower income people in the state.  And Obamacare... ain't single-payer, but it sure as hell improves healthcare access for a lot of people, mostly at the lower end of the income iceberg.

Meanwhile, drugs.  While still technically illegal, Canadian imports are a booming business.  Enforcement is less and less enthusiastic.  For an increasingly medicine-reliant, unhealthy society, there's a downside, to be sure, but for folks who need life-saving drugs and can't afford 'em, well.  George Bush was even forced to agree with Medicare prescription drug coverage (which had always been available under Medicaid, which is one big reason that program is better).  But what we got was Medicare Part D, a private insurance mandate  -- including a huge and terrible "donut hole" -- so it was progress, but needed fixing (ever heard that one?).  The donut hole was a significant hardship: originally costing oldsters from $750-3600 for their longer and longer row of little pills.  Well, Obamacare is fixing it: the infamous donut hole is closing, folks, not fast enough, but it's closing.  By 2020, it's gone (unless the program "collapses, quickly and totally.")  Medical marijuana is also gaining ground, whatever you think of that (I think it should be legal, as far as that goes, but I'm unconvinced by some of the claims about the effects.)

There's more, but the point is, if we look at Canada, and how they did it -- province by province -- we are a long way from the goal line.  But it does appear that the debate is far from over, and we are inching ahead.  Progress is spotty but tangible.  We must keep pushing ahead.  If conservatives succeed in repealing Obamacare or it "collapses quickly and totally," that will not be progress.  It will be catastrophic, and we have no way of knowing whether we will ever get health care reform passed again (if not, will it have been worth it?)

Here's another analogy: the Illinois Constitution.  Could we potentially benefit from a totally new document?  Of course, hypothetically, we could get rid of the flat tax, etc.  But what is likely to happen at this political moment if we push for a re-write?  Disaster.  Single-payer is in a similar historical predicament.  We need it, but it will not happen now.  It just won't.  All the evidence that exists says so.  Clintoncare ( a far cry from single-payer) couldn't even pass, and Obamacare (a step to the right) is wobbling dangerously.  One state out of 50 has passed single-payer ( a modified version).  The polls, too, appear to say support for single-payer is dropping, not climbing.  And the results have always been mixed. 

Now back to the earlier point about the public sector as tool for the ruling class: what's the number one reason for skepticism about government health care?  People say a lot of stuff (socialism, godless, fascist, Muslim, birth certificate, blah blah blah) but when you unpack it, it comes down to this: people don't trust the government.  Should they?  I don't, not really.  But if my house is on fire, I call the government.  I LOVE our local GOVERNMENT library.  Government screws up a lot of stuff.  They screwed this up.  They also kill children and lock up people over nonsense.  But they do some things well.  Food stamps and Social Security have been incredibly successful programs, and, yeah, people complain about the National Health in England and Medicare in Canada, but if you even suggest getting rid of them, they look at you and KNOW that you are in fact crazy.  We need the government to do this.  Sooner rather than later.

So I'm not saying single-payer is pie in the sky.  I'm saying it's a goal, but take away Obamacare and we are most likely to revert, not progress, at this time.  Because if it fails, no matter what Ford says, it will be because of rightwing opposition, fear and ignorance.  So we educate, we organize, and, yes, we agitate, but Platonic arguments like Glen Ford's are not only not helpful; they are actually destructive.

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