Religious progressives who understand their task as continuing to cheerlead uncritically for Obama’s “plan” (as against no reform) have been insisting that the cardinal principle is to get everyone covered—and that every other issue pales in relation to that overriding moral imperative.
Treating the matter this simplistically means choosing to ignore some really ugly truths.
1. The tender mercies of the private insurance system: The President said last night that any bill he signs will ban the most loathsome practices of the insurance companies: e.g., dropping people who actually make claims, watering down existing coverage without telling people, and denial of coverage for pre-existing conditions. But neither Obama nor anyone else pushing reform-at-any cost has said exactly how these loathsome practices will be controlled.
And as it is now crystal-clear that the insurance companies have achieved everything they wanted under cover of “reform,” why should we believe that their well-documented arrogant and inhuman behavior toward their customers will change once they effectively own the whole population?
2. The enormous windfall to insurance companies and the entire medical-industrial complex: What is now likely to get the President’s signature will represent the biggest transfer of power and profit to private hands that we have witnessed in our lifetimes. Big Pharma, in the smiling well-fed face of Billy Tauzin, already brags about how few concessions it made in order to get its slice of the pie. Max Baucus makes no secret of the fact that his version of “reform” (Senate Finance) — the last and most decisive committee bill to be written — has been engineered for the benefit of the insurers. The staff that Baucus has assigned to crafting his bill were (and still are, for all practical purposes) lobbyists for Cigna and other insurers.
In effect, what the Obama Administration and conservative Democrats are now doing is driving the healthy uninsured into the arms of private insurance firms, while leaving the poor, the disabled, and the elderly to remaining public plans: Medicaid and Medicare. Political philosopher William Pfaff wrote a couple of days ago that at the rate things are going we might as well let corporations appoint members of Congress and “eliminate the middlemen”; nothing illustrates this better than what is now happening on health care.
3. The cost to existing public programs: The President said last night that not one dime of new taxes will be needed to effect his reform. And, indeed, we’re certainly not hearing Obama talk any more about rescinding the tax bonanzas the super-rich received from Bush in order to pay for health care coverage.
OK, so where is the money going to come from? New “efficiencies” in the system? Highly doubtful, now that we’re leaving the profit-driven private insurance system in place and in power. No, the needed money is going to come from cuts to programs serving the poor and disabled and elderly: that’s right, to Medicaid and to Medicare. And probably to Social Security itself, because Obama has already said he plans to revisit “entitlement” costs.
Think about the ethics of saying to the whole nation that we will address a fundamental human need — health care — without committing new funds, when we just spent untold amounts of public funds writing blank checks to big banks (many of which, it now turns out, didn’t want or need the money).
I want to be clear that I share the view that universal coverage is the most important moral good that we should be seeking in health care reform. But for the ethically alert, the concerns I am raising here cannot be dismissed as mere details. After all, as we like to say, God — or the Devil — is in the details.