The Austin Chronicle

Page Two: Dreams for Sale

On magic, gremlins, and health care reform

By Louis Black, September 4, 2009, Columns

A few months back, I wrote the following in this column:

"As a member of the management team of two businesses that both pay 100% of full-time employees' health insurance, I am aware of and involved with this issue. Unlike many of the savants on all the differing sides, on a monthly basis I'm reminded of the increasing expenses and shrinking benefits [of health insurance]. Consequently, I'm flummoxed by the argument that a free-market solution will see competition driving down costs while improving the quality of care.

"The current state of health-care plans is more than troubling. In my experience, one rarely settles into a long-term relationship with an insurer. Instead, something like the following scenario occurs: In year one, a contract is signed for a new plan to serve the staff. The second year, the rates go up significantly but not outrageously. The third year, the company often offers two different rate plans, with the rates of both increasing by absurd percentages. The less expensive plan often eliminates an area where coverage has traditionally been provided. The rate for the cheaper, less comprehensive option usually ends up increasing by a medium/high single-digit percentage, while keeping the same coverage incurs a double-digit increase, the higher rate indicating that the company is trying to steer you away from continuing your current coverage. Currently, we are seeing this in terms of the amount of aftercare that is covered by insurance. It used to be generous, if not unlimited. Now it is being substantially cut back."

Ever-escalating rates, exclusionary coverage, cutbacks on benefits in general (with some being eliminated), and ongoing increases in co-payments and other costs to those with insurance: These are problems facing even those employers who are happy to pay for their staffs' health insurance. Yes, there are those who are far more interested in minimizing the problem than considering it. Some aggressively claim there is no crisis, while others cast the problem as consisting solely of the 40 million or so Americans who are uninsured (some include the millions of underinsured as well). A general concern seems to be that the rest of us will suffer if health care reform is even considered.

The health care crisis is far from a fiction or a subversive ploy to allow the government to take complete control of all our lives. The six blind men examining the elephant seem prescient compared to many who are against health care reform, including those mentioned above. Too many are either trying to ignore the problem or are breaking it down in ways that serve to trivialize it. The problem, very real and growing, comprises many factors – including not only health insurance, health insurers, those who are covered, and those who are not, but also health care costs, patients' and doctors' rights, malpractice insurance, other costs associated with litigation, the pharmaceutical companies, and pre-existing, government-funded entitlements. These are all interrelated and inseparable aspects of this country's health care, and all have to be considered if the goal is real change.

In my life, the health care issue is not abstract but a monthly and annual budget concern. I am angry with Republicans, certain industry groups, and any number of misguided citizens' groups that are not just opposed to reform but, in order to sink it, have made up more and more outlandish charges about the content of the legislation. It is necessary to emphasize that my anger is neither partisan nor predetermined, nor does it originate from the position of a liberal Democrat. Rather, it comes from being an entrepreneurial capitalist who passionately believes management's responsibility to staff is crucial to the effective operation of any business.

There is a more than legitimate debate to be had over an issue as complex and massive as this one. Opponents could be detailing both genuine concerns with the reform concept and substantive criticism of the legislation. There are ideological concerns with the scope and purpose of the legislation, as well as any number of serious issues regarding the logistics of actual implementation. But those are not the topics being discussed.

The good of the country, in fact, hardly seems a factor – and certainly is not nearly as important as the popularity of the party. The Democrats are no purer than the Republicans when it comes to these kinds of shenanigans, but on this one it is the Republicans who have been tripping over themselves recasting complicated issues into a series of barely related slogans designed to mislead and scare the public.

This strategy offers fiction instead of criticizing content, demonizing proponents instead of talking about the actual need or acceptable design for reform. The Republicans and their fellow travelers, smelling Democrat blood in the water, have abandoned even vaguely relevant discussion points. Instead – and with some ignoring their own histories of comment and legislation on the topic – many have acted as though this is demonically mandated legislation, drafted by Marxist zombies and Nazi ghouls. This recasting allows them to portray the health care debate as a conflict between socialism and capitalism and to claim, disingenuously, that the real issue is that the Democrats are far more concerned with the good of the masses than they are with the rights and needs of individuals. Thus, they can plug into all too familiar, though irrelevant, anti-communist fervor and the carefully processed, artificial patriotism of championing the "American Dream."

This gives opponents the chance to use every tool possible against health care reform without having to take too much of a stand. Further whipping up a genuine sense of indignation, opponents complain that the process has not been bipartisan, as President Obama desired. Congressional Republicans, though offering sound bites about this lack of input, seem overwhelmingly committed to only one thing, which is not discussion or compromise but gutting or derailing reform in order to embarrass Democrats. They certainly have not offered viable alternatives to dealing with the problem.

Meanwhile, the chorus of pundit clowns, regardless of individual ideological positions, takes its usual knee-jerk position that the problem is not complex but easy, because there really is no problem – only evil fellow Americans who are consciously trying to harm the republic.

President Obama and the Democrats have by no means done a dream job of advocating their positions and advancing the legislation. Given that these issues are among the most complicated problems facing our government, trying to move the legislation along too swiftly to meet an unnecessary and artificial deadline was a terrible and dishonest strategy.

It also would be disingenuous beyond comprehension to argue that, with such massive reform involving so much money, anyone should be confident that the 1,000-plus-page, Hail Mary health care reform bill is fiscally sound and socially reasonable. Despite my enthusiastic support for reform, as well as my feeling that government generally does a much better job than it is credited for, this one causes worry.

When the Democrats pass extremely long bills that few legislators have read all the way through, it is as disturbing as it was when the Republicans did the same thing again and again during the Bush administration. Conveniently, in this debate Republican members of Congress have taken umbrage with the length and speed, again benefiting from their topic-specific partisan amnesia.

When a debate becomes as acrimonious as this one, the constituency of concerned citizens and politicians with very germane questions who have not yet decided how they feel about this reform tends to get lost in the histrionics: Attempting to raise those issues usually has one side or the other charging at them. When "questions" in the discussion are actually disguised indictments or endorsements, actual questions have become exotic.

In terms of constructive alternative solutions to health care problems, many throw around the idea that we should just trust the free market system to deal with this problem, because government involvement in anything dooms the project to disaster. The problem with this argument is that there is no "free market." There is a regulated market, which is actually what is desired by most businesses and individuals and also provides the most benefit to the general public. It should be noted that at least some of the federally legislated regulations relevant to health care came about because of the lobbying of major health-related organizations.

The almost inevitable success of this market is usually cited in the context of the guaranteed failure of the government at anything. This position makes me nostalgic for those magical days at the beginning of the first Bush administration. Fully embracing both those ideas, President Bush suggested that the Social Security system be revised so that, rather than being required to give the government the money, workers would be allowed to consider stock-market investment options for that portion of their earnings. The argument was that this would both empower the workers and help address Social Security's long-term budget concerns.

Imagine if that idea had actually been passed into law quickly back when it was brought up. Where would workers in this country be now, in terms of retirement savings? The good news for many, I guess, is that those wonderful and dependable free-market financial institutions – Bear Stearns, Merrill Lynch, American International Group, Washington Mutual, Lehman Brothers – were there, allowing Americans to invest savings in order to supplement their Social Security. (Unfortunately, this didn't work out in exactly the way our "trust private enterprise" friends envisioned.)

As much as I'm attracted to reality, I find that it really is thoughtless, dogmatic sloganeering that helps me make it through the night. Currently, the above is my fairy tale of choice to tell myself when I can't sleep.

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