by Ernie Haberkern
The Health Care Reform bill has finally made it through the archaic legislative labyrinth our slave-owning founding fathers left us. Our modern corporate capitalists have found this unrepresentative system as useful as the slave owners did. One of features of the system is that it facilitates behind-closed-doors dealing that makes it extremely difficult for the average voter, or even the fairly well-informed voter, to find out what exactly the effect of the legislation will actually be. In fact, the result is usually so complicated that it often has consequences unforeseen and unintended by the authors of the legislation.
So what does this ‘reform’ actually amount to? In the first place, there is no regulation of the cost of drugs. In particular, the current twelve year monopoly granted to companies for brand name drugs remains in effect. This deal was made last August and in return the pharmaceutical industry, which played a major role in the defeat of Bill Clinton’s attempt to pass a health care bill, actively lobbied in favor of Obama’s plan.
The insurance industry will have some of its most egregious practices outlawed. People can no longer be denied insurance because of a ‘pre-existing condition’, a vague phrase allowing insurers to deny coverage based on their estimation of the likelihood that they may actually have to pay for some form of treatment. They will also be prohibited from dropping coverage for people who actually get sick even though they may have been paying their premiums, and contributing to a company’s profits, for years. In return, the Obama administration, very early on, backed off on a ‘public option’, that is a government financed competitor to the private insurance industry modeled on Medicare, the government run single payer system for people over 65. Obama had made this a major campaign promise.
The most important victory of the insurance companies, however and the most significant feature of the new system is the forced enrollment, under threat of a fine, of millions of new customers in their plans. It is, in effect, a steeply regressive tax to finance highly-profitable and inefficient corporations. (As compared to Medicare, for example, whose overhead is much lower.)
In addition to this regressive tax, the new system also helps finance this operation by significant cuts in Medicare. The Republicans quite rightly emphasized these cuts in their opposition to ‘Obamacare’. Of course, the Republicans opposed Medicare when it was introduced and are themselves in favor of cutting the program. But the Obama administration and the leadership of the Democratic Party were equally demagogic. In the end this is a bill that is aimed not at benefiting Americans who need increasingly expensive health care but at propping up a section of the capitalist economy that was facing disaster. That is the real ‘health care crisis’ that this new system addresses. The news stories about cancer patients who were being bankrupted because their insurance companies dropped their coverage made headlines but it is not clear that they will be helped. In any case, they are not the intended beneficiaries of this scheme.
The ‘health care crisis’ that this new system is meant to address was exposed in a curious side story. On 20th March, Maureen Dowd, an op-ed columnist for the New York Times, wrote an article with the headline ‘Eraser Duty for Bart?‘ The subject of the column was a Democratic congressman, Bart Stupak, who, at the bidding of the U.S. Conference of Catholic Bishops, was threatening to vote against the bill if it did not explicitly forbid the coverage of abortions under the insurance policies paid for by the new system.
Stupak was attacked by religious orders representing tens of thousands of nuns who flooded his office with phone calls. At first Stupak took the position that the bishops and the pope, not a bunch of nuns, ran the Catholic Church. But, a few days later, he publicly announced that he was withdrawing his amendment and would vote for the bill. In return, Obama promised that he would sign an executive order forbidding such misuse of the funds.
As Kathleen Parker pointed out in a column in the Washington Post on 24th March, it is not clear whether such an order would legally trump a law passed by Congress and signed by the President. In any case, such a decree could always be rescinded at any time. Parker did not point out that Obama had also promised voters a public option to win their support and then reneged when it became politically expedient.
Maureen Dowd has a lot of fun recounting Bart’s troubles with nuns as a Catholic school boy, attributing his reversal of position to the nuns once again ‘batting his head against the blackboard’. But there is a more serious issue here which Dowd alludes to but does not dwell on. She quotes Tim Ryan, an anti-abortion Democrat from Ohio as saying: “You say this is pro-abortion yet you have 59,000 Catholic nuns from across the country endorsing this bill, 600 Catholic hospitals, 1,400 Catholic nursing homes endorsing this bill.”
The numbers are significant. The orders of nuns who came out against the U.S. Conference of Catholic Bishops are one of the main sources of labor for Catholic hospitals. As Reed Abelson writing in the New York Times of 21st March points out, hospitals are one of the main beneficiaries of the new bill. Hospitals, including for-profit hospitals like some Catholic hospitals, are required to treat patients who show up at their emergency rooms even if they can’t pay for the treatment. By forcing such people to buy insurance or pay a fine the hospitals are reimbursed. While it is probably true, as Maureen Dowd claims, that the nuns are motivated by their Christian sympathy for the poor and suffering they, and certainly the religious orders they belong to, also have a financial interest in the legislation just passed. For many of them, their jobs are at stake.
This little incident makes clear who the real beneficiaries of this new system are.