Krugman's Health Care Sell-Out: The Health Care `Reform' Bill is Worse than Nothing
By Dave Lindorff
Paul Krugman, one of the few liberal columnists writing for the New York Times, claims that at some point in the hoary past when he “began writing a lot about health care,” he was in favor of a Canadian-style single-payer health care system. He adds that even today if he thought there was “any chance of creating Medicare for All any time in the next decade,” he would be “pushing for single-payer now.”
But on Christmas, Krugman threw in the towel, calling on progressives to support the Senate’s version of health care legislation. Suggesting that the so-called Senate Health Reform Bill, if it had been the law back in Dickens’ time in England, would have saved Tiny Tim without any need for the belated charitable intervention of Ebenezer Scrooge, Krugman says progressives should recognize that the Senate bill is the best they can hope for, and that they need to accept that politics is “the art of the possible.”
Krugman goes on to say that despite some “flaws and limitations,” which he leaves unexplained, the Senate bill is “a big win” for progressives--and for America.”
But is it?
Certainly the Senate bill, and the only slightly less cruddy House version, with which it must be reconciled (let’s be clear here that the ultimate act, when passed, will much more closely hew to the Senate version than the House version, given the number of conservative Democrats in the Senate), does a few good things, such as increasing funding for community health clinics, expanding Medicaid, the health insurance system for the poor, and banning the current insurance industry practice of denying coverage to people with pre-existing medical conditions. But these small positive steps pale in comparison to the truly noxious things this bill does, and the things it fails to do.
The most outrageous thing the health “reform” bill does is further consolidate the death grip that the insurance industry has over health care access and delivery in America. It does this by mandating that everyone buy health insurance, on pain of being slapped with a heavy fine by the IRS. Since most of the 47 million Americans without health insurance are younger and healthier than average, what this measure does is hand the private insurance industry a huge captive customer population who will be stuck with high-cost, low-benefit insurance that will generate huge profits for the industry. The industry will be further enriched by nearly half a trillion dollars in subsidies needed to help low-income people or small businesses buy their mandated health insurance--subsidies which will end up going directly to insurance companies, which will be offering in return wretched bare-bones plans that will only cover some 60% of actual medical costs.
Supporters say that mandating that everyone have health insurance is akin to mandating that every driver of a car buy liability insurance, but there actually is a huge difference. Driving is a matter of choice. If a person doesn’t want to buy car insurance, she or he can decide not to own a car. That reality at least forces auto insurers to compete in offering low-cost minimal insurance plans. Nobody can decide not to buy health insurance under this plan though. It is a historic first: a law requiring American citizens to buy a service from a private company.
Adding insult to injury, the bill does almost nothing to limit costs. This is why doctors, hospital and drug companies and the insurance industry, all of which spend millions of dollars lobbying for this law, love it (health insurance company shares jumped on word of Senate passage). Indeed, the government’s own Center for Medicare and Medicaid Services (CMS), predicts that the law, if enacted, will cause US health care costs--already the highest in the world on a per capita basis and as a share of GDP by a factor of almost two--to rise faster than ever. Furthermore, to keep the projected costs of this bill at an alleged $871 billion over ten years, a huge amount of money is stolen from important existing programs, including $43 billion from payments to safety-net hospitals (mostly public institutions in urban centers which serve poor populations), and from cuts in Medicare funding that could for the first time lead significant numbers of physicians to stop seeing elderly patients on Medicare.
The reform plan is terrible for other important reasons too. In order to sell it to one lone hold-out Democrat, Sen. Ben Nelson of Nebraska, Senate leaders allowed strict limits to be put into the bill making it almost impossible for low-income women or families to buy insurance that includes payments for abortions. The bill also undermines trade unions by taxing, at a rate of as much as 40%, those health plans which, through years of negotiations, offered quality care to workers. As the group Physicians for a National Health Program (PNHP) points out, group health insurance costs are also largely driven by geographical and demographic considerations, and thus this penalty tax actually targets workplaces that employ more women, or that have older workers, or which are located in higher-cost regions such as New York or California.
But surely the worst thing about this bill is that far from putting the US on a course towards some eventual humane national health system like those that exist in the rest of the developed world, and even in many countries in the less developed world, it actually locks in the power of the insurance industry even more solidly, making achieving true health reform an even more difficult challenge than it has been.
Krugman is wrong. If the health plan envisioned by Congress had been the law of the land in Dickens’ time, Tiny Tim’s survival would still have been dependent upon Scrooge’s largesse. If his parents did manage to buy some subsidized insurance policy (and under the Senate version, over 20 million Americans would still be left uninsured!), the deductibles and co-pays would be so high that they still would not be able to get him treated for his deadly disease, and the dark future predicted by the Ghost of Christmas Yet to Come would still have befallen him and his family.
Krugman is also profoundly wrong in his gloomy prediction that there is no chance for true health care reform (as defined by expanding Medicare to cover everyone in America), any time in the next ten years.
As the insurance industry continues to rake in obscene profits, as America’s health statistics continue to plummet, and most importantly, as the huge population of baby boomers hits retirement age and sees their health coverage under Medicare gutted and their children and grandchildren struggling to pay for care, the stage will be set for a radical political realignment, with socialized medicine as one of its key demands.
The liberal attitude expressed by Krugman, of urging progressives to accept a tenth of a loaf, only works to push off the day of that political revolution.
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DAVE LINDORFF is a Philadelphia-based journalist. He is author of “Marketplace Medicine: The Rise of the For-Profit Hospital Chains” (Bantam Books, 1992). His most recent book is “The Case for Impeachment” (St. Martin’s Press, 2006). His work is available atwww.thiscantbehappening.net
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living in America without health insurance
The Silent Patient - Suffering in Silence
We squabble over health reform and across the country patients suffer and die daily without proper care. The public option may not be, but scraping all is not the alternative. Doing nothing cannot be an option. Reform is needed. The failings of our health system are many. Most egregious is standing by and allowing millions of our citizens to be without health insurance. Without insurance, they have no physician and without a physician, they have no medicines.
For those preferring to kill health reform 2009, as a practicing primary care physician, I offer my observations from the free medical clinics in Little Rock and Kansas City.
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They arrived early - before the doors opened. Kansas City was the third medical clinic organized by The National Association of Free Clinics and sponsored by MSNBC with funds raised by Keith Olberman. The clinics were exclusively for the “unseen patient” - those without health insurance.
The first one-day clinic, in New Orleans, cared for 1002 patients. The second was in Little Rock where 978 people were seen in one day. Kansas City was the third clinic where in two days services for 2298 people were provided. At discharge, all patients had follow up services arranged in local free clinics.
Hundreds of health professionals and thousands of volunteers participated. Many came long distances. I traveled to Little Rock for the one day Saturday clinic in mid November. Four weeks later I was in Kansas City for the two-day mid-week clinic
Coming from Massachusetts, where I have practiced primary care medicine for the past thirty-five years, I was unable to obtain a short term out of state license in either city. I was asked to triage the registration line for anyone needing urgent care. This afforded me an opportunity to my way through the crowd speaking to the hundreds of citizens patiently waiting. “Doc, I have waited for six years to see a doctor, another four hours is nothing.”
The stories in both cities were identical. After more than four decades participating in the medical profession, I thought I was prepared to hear anything. I was not. The citizens lining up were the ones not seen before they become desperately ill and arrive in our emergency rooms or morgues. Then their acute illness precludes discussion of their exclusion from health care.
More than 80% of the folks we cared for were working. Some had more than one job. None of their jobs provided health benefits. Others had been laid off and could not afford COBRA. Many did not have enough hours of work to qualify for their employer’s health insurance.
None had medical or dental insurance. Few had seen a physician in the past year. Forty percent had not seen a physician in the past six years. Any care they might have received was urgent, fragmented and without follow up. All had the same reasons for having neglected their health. Without insurance, they could not afford to pay for a physician visit. Without insurance they could not afford to fill their prescriptions. Without insurance, they could not afford any surgical procedure. If they had been sick enough to need emergency care, they were then saddled with an enormous bill that dissuaded them from seeking further care of any sort.
A man with a below knee amputation was sitting in his wheel chair. He hoped the clinic would assist him to obtain the prosthesis his medical insurance had denied devastating hopes to walk again and return to his job and be able to provide his family.
A woman grimacing in pain, had cancer treatment two years ago but was unable to continue treatment without insurance. No insurance, no physician, no medication.
Another woman wore a trench coat to cover her emaciated frame. She had come without an appointment. She had had three seizures in the past two weeks. A local emergency room where she had sought help told her that the level of her seizure medications was “OK” and then discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth and tongue. She could not eat. When I told her that we would care for her and arrange for further care, I could not see an intact tooth in her smile.
A young man with labored breathing and sweat dripping down his forehead was given a wheelchair. His weak voice told me five days ago he was in the intensive care unit of a local hospital for “swollen legs and chest heaviness”. He did not understand why his legs had swelled then or why the swelling had recurred. For a month, he experienced chest pains walking across the room. He needed three pillows to avoid awakening from sleep breathless. At discharge, he was handed a list of unaffordable medications that he did not understand. Continuing care was not arranged. He was had unstable angina. I wheeled him to the front of the line, and EKG showed blocked blood flow to his heart.
An ambulance was called and he was taken back to the emergency room. Why was this man’s leg swelling and chest pains not completely evaluated before discharge - because he did not have health insurance? Had the free clinic not occurred and his daughter not insisted that he come, would the cause of his death been his heart disease or the failures of our health system?
The slouched posture of a young man avoiding eye contact told me he did not want to talk, but had something to say. Later, I learned the plans to commit suicide of three young people had been averted. Surely he was one. Without health insurance, he did not have a physician to speak with. It is likely that he would have completed his plans were it not for the free clinic.
It was the severity of illness in the absence of treatment that was overwhelming. It was not just diabetes but it was diabetes with hemoglobin A1C of 12 and14. It was not just hypertension but is was blood pressures of 190/120. Some had never been diagnosed or treated.
The last time I had seen patients with this burden of illness was 40 years ago as a medical
student. Every patient’s story ended with the haunting refrain: “no insurance, no cash, no doctor, no medication”. It was was spoken in hypertension, diabetes, heart disease, depression or any other diagnosis. They were the "same" people I had seen lined up in the hospital corridors before Medicare was fully implemented. Unable to afford or employed without the benefit of health insurance, these tax paying citizens had been deprived of the
benefits of the medical advances of the last four decades.
The American Medical Association claims to support health reform, but they were not present in New Orleans, Little Rock or Kansas City. Absent was the American Association of Medical Schools planning the education of tomorrow’s physicians while remaining remote from the health crisis of today. There were no deans of medical schools nor their professors. Could there be a more appropriate mission for professional societies or medical schools than striving to assure all citizens have access to basic medical care. My profession shames me.
Absent were the politicians, bragging with self-righteousness, that they cannot support a ‘public option’ or expansion of Medicare for a multitude of hypocrisies and fictions, as they pretend to reform our health system without reforming health insurers.
The cost of reform is not the question. We already incur the expense with the loss of manpower and the extraordinary cost of end of life care. The question is how much it costs not to reform. The question is how much we value equality. The question is how we value our neighbor. The question is how long our nation will allow 47 million citizens to be marginalized. The question is of how we see ourselves. . My country embarrasses me.
Upon leaving the Kansas City Civic Center at 9:30 PM when the last patient was discharged, I was told of a woman who rushed to hug the organizer thanking her for allowing her to volunteer. She had learned that the patient she was pushing in a wheelchair was her neighbor.
Ralph B Freidin, MD
Lexington, MA