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On February 28, 2010 on CNN’s State of the Union, Nancy Pelosi, Speaker of the US House of Representatives, said that the health insurance companies didn’t want a government-financed and operated insurance option for American citizens so it was off the table.  Her statement reminds me of the earlier one by Richard Durbin of the US Senate, who remarked after his forclosure-assistance amendment failed that the banking lobby owns Congress.   Would there have been the hyperbole of “socialism!” associated with the public option for health insurance were that proposal in the interest of the industry at issue (i.e., at fault)?  If so, it is interesting in a sad sort of way that a culpable person would have the gall to use exaggeration (there would still be private insurance so the sector would not be socialist…meaning owned and controlled by the state).  We have seen the same thing from the banking lobby in fighting reform efforts in the wake of the financial crisis of September, 2008.   In other words, we can isolate a pattern here: even when companies (or an industry) are at fault, they can still own Congress when their interests are at stake.

It is particularly disconcerting to me that so many citizens fall for the self-interested exaggerations when it would be more natural for people to be angry at the culpable people for continuing their unethical business practices (and going on to stop reform that is at least in part due to their bad practices).  Take for example, Representative Dennis Cardoza, Democrat of California in the US House. The husband of a family practice doctor, he is intimately familiar with the failings of the American health care system. His wife “comes home every night,” he said, “angry and frustrated at insurance companies denying people coverage they have paid for.” Even so, he is on the fence on the Democratic health-care reform proposal because he wants stronger anti-abortion language and more cost control.  Were he really angry like his wife, he would be pushing not only for the bill, but for the public option or for real restrictions on the insurance companies, rather than allowing secondary issues to block him.  In other words, I don’t believe he is really that angry at the companies refusing to fuffill their responsibilities to their customers who have paid the premiums.  Also, he is allowing himself to succumb to the self-interested manipulation of the same firms that he is ostensively angry at.  It is in the health insurance companies interest that costs be reduced because then their expenses are reduced (and their profits, which were very high in 2009…even as they were denying treatment to some).  If he were really angry like his wife, he would not be so willing to do something that would benefit them so much; rather, he would be working to take power and money away from them.

Unfortunately, the problem kids are able to thwart our efforts to clean up after them.  America’s Health Insurance Plans, a lobby for insurers, announced in March, 2010 (as Congress was considering health-insurance reform) that it was buying more than a million dollars’ worth of television advertising time to explain why insurance premiums had been rising. The week before, the White House had indicated that the industry’s rationale for the raised premiums was unconvincing.  Too many of us are letting industries get away with their mis-representations geared to thwart reform.   The health insurance industry’s ads convince us that the companies really aren’t sharks; we ignore Sen. Rockefeller’s likening of the companies to sharks—you don’t know there is a shark until you see its fin and feel its sharp teeth.  In other words, our anger is too easily (and conveniently…for the sharks, which want to continue feeding) dissipated.  We let the bad kids off the hook and go on as if the problem were somehow no longer out there.  This puts the misbehaving kids in a position to thwart any parenting.   In short, too many of us are unwittingly being manipulated by the bullies (who are therefore getting away with murder).   I suppose I shouldn’t be surprised that spoiled  kids would not feel culpable for their own bad behavior, but I am.  I am perhaps even more disappointed in the parents (i.e., the American people) who let themselves be manipulated by such kids.  It is like watching the parent of an alcoholic teenager be in denial and thereby enable the kid to continue drinking even though the kid beats up other kids when he or she drinks.  “Oh, Tommy didn’t mean it; he is really a good kid.  I don’t think we need to look at a group home or jail. He will be good if he can relax with a beer.  Here Tommy…” 

Whether in dealing with the people at the health insurance companies who are in denial or the representatives and their supporters among the public who are also in denial and are enabling them, it is an exercise in futility and utter frustration to see this dynamic and want to shape it up because the sickness has strong defense mechanisms against real change.  So I ask: can a dysfunctional system be fixed?  Can it fix itself?  Probably not.  So are there enough people in the US outside of the dysfunction who could fix it above the screams of the sick who do not want the shot?   Imagine a physician acquiescing to a kid’s demand that the shot not be given.  In a physcian’s office, the sick kid does not get to decide—or to put it another way, there are enough adults in the room that the shot is given over the kid’s objections.  So where are the adults?

Sources: http://www.msnbc.msn.com/id/35628488/ns/politics-the_new_york_times/ ; http://www.nytimes.com/2010/03/10/health/policy/10health.html?ref=us

Goldman Sachs, which played a role in enabling Greece to hide its public debt, urged investors in March, 2010 to buy shares in two big health insurance companies, UnitedHealth Group and Cigna because their rates were sharply up and competition was down. According to the NYT, the White House claimed, “ the Goldman Sachs analysis shows that while insurers can be aggressive in raising prices, they also walk away from clients because competition in the industry is so weak.”  Rate increases ran as high as 50 percent, with most in “the low- to mid-teens” — far higher than overall inflation.  Kathleen Sebelius, the secretary of health and human services, stated on March 10, 2010, that she was left unconvinced after meeting with health insurance company execs at the White House the previous week because medical cost increases could not justify the rate increases. Furthermore, she pointed to the profit increases, some as high as 50%, in 2009 over 2008, and large executive salaries as evidence that the firms could have absorbed more of their cost increases than they did.  Cutting off customers when it is time for a firm to pay up while recording higher salaries and profits indicates that something is structurally wrong with the industry (and with the firms, ethically speaking).  If the execs lied at the White House, citing costs that “had to be passed on,” we ought not be so gullable at the managers’ claims in the future.  Also, if they were lying, we might recall Senator Rockefeller’s description of the insurance companies as sharks…feeding machines that are often not seen until their fins break the water-surface and their teeth are coming down on you.  Otherwise, the water is calm.

In February, 2010, the US House of Representatives passed a bill that would repeal the anti-trust exemption for the industry.  Armed with fresh retained earnings, the oligarchic industry was in a good place to fight that bill in the Senate.  In other words, the bill abruptly stalled. That the repeal was so difficult, if not impossible, to achieve is itself telling.  Once an industry has such clout and power that it can effectively veto legislation it doesn’t want—even as the firms cut customers off when they get sick (not to mention pre-existing condition abuses)—our republic itself is in danger.  In the regulatory literature, this is called “capture theory.”  The pubic good is captured by concentrated (and vested) business interests. The plight of financial sector regulatory reform in the wake of the financial crisis of 2008 is another case in point.   In short, cleaning up these messes should be easier, even given the encumbering checks and balances in the US Government.  The fact that it is not should give us great pause.

Source: http://www.nytimes.com/2010/03/07/health/policy/07health.html?ref=politics

I must admit I’m sad that the health insurance companies were active in determining the law. I don’t think the vested interests in the status quo can be invested in a sufficent degree of change. For instance, the companies vetoed the public option, even though it can be argued that it is in the public interest.  Furthermore, immediately after the health-insurance reform became law, some health insurance companies decided to interpret the requirement that children with pre-existing conditions do not have to be covered after all.  “The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee. Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”  But this is what happens when the industry’s lobby is invited to participate in writing the legislation.  Self-interested fine print is inserted for the purpose of being exploited as a loophole.  In other words, this is no accident, and our representatives should have had their staffs on the watch for it.
I believe that business/industry has too much power over public policy in the case of the US Government. After the health insurance reform bill passed the US House, President Obama said “this is what change looks like”…but can it be real change when whether the extant firms can make money off of it?

The other thing that bothers me is when the Tea Party (and Repubs) said that the health insurance reform that uses health insurance companies is socialism and the government taking over health-care. This is to take a very moderate reform and portray it as radical…so there would not be truly radical reform that says the hell with the health insurance companies. Why can’t we say the hell with them? Why can’t we recognize the conflict of interest in such a company being a player in the writing of reform? …especially if the player has a veto!

I think the hyperbole is a subterfuge for the greediness of the wealthy—which is a reflection of how much money is valued in the lower 48 States. I am just beginning to sense that the culture itself values money/wealth differently than in Europe (I’m perhaps overgeneralizing here too…not distinguishing northern from southern Europe). I’m trying to distinguish greed from how much wealth is valued…arguing that the latter is different here.  Greed is everywhere.  However, some cultures value wealth more than others do. The extent here is very hard to notice because it is so basic in the culture. It is like a fish seeing the water! But I think Europeans can see it…looking at the culture here from the outside. I’m positive that we don’t see it…for we are in it.  I think we should listen to what people around the world say about American culture.  I think we could learn something about the society we are.

Source: http://www.nytimes.com/2010/03/29/health/policy/29health.html?ref=us

It is odd that even after a bill becomes a law, it can be defunded.  One would think that Congress would be required to pass the funding that is required by the law. The Republican Party is strategizing on how to deconstruct Obama’s health-insurance law through various means.

Republicans could turn to the annual appropriations and budget process or push stand-alone bills to delay or stop funding for provisions of the law they dislike, including the individual mandate, the health insurance exchanges and the Medicaid expansion. They might also work to weaken provisions in the bill that deal with Medicare physician reporting requirements that some physicians find onerous and block the creation of a nonprofit research institute to examine the effectiveness of various medical treatments. Mandatory funding, which comprises much of the health measure beginning in 2014, will continue unless Republicans can change current law, a heavy lift considering such initiatives would have to pass both the House and Senate and win Obama’s signature. Discretionary funding must be approved each year but differences between House and Senate versions of appropriations measures must be ironed out and that generally produces a compromise package. Why all of the law’s funding would not be mandatory—as the law is a law—is beyond me. Also, how the mandatory funding could comprise much of the law when the individual mandate, the exchanges, and the medicaid expansion can be defunded, is also beyond me.

A major problem with the defunding strategy is that since so much of the bill is inter-related, trying to dismantle it piecemeal could lead to unintended consequences. While the individual mandate is unpopular, “you can’t pull it out of the law without all sorts of other elements falling apart,” Reischauer says. And scrapping the mandate, which requires most people to have coverage or pay a penalty, would anger health insurers — a core GOP constituency. Insurers have agreed to abide by new consumer protections, such as not denying coverage based on a pre-existing medical condition, in exchange for 32 million new customers. Hospitals agreed to payment cuts on the premise that more people would have health care and hospitals would have less uncompensated care. In other words, because the health insurance industry got basically what it wanted—the mandate without a public option—it would be highly unlikely that certain parts of the law would be defunded unless it were in the interest of the health insurance companies.  Therefore, the mandate is not apt to be defunded unless the rest of the law is to go down too.

I contend that law should not be allowed to be defunded. That is, upon passage, the law should have its required funding established as a matter of law.  Secondly, I contend that private companies with a vested interest in a law should not be allowed to have such power that they can tailor the law to their liking. Extant industries have too much power in the US Government.  As a reflection of this condition, we over-rely on private companies and the market—ignoring their downsides. Where basic necessities such as access to basic health-care is concerned, our over-reliance can be fatal.

Source: http://www.msnbc.msn.com/id/39295110/ns/health-health_care/

I've been following politics less now that Obama has caved on his campaign pledge (or promise) not to extend the bush tax cuts for the rich.  The added growth expected in 2011 from ALL of the cuts is just a half of a percent of GNP growth.  I have read that the rich save their tax cuts rather than use them in ways that stimuate the economy.  As for savings, banks have enough capital to lend (this isn't why they are still skittish in 2010).  That the vacuous argument that tax cuts for the rich will somehow create lots of jobs and save the economy from another recession has had <em>any</em> weight or credance really discourages me about American political discourse.  That Obama didn't "just say no" is also discouraging. On December 14, 2010, Pat O'Reilly said on his Foxs News show that the "far left" is in retreat because Ameriicans have rejected it.  He said even Obama has rejected the left. I think the left has vanquished itself.  Perhaps it could be said that the left is willingly impotent. Where is Al Gore?  Ralph Nadar?  Micheal Moore?  silence.  Only the sound of Obama caving. He should have refused to sign a tax cut continuation for the rich and said the Repubs could refuse to extend the cut for lower and middle income people--it would be the Repubs provoking the resumption of higher taxes for everyone rather than just on those who can afford them.  We need a Teddy Roosevelt or an Andrew Jackson. Teddy stood up to Standard Oil, and Jackson stood up to the Second Bank of the United States. By contrast, Obama has operated largely in line with Wall Street (e.g., the bailout for the banks rather than foreclosed homeowners) and the health insurance industry (e.g. not even a public option, which was odious to the industry).  Barak Obama does not want to displease the powers that be; I suspect reelection has a lot to do with this state of affairs.  This raises the question: is there a counter in American politics to the selfishness of property?