What Obama Doesn’t Want You to Know About His Health Plan

At the top of PBS’s latest Bill Moyers Journal, Moyers chose clips of the “usual suspects” opposed to Obama’s health care proposal – a Republican legislator shouting “socialism,” Glenn Beck, Michael Steele, and Bill Kristol, who worked to “drive a stake through” the heart of health care reform in 1993 and 2009. The problem with the GOP’s stock opposition language is that it inaccurately describes what’s really wrong with Obama’s plan, which enriches the profit-motivated private sector and strengthens its controls over policies, at the expense of average Americans forced to sign up.

The real reason insurance companies brought back “Harry & Louise” ads: Obama’s plan rewards private health insurance companies with expanded enrollments but little reward for the Americans “mandated” (forced) to buy these plans. (See Paul Krugman’s blog post, “Why markets can’t cure healthcare.” Aside from Krugman and Moyers, are there any media outlets revealing this major flaw in the proposed system?) Thankfully, Moyers’ two guests revealed why Obama is keeping his talk “vague” so he can hide the cozy deals he’s made with private companies’ lobbyists:

“What [Obama] has essentially advocated is throwing more money into the current system. He’s treating the symptom and he’s not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don’t get our money’s worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let’s throw some money into it. … Into the same system. That’s his problem. The other problem, in the press conference, was that he was trying to mobilize public support for a bill, and we don’t know what that bill is.”

“[H]e’s been vague right from the very beginning on this point. … I like to step back and say, “Well, what exactly is he talking about? What exactly does he mean?” And he has not been clear on that. … [H]e’s been AWOL, A-W-O-L –on details.” … “He has been out to lunch on this.”

“[Obama's plan] delivers to the private insurance industry a captive market. By the mandate. For whatever price they want to charge. … this is going to come up as a big surprise to people to realize they’re going to have to buy insurance from private insurance companies or face a tax penalty. … they can charge whatever they want. That there will be no bargaining. [That includes Medicare Part D, which under Obama's plan will continue to prevent Medicare from price-shopping for the least expensive prescription drugs.]

Who are the two Journal guests who said made these serious criticisms of Obama himself as well as his health care proposal? Their credentials are impressive:

Trudy Lieberman covers health care reform for the Columbia Journalism Review and directs the health and medicine reporting program at the City University of New York’s Graduate School of Journalism.

Marcia Angell, a physician herself, is Senior Lecturer in the Department of Social Medicine at Harvard University Medical School and was the first woman Editor-in-Chief of the New England Journal of Medicine. She, too, has written widely and often about health care reform.

If his two distinguished guests are so opposed to Obama’s plan and approach in selling his program to Americans, why did Moyers begin his show with a hit job on the right’s critics? What did his intro have to do with what his guests said? Is the reasoning of critics on the left more acceptable than that of the right’s? Apparently so.

You can watch a video or listen to a Podcast of the entire segment here, and you can read the full transcript.

I find Trudy Lieberman and Marcia Angell’s observations to be critically important since they spend their professional lives assessing health care delivery systems. They had plenty more to say about the grave problems with Obama’s plan that — of course — benefits his and Congress’s rich political donors and will end up costing Americans more.

One of my major problems with the bill is that although Obama says that his plan will save money, he in no way explains how that will happen. When Obama claims that his $1.4 trillion dollar plan will be “deficit neutral,” I’m amazed that he thinks he can pull that verbal trick and think any of us will buy it.

Here’s a major section of the transcript from which I pulled the quotes above the fold — and I’m not putting the text in blockquotes.

NOTE: Scroll down to the section I’ve boldfaced: What most people don’t realize is that Obama’s plan will be a huge financial bonanza for private insurance companies because people will be forced to buy health insurance even if they can’t afford it, and that the price they pay will not be less than currently available health insurance plans.

[...]

BILL MOYERS: But the President’s already stepped on booby traps of his own making, and minefields laid by his own party, especially when the Congressional Budget Office reported that his reforms, instead of controlling costs, would send the national debt further into the stratosphere.

Meanwhile, supporters who want to scrap the present system for fundamental change are staring glumly through the fog of war at a battlefield in total disarray. They fear that in the White House’s desire to get a bill — any bill — passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than water down, a steady diluting of what they’d hoped for, or America needs.

The big drug companies are already so pleased with what they’ve been promised that they’ve brought back Harry and Louise — the make-believe TV couple who helped take down the Clinton health care plan.

LOUISE: Because everyday more and more people are finding out that they can’t afford healthcare.

BILL MOYERS: But this time they’re in favor of reform…

LOUISE: Coverage people can afford. Coverage they can get…

BILL MOYERS: Could it be that Harry and Louise are happier because this time, they’re in on the deal?

What to make of all this? I’ve asked two expert analysts of health care to help me out.

[Introduction of guests.]

BILL MOYERS: So, Trudy Lieberman, is it Waterloo or no Waterloo, is that the question?

TRUDY LIEBERMAN: Waterloo for who? Whether it’s a Waterloo for the American people, who aren’t going to or may not get a resolution of this, and they certainly do need some help along the way with health care. Or is it, say, a political question for the President?

[...]

MARCIA ANGELL: So– well, it can– the failure can show up before he’s out the door. And then he’s got a real problem. He was right in his press conference, when he talked about cost as the central issue. And he said, if we don’t control cost, not only will the health system continue to disintegrate, but it’ll drag the whole economy down with it.

What he has essentially advocated is throwing more money into the current system. He’s treating the symptom and he’s not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don’t get our money’s worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let’s throw some money into it.

BILL MOYERS: Into the same system?

MARCIA ANGELL: Into the same system. That’s his problem. The other problem, in the press conference, was that he was trying to mobilize public support for a bill, and we don’t know what that bill is.

TRUDY LIEBERMAN: I want to get to that point, because he’s been vague right from the very beginning on this point. We have not known exactly what the Obama health plan has been. Even though the headline writers, and the press has been talking about his health care overhaul for months. And so, I like to step back and say, “Well, what exactly is he talking about? What exactly does he mean?” And he has not been clear on that.

BILL MOYERS: You said he’s been AWOL, A-W-O-L–

TRUDY LIEBERMAN: Yes.

BILL MOYERS: –on details.

TRUDY LIEBERMAN: He has been out to lunch on this. And I think that’s a deliberate strategy on the part of the White House.

MARCIA ANGELL: Yes.

TRUDY LIEBERMAN: What they had done is learn from what they call the Clinton mistakes in ’93-’94. And what happened then is that Hillary came out with this big 1 thousand-page bill, although we have now another 1 thousand-page bill. And let the special interest groups sort of pick it apart. This time, they decided not to do that. That they would be deliberately vague about this. And stay as vague as they could be until push came to shove.

And so basically, it’s my belief that this whole discussion about health care reform is flying over the heads of the American people. They know about reform, but they don’t know– they know the words reform, but they don’t know what they mean at all.

BILL MOYERS: I had the same reaction you did to that press conference. And I woke up Thursday morning after the press conference, to the headline of “The New York Times” that read, “President Seeks Public Support On Health Care.” And in the margin of the Times I said, “Does the public know what is in this health care–”

MARCIA ANGELL: He doesn’t know. Nobody knows. One thing we …

BILL MOYERS: Well, somebody has to know. They keep talking about it.

MARCIA ANGELL: Well, he says, let Congress do it. In their wisdom, they’ll come out with something, and I will give you a few feel-good principles. And then we’ll wait and see what happens. Because he doesn’t want his fingerprints on it if it fails. [GOOD FOR ANGELL for pointing out Obama's slippery political style.]

The next section of the Journal interview covers the perils of basing Obama’s plan on the private health corporations, and echoes Paul Krugman’s blog post, “Why markets can’t cure healthcare.” First, here’s what Krugman wrote about the wrongheaded provisions in Obama’s market-dependent plan:

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends a lot of money on socially destructive activities.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (”I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn’t work as a standard market story.

All of this doesn’t necessarily mean that socialized medicine, or even single-payer, is the only way to go. There are a number of successful health-care systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

(Read all.)

Now back to the Moyers interview:

TRUDY LIEBERMAN: I feel the American people need to know what is in that bill. And what’s in the bill is an individual mandate that is going to require all Americans with a few exceptions, to carry health insurance. And that means if you do not get insurance from Medicare or Medicaid or your employer. You’re going to have to go out and buy health insurance.

And that is a lot of money for most people because most of them would buy it now if they could afford it. About 85 percent of the uninsured require subsidies, because they can’t afford it. And I think this is going to come up as a big surprise to people to realize they’re going to have to buy insurance from private insurance companies or face a tax penalty.

MARCIA ANGELL: Well, that goes to the cause of the problem. We are the only advanced country in the world that has chosen to leave health care to the tender mercies of a panoply of for-profit businesses, whose purpose is to maximize income and not to provide health. And that’s exactly what they do.

BILL MOYERS: The President, as you were saying a moment ago, is saying to everybody who’s not covered, we’re going to mandate that you exercise that right. We’re going to mandate that you buy some form–

MARCIA ANGELL: We’re going to deliver the private insurance companies a captive market. That’s right. And they love that.

BILL MOYERS: Say that again.

MARCIA ANGELL: They love that.

BILL MOYERS: The– his policy does what? His program?

MARCIA ANGELL: Delivers to the private insurance industry a captive market.

BILL MOYERS: By the mandate.

MARCIA ANGELL: By the mandate.

BILL MOYERS: It says “Marcia Angell, you’ve got to–”

MARCIA ANGELL: For whatever price they want to charge. Right. And so, this will increase costs. And let me tell you what he’s running into, and he’d like to be able to pull a rabbit out of the hat, but he won’t be able to. If you leave this profit-oriented system in place, you can’t both control costs and increase coverage. You inevitably, if you try to increase coverage, increase costs. The only answer, the only answer, and he said it at the beginning of his press conference, is a single payer system. In his first sentence, he said, that is the only way to cover everyone.

BILL MOYERS: But he’s also said, if we were starting the system from scratch, we could have single payer. But we’re not starting this system from scratch.

MARCIA ANGELL: You know, you don’t pour more money into a failing system. You convert.

BILL MOYERS: I saw back in the spring– the chief lobbyist for the Big Pharma industry, Billy Tauzin, used to be a member of Congress. He was on CNBC. And he was in support of this bill, whatever this bill is. Because it would broaden the industry’s customer base by providing subsidies for people to buy–

MARCIA ANGELL: Exactly.

BILL MOYERS: More coverage from the private insurers.

TRUDY LIEBERMAN: At whatever price they want to charge. It will be a bonanza for the health insurance industry. And a bonanza for the pharmaceutical industry. And for the doctors, too. Because the doctors are going to get more paying patients, because people will now have this ticket, this insurance card, that they can whip out when they need medical services.

BILL MOYERS: So, does this explain why Harry and Louise, who were around 15 years ago to help defeat Bill Clinton’s health plan, Bill and Hillary Clinton’s health plan, are back now in support? Seemingly to be in support?

MARCIA ANGELL: You bet it does. You bet it does.

Please check out Jerry Policoff’s article published here in May: “Barack Obama Spins the Facts, Takes Single-Payer Health Care Off the Tab.” Jerry’s piece begins with this question from a town hall meeting that made Barack Obama “uncomfortable”:

Last Thursday at a town hall meeting in Rio Rancho New Mexico President Barack Obama was asked why, when “so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single-payer off the plate (audience applause), and why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?” (more audience applause)

Once again, as Jerry makes clear in his article, Obama and Congress are doing the bidding of the lobbyists for the health care industry.

This is no surprise to the writers and readers at No Quarter who investigated Obama during his presidential run. While he claimed to be supported by small individual contributors, in fact the lion’s share of his campaign monies came from big corporations and their executives. It is they that Obama is serving, not the American people.

We need reform of our health care system. But we don’t need a plan that further rewards private industry at the exense, yet again, of the American taxpayers.

On his blog page, Bill Moyers posted “Diagnosing Proposals for Healthcare Reform.” Moyers reviews the opinions of his two guests, and adds a comment by “Clinton administration Secretary of Labor Robert Reich agreed that ‘single payer’ is the best idea, but said that it is politically impossible and that the ‘public option’ should be enacted anyway.”

At the end, Moyers asks you to weigh in:

What do you think?

If instituted, do you think President Obama’s proposed “public option” for health insurance would be sustainable? Why or why not?

Is flawed health reform legislation better than nothing or, as Marcia Angell argues, even worse? Should we start over? Explain.

Let Moyers know what you think.