Can the Townhallers Be Left, Rather Than Left Behind?

Monday 21 September 2009

by: Dean Baker, t r u t h o u t | Perspective

Can the Townhallers Be Left, Rather Than Left Behind?
(Photo: brykmantra / Flickr)

The size and energy at the anti-health care reform protests last weekend were impressive. While some of the leaders are clearly racist nutballs, who can't accept that an African-American is in the White House, many of the tens of thousands who showed up in Washington and elsewhere came out in response to their perception of a government that does not respond to ordinary people.

They have a basis for this complaint. It is hardly a secret that President Obama cut deals with the health insurance industry, the pharmaceutical industry, and other powerful interest groups. This may have been necessary for him to get a health package through Congress, but it's hard to blame people for being suspicious.

Many of the protesters were not against the government playing a role in health care. In fact, one of the mostly widely expressed concerns was that the President Obama's health care plan would worsen the quality of Medicare.

Supporters of reform believe that this reform will be a step forward in providing quality health care for everyone, but how confident can anyone be in this view? If there is no public insurance option, as is likely to be the case, how confident can we be that regulators will prevent the sort of abuses that are currently widespread in the insurance industry?

Insurance companies may not be able to deny coverage based on pre-existing conditions, but that doesn't mean that they will necessarily pay claims. In the post-reform world many families may find they have as much trouble getting insurers to pay claims as they do today. They may also find that insurers don't include adequate lists of specialists in network, thereby forcing patients to either incur large expenses for going out of network or wait months for treatment.

Supporters of reform believe that regulators will act to prevent such abuses by insurers, but there is not much reason for this confidence. Under any version of reform likely to pass, most insurance regulation will still be at the state level. Many state regulators do not have a good track record of reining in abuses by the insurance industry.

What do we get if the federal government requires people to buy insurance, which quite possibly would be bad insurance, and provides subsidies to do so? By definition this would mean more people have insurance, but it doesn't mean that people will have good health care. And, in the process, we will have made the insurance industry, the pharmaceutical industry and the hospital industry considerably more profitable.

This is an example of what was known in last fall's presidential campaign as “spreading the wealth around,” but as is generally the case in this country, the direction of redistribution is upward. The government would be taxing ordinary people and/or requiring them to make direct payments to insurers in order to enrich major corporations and their top executives. Certainly, the townhallers have every right to be upset about being forced to give their money to the multi-millionaires running United Health, Cigna, and the rest.

This suggests two obvious options. First, we can go back to the much maligned public option. As my libertarian friends used to say in other contexts: “what's wrong with giving people a choice?” We know why the insurance industry hates the public option: They don't like competition. But what possible reason can the townhallers have for objecting to giving people a choice? It is an option. If they don't like it, they don't have to eat it. Surely, someone with President Obama's communication skills can make this point.

Suppose the insurance industry is so powerful that it succeeds in keeping the public option off the table. There is no reason to let these guys just run off with our money. There is another possible route to limit the upward redistribution of income, if not to limit abuses. We simply impose compensation restrictions on the executives of insurance companies who benefit from the public subsidies.

In other words, if insurers enroll people with a subsidy from the government, then the pay of their executives (including stock options, bonuses, executive jets etc.) will be capped at $2 million or $3 million, rather than the $30 million, $40 million or $50 million that some of these honchos currently rake in. This would be an entirely voluntary pay restriction. If the execs don't want their pay restricted, then they don't have to accept the public subsidies.

It is clear that most of the health care reform protesters don't have a clear conception of the policy issues. But they do have a real basis for concern that they are about to be ripped off for the benefit of the rich and powerful. It would be nice if those of us who support reform could honestly assure them that this is not the case.

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Comments

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The only way to make any

Mon, 09/21/2009 - 15:20 — Anonymous (not verified)

The only way to make any restrictions work is to not only tie it to CEO pay but total corporate profits like they do in Switzerland, Germany, and others. Regulate the companies similar to utilities. If we offer this as an alternative the insurance companies will be clambering for a public option. Personally, single payer is the only way to go. If you've seen Sicko, it makes the point very effectively. Should be required viewing for congress and the Townhollerers.

I'd like to add that the

Mon, 09/21/2009 - 15:25 — Anonymous (not verified)

I'd like to add that the confusion about who is on their side and what it means to be a patriot is the product of a disinformation program that has been going on since before the Civil War. Some of their concerns and sense of patriotism are genuine and can be directed toward better ends if they are educated rather than simply insulted and attacked. What we all need right now is more truthful and intelligent information and less shouting and name calling.

ATTENTION!! Congress Has The

Mon, 09/21/2009 - 17:14 — jacksmith (not verified)

ATTENTION!! Congress Has The Votes Needed To Pass A Public Option - TODAY http://bit.ly/TCq7O Why A Strong Public Option Is Essential - By jacksmith - Working Class Robert Reich explains the pubic option: http://bit.ly/dDYSJ http://robertreich.blogspot.com/ It's not just because more than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% republicans). Basically everyone. It's not just because according to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. With 79% of seniors supporting creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!! It's not just because it will lower cost. Because a strong public option will dramatically lower cost for everyone. And dramatically improved the quality of care everyone receives in America and around the World. Rich, middle class, and poor a like. It's not just because it will save trillions of dollars and prevent the needless deaths of millions more of YOU, caused by a rush to profit by the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! It's not just because every expert in every field, including economist, and Nobel laureates all agree that free market based healthcare systems don't work. Never have and never will. The US has the only truly free market based healthcare system in the World. And as you all know now, IT IS A DISASTER! It's not just because providing or denying medically necessary care for profit motivations is wrong. Because it is WRONG! It's professionally, ethically, and morally REPUGNANT!, Animalistic, VILE and EVIL. THE REASON THE PUBLIC OPTION IS ESSENTIAL: The public option is ESSENTIAL because over 200 million of you are trapped in the forest of the wolves. Which is the forest of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! With no way out except through needless inhumane suffering, and DEATH. While the wolves tear at your flesh, and rip you limb from lib. Then feast on your lifeless bodies like a dead carcase for transplant parts. At the most vulnerable times of your lives (when you were sick and hurting), millions of you have had to fight and loose cruel, but heroic battles. Fighting against the big guns of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! in the forest of the wolves. All because you have no place else to go. You have no other CHOICE! But the PUBLIC OPTION will give you someplace safe to go. And it will give us someplace safe to take you. The public option will be your refugium (your refuge). Where the wolves cannot get at you when your down, hurting, and vulnerable. Where everyone who needs it can find rest, security, comfort and the care they need. Protected by the BIG GUNS of We The People Of The United States. THE MOST POWERFUL PEOPLE AND COUNTRY ON EARTH. This is why it is so critical that we do not lead another 50 million vulnerable, uninsured Americans into the forest of the wolves, without the protections of a Strong Government-run public option. We The People Of The United States MUST NOT LET THAT HAPPEN to any more of our fellow Americans. If healthcare reform does not contain a strong public option on day one. YOU MUST! KILL IT. Or you will do far more harm than good. And millions more will die needlessly. Rich, middle class, and poor a like. To those who would continue to obstruct good and true healthcare reform for the American people, and who seek to trap millions more vulnerable Americans in the forest of the wolves. We will continue to fight you. We are prepared to wage all out war against you, and will eagerly DESTROY! you. Time...is...UP! YOU HAVE BEEN WARNED! No Co-op's! No Triggers! NO INDIVIDUAL MANDATES! without a Strong public option on day one. Healthcare reform can be the GREATEST! Accomplishment of our time and century. A time when future generations may say of us, that we were all, AMERICAS GREATEST GENERATIONS. BUT WE MUST ACT! I therefore call on all my fellow Americans and the peoples of the World. To join us in this fight so that we may finish becoming the better America that we aspire to be for everyone. SPREAD THE WORD! I have been privileged to be witness as many of you fought, and struggled to take your first breath, and your last breath on this earth. Rich, middle class, and poor a like. Life is precious. Whatever the cost. WE! MUST SUCCEED. God Bless You My Fellow Human Beings jacksmith - Working Class Things You Can Do To Help NOW! http://www.everydaycitizen.com/2009/09/tired_of_watching_people_die_n.html No Triggers! http://www.huffingtonpost.com/jason-rosenbaum/a-trigger-for-the-public_b_277910.html Triggers http://www.huffingtonpost.com/david-sirota/weve-seen-these-triggers_b_283583.html Krugman on heathcare (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/) Senator Bernie Sanders on healthcare (http://www.youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded) John Garamendi on the Public Option and the Grassroots: http://bit.ly/TJMty Howard Dean on the Public Option http://www.youtube.com/watch?v=8SKfW2dUnow&feature=player_embedded We're Number 37! in quality of health care http://www.youtube.com/watch?v=yVgOl3cETb4&feature=player_embedded Twitter search (#welovethenhs #NHS #hc09 #hcr #healthcar #obama #p2 #topprog #) Check it out.

There are a multitude of

Mon, 09/21/2009 - 17:24 — Eilish (not verified)

There are a multitude of problems with the health insurance bill, and I'm afraid we've passed the point of 'no good will come of it'. Insurance reps at my workplace have told me that the bill has a quiet couple of paragraphs on prescription drugs that will limit the number of painkillers per month, and limit to generics only if the drug has one. I know a few people who literally only exist on pain pills for horrendous conditions. If drugs are limited, these people will die from the stress or at their own hands. Soldiers are lucky that the VA doesn't have this provision. I myself seldom use painkillers, but for lupus there are times I feel like screaming if they aren't available. Each body is different in the amount of pain killer needed, which can only be evaluated case by case. There are horror stories about generic drugs, because they are only required to be within 66% of the prescribed active medication ingredient. For the two drugs that I take this was disastrous. Brand name drugs must be 100% compliant; how do we think generics can be cheaper? My insurance company arbitrarily gave me generics contrary to my (2) doctor's specific scrips and it nearly killed me. Has killed many others on these drugs. This bill is so flawed, chopped up, scribbled over and just outright dangerous, that I believe it should be scrapped and a breather taken before trying again. It's more important right now that JOBS be the issue; how many people will be on a public health care program because they can't pay for it??

What is truly radical is not

Mon, 09/21/2009 - 18:11 — Linda W (not verified)

What is truly radical is not the public option, it's the insurance mandate. Traditionally, the government has collected taxes then distributed the funds for our nation's needs - that could include single-payer health care. But for the government to demand residents transfer up to 13% of their income DIRECTLY to a corporation is simply un-American, and possibly unconstitutional. What can justify creating a new bureaucracy, using near Gestapo techniques, to insure compliance with this new mandate? Regulation can keep insurance companies from cancelling policies once someone becomes sick. We can make other provisions to cover people with pre-existing conditions. And those "free riders?" Some studies find they only account for 1.7% of increased health insurance premiums, hardly a problem that needs to be dealt with via a draconian mandate.

I presume the thrust of

Mon, 09/21/2009 - 18:55 — Robert Walters (not verified)

I presume the thrust of President Obama's parade around the media circuit is aimed at communicating many of these facts about the healthcare reform proposals and the public option. Many of the enraged citizenry who show up at the town hall shouting matches are indeed fearful of having their healthcare access compromised by any reform, and they rightly distrust the bought-and-paid-for Congress to truly represent their interests instead of those of the Congress' paymasters -- the corporations. But part of the outrage also is hang-over from the unconscionable bail outs of Wall Street, which have done precious little to ease the financial burdens and pains of Main Street. Regrettably, too many of the protesters are as inarticulate as the Obama Administration has been (about reform); hence, they simply express blind rage, mis-directed at the Obama Administration at the behest of those dangerous demagogues (Beck, Limbaugh, Hannity, et al, and some members of the Congress/Senate Rethuglican Caucus) who have an altogether different axe to grind with the Administration. When people become enraged, clear/logical thinking goes right out the window, and irrational bile takes its place. A situation right out of 1930s Germany!

...if insurers enroll people

Mon, 09/21/2009 - 19:14 — Anonymous (not verified)

...if insurers enroll people with a subsidy from the government, then the pay of their executives (including stock options, bonuses, executive jets etc.) will be capped at $2 million or $3 million... Why so much? How about twice as much as the President, or a Senator, or a Supreme Court Justice makes? Or, if they are relying on public money, why not use the Civil Service pay scale? Perhaps they secretly think that Civil Servants are underpaid...

Racist Nut jobs? Prove it or

Tue, 09/22/2009 - 07:14 — Tom Martin (not verified)

Racist Nut jobs? Prove it or stop slandering. When one pretends to do an informative piece if they are going to lead off with an inflamatory line they better back it up else look like a pandering liar. I was at the DC Protest, it recorded in its entirety and available on C-span you can listen to every speaker look up every group and you will see no leaders supporting racism. When there are over a million people there will be a few nut jobs - they do not define the movement. I agree with Reverend Sharpton that race is not the issue here and we are being distracted from more important things. The only color that counts is the color of money. The signs en mass focused on the fact that government is broke and putting us deeper in massive debt. The government IS by in large the problem with health care - Why cant people individually shop for best insurance - why no tax deduction for that but employers do? Why cant we shop cross state lines? Why is there zero incentive to shop for low cost on non immediate procedures?... Try capitalism, the untried ideal

...Except that these

Tue, 09/22/2009 - 07:56 — Anonymous (not verified)

...Except that these protesters aren't the ones angry about the lack of the public option. They're the ones demanding no public option in the bill. Claiming that they're upset because they will be forced to fork over their money to big insurance makes no sense when these are the people who killed any hope for a single payer plan. If there is no public option in the bill, it will be because of these people, who are convinced that a public option, which would create real competition in the insurance marketplace, is a bad idea.

Mandating the purchase of a

Tue, 09/22/2009 - 08:03 — j bentham (not verified)

Mandating the purchase of a health insurance policy from the very companies responsible for out-of-sight health care costs is an absurdist's wet dream; it's also exactly what Barak Obama claimed he would not support when he was campaigning for the presidency and discussing needed health care reform. He got it right, then; he's reversed himself entirely on this issue now. Mandated untrustworthy overly-costly and unaffordable health insurance is punitive government. Perhaps all us Progressives should be out there with the tea-baggers, screaming our heads off.

It's true that the

Tue, 09/22/2009 - 08:49 — radline9 (not verified)

It's true that the government doesn't usually respond to ordinary people, but if this is the claim, why are these people demonstrating against health care for ordinary people?

I think that the underlying

Tue, 09/22/2009 - 09:02 — Anonymous (not verified)

I think that the underlying issue here has been overlooked by the commenters. Not only is the President not doing what the ordinary people want, but neither is Congress. The health care objections are not just an issue over the public option. The bills that have been proposed by the Pelosicrats and the Obamunists do not provide a level playing field, but at best set up the entire industry for direct government control, and at worst implement a government monopoly, i.e., socialized medicine. The more radical the bill, the greater the opposition. The greater the opposition, the braver the extremists get in piggy backing on the opposition and broadcasting their ridiculous viewpoints. In addition, when the President staffs his cabinet with communists, racists, socialists, and other extreme leftists those at the opposite end of the spectrum will become vocal. By "cutting deals" to get "his" reform passed he is building mistrust with the people. He is demonstrating the same traitorous tendencies as Pelosi and the rest of her cronies (including some of the Republicans) - putting their egos above the orders of the people of the US.

I disagree with the author's

Tue, 09/22/2009 - 10:37 — Anonymous (not verified)

I disagree with the author's view that many of the people showing up for the anti-health care protests were there because they thought the administration cut deals with the large corporations. These were all right-wing people who get their misinformation from Glen Beck, Rush Limbaugh, and others like them, who never criticize corporations. They are concerned about Medicare only because of the lies told by those propagandists, not because of anything real. However, there are many people on the left who are very concerned that Obama and so many other Democrats are in bed with the same corporations who are the root cause of the problems they say they are trying to fix. I have heard some Democrats wonder where the supporters of health care reform are to counter the right-wing demonstrators. It is obvious to me: they are waiting for real reform, or at least half-way reform! If Obama is so willing to give up the public option, the only thing in the bill that makes it half-way decent, why in the world would you expect anyone to fight for it? Come on, we aren't as stupid as the people who believe the right-wing propaganda. We won't passionately fight for imaginary reform. Give us something to fight for! And fight with us, instead of only "compromising" until there is nothing left worth fighting for!

Frank Rich also thought

Tue, 09/22/2009 - 10:51 — Martha Elizabeth Ture (not verified)

Frank Rich also thought these were populists with a legitimate point. Bunk. These are the folks who throiughout US history and back seven centuries in Euro history have always been marginalized for dingbat credos and fanaticism. Remember the beef over school vouchers? Recall the Scopes monkey trial? Who are the teabaggers? They are nuts. Religious nuts. They prefer ignorance to education. Only way to change them is to have academia take over the churches.

"Insurance reps at [your]

Tue, 09/22/2009 - 13:30 — Anonymous (not verified)

"Insurance reps at [your] workplace" are not the best source for unbiased, truthful information about Health Care reform. The fact is that Insurance that is tied to employment is not insurance - it is a job benefit - like salary and vacation days. if you lose your job, you lose your coverage. If you lose your job because you are sick, you are doubly hurt - no job and no insurance. We need a health care plan that "insures" that you can get health care whether you are employed or not. That you can get for a reasonable rate if you have a prexisting condition. That will cover your needs when you need it. We need single payer health care. Medicare is an excellent example of single payer health care - it works. Seniors who have it love it and would not give it up for anything.

Oh, Lord, we have someone

Tue, 09/22/2009 - 15:38 — Anonymous (not verified)

Oh, Lord, we have someone commenting here on the dangers of the health insurance bill because of things that insurance company reps told him at work! This is exactly the kind of problem that is turning the country into gridlock. Would it help to ask what reason an insurance company would to lie?

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