How Corporate Media, Sellouts in Congress and Industry Bigs Have Hijacked the Health Care Debate

[Guest guest]

How Corporate Media, Sellouts in Congress and Industry Bigs Have Hijacked

the Health Care Debate

By Joshua Holland, AlterNet

Posted on July 29, 2009, Printed on August 3, 2009

http://www.alternet.org/story/141627/

If you can frame the terms of a debate, you've gone a long way toward

winning it before you've begun. Tragically, Republicans, the health care

industry and business-friendly " Blue Dog " Democrats have largely been able to do

exactly that, with a substantial assist from the corporate-owned media.

 

 

They've successfully focused the health care debate on the short-term

costs to the federal government's bottom line, obscuring the potential impact

that a meaningful realignment of the health care system would have on the

economy as a whole. In so doing, opponents of reform have hoodwinked much of the

public into believing that investments in America's national health care system

will wind up costing individuals more than they had gained from the effort.

 

 

 

In fact, they've done such a good job that much of the discourse has

revolved around what is arguably one of the least-relevant aspects of the

proposals being debated in Congress: whether they " cost too much " or are

" deficit neutral " in terms of their impact on the federal budget over the next

10 years.

 

 

 

Much of that discussion has been fueled by a series of estimates issued by

the Congressional Budget Office -- estimates based on incomplete drafts of the

legislation now moving through Congress. Yet, by and large, the mainstream media

have dutifully repeated the spin without mentioning that the critics are touting

the CBO's preliminary projections as definitive and final.

 

 

 

Even worse, a study of cable news reporting by the media watchdog group

Media Matters found that when the CBO issued a follow-up to an earlier, more

pessimistic projection of the bill passed by the Senate Health, Education, Labor

and Pension (HELP) Committee, it went all but unreported by the cable news

networks. CBO projected it would cost $611 billion, while an earlier estimate --

which was dissected eight ways to Sunday by the same cable networks -- suggested

it would run an even $1 trillion.

 

 

 

There are also benefits contained within the proposals that are impossible

to score in limited budgetary terms. For example, if the House bill were passed

as it stands today, it would all but eliminate health-care-related bankruptcies

by capping the amount of out-of-pocket expenses with which a family or

individual can be burdened. A group of researchers from Harvard studied over

2,300 bankruptcies filed in 2007 and concluded that more than 6 in 10 were due

to medical causes. What is it " worth " to our society to ease that kind of pain?

It's not in the purview of the CBO to say.

 

 

 

That's just one of several reasons why the budgetary impact over 10 years

of a program of long-term reforms is such a poor metric for judging its value.

First, the very same preliminary CBO estimates that are being used to gin up

fear of a budget-busting boondoggle that will saddle our grandkids with debt for

generations to come also suggest that the proposals would extend health coverage

to tens of millions of uninsured Americans. Why such a significant improvement

in the health and economic security of so many real people should be expected to

come at no cost to the government's balance sheet is a mystery.

 

 

 

Second, it fundamentally obscures the actual terms of the debate in

Congress. Leaders in both the House and Senate have promised that the final

legislation will be fully-funded -- " deficit neutral " -- and the battle lines

have in fact been drawn not only around what form the final bill will take, but

also how to pay for it.

 

 

 

Moreover, the narrative is based only on the impact of the proposals on

the federal budget in isolation, all but ignoring the larger effect that fixing

the system (if done right) might have on the economy as a whole. Under

consideration are various proposals designed to rein in the spiraling cost of

health care across the entire system.

 

 

 

So these are not sunk costs, but investments that analysts expect will

have a significant payoff. A study by David Cutler of Harvard and the Rand

Corp.'s Melinda Beeuwkes Buntin estimated that just three elements within the

larger proposals offered by Democrats so far -- all of which come with start-up

costs in the beginning -- would result in $550 billion in savings to the larger

health care system over the next 10 years (PDF).

 

 

 

Those kinds of savings are desperately needed over the longer term -- the

status quo, if allowed to continue on track, threatens to undermine the

competitiveness of American business and leave more and more people without

coverage (researchers have found that fast-rising premiums, more than any other

factor, has driven the decades-long rise in the number of uninsured Americans).

And skyrocketing premiums force employers to squeeze wages, which impacts

communities' tax revenues and deprives the economy of consumer dollars.

 

 

 

So the more salient question is: How can we possibly afford not to fix the

current system? In 1960, we spent less than 5 percent of the gross domestic

product on health care, and all but a small number of working-age Americans had

access to care. Today, health-care spending represents around 17 percent of our

economic output, and about 1 in 6 lack coverage. And, according to virtually

every projection out there, it's only going to get worse unless we make

substantial reforms soon.

 

 

 

In 2007, the U.S. spent an average of $7,290 per person on health in total

(both public and private care). The average costs in other wealthy countries --

generally with better outcomes -- was $2,964. Here's a graphic representation of

where we're likely to go in terms of costs if we leave things as they stand:

 

 

 

 

 

 

(click for larger version)

 

 

 

 

Economist Josh Bivens of the Economic Policy Institute wrote that the

non-budgetary effects of fixing the system " will pay off big for American

families in the form of lower premiums, co-pays and space for wage growth. "

 

 

 

Bivens adds: " The reason is simple: health care is an area where the more

costs are loaded up on the federal government, the more efficiently care tends

to be delivered overall. " Bivens points out that although the U.S. spends far

more than other advanced countries on health care, far fewer of those dollars

are in the public sector and suggests that the difference is a major reason why

we get far worse results (in terms of access, life expectancy at birth, our

chances of living until age 60 and most other meaningful metrics).

 

 

 

To illustrate the savings built into public-sector health spending, he

goes on to cite an analysis by the Lewin Group of competing approaches to reform

that measures the impact on federal spending and overall health spending. The

results are summarized in this graphic:

 

 

 

 

 

 

 

 

 

 

(click for larger version)

 

 

 

 

 

 

On the left, is Rep. Pete Stark's, D-Calif., proposal for a single-payer

system (one that closely mirrors Rep. John Conyers', D-Mich., HR 676, which has

85 co-sponsors in the House). As you can see, while it extends coverage to

everyone -- which obviously costs money -- it is the only approach studied that

would also result in a reduction of health care spending overall.

 

 

 

In the middle is a hybrid along the lines of the House bill (the Lewin

Group used a similar proposal promoted by the Commonwealth Fund). According to

Bivens' analysis, although " federal health spending [would] rise " as the system

is implemented, the " increases in federal spending . are accompanied by large

reductions in spending by households and businesses. Net total health spending

would rise by less than $18 billion, an amount that is more than explained " by

new funding to cover the previously uninsured.

 

 

 

The right column, appropriately, shows the impact of Sen. Mike Enzi's,

R-Wyo., plan, a boilerplate conservative proposal based on offering tax cuts to

those who purchase private insurance and slightly expanding eligibility for

Medicaid.

 

 

 

It does increase federal spending by slightly less than the other

approaches analyzed, but in the process it also increases total health care

costs more than the amount of tax dollars sunk into the plan, while insuring

only the relatively small number of people who make just a bit more than the

current cut-off for Medicaid.

 

 

 

But even that standard doesn't tell the whole story. Looking only at how

the current proposals impact health spending over a 10-year window ignores the

longer-term impact they might have.

 

 

 

For example, contained within both the Senate and House bills are

provisions that would create more incentives for preventive care. Most analysts

agree that prevention costs a lot less than waiting for people to develop

serious illnesses and then treating them, as we now do, but those savings can

only be fully realized over the long term.

 

 

 

If a young obese person visits a doctor whom he or she might not have seen

because of a lack of insurance, and as a result of that visit makes changes that

prevent him or her from developing diabetes -- with all its attendant

complications -- it will save the health care system a small fortune, but

probably not for several decades.

 

 

 

Finally, there's a sad irony to this whole discussion -- one that few

commenters have bothered to note. It is true that the potential savings

contained in the proposals currently on the table are limited, but it is also

true that the reason for that shortcoming is that congressional leaders have

ushered through a series of bills that are far less expansive than progressive

reformers have long advocated, and that's only been done to mollify the very

same Democrats and Republicans -- those ideologically opposed to the effort

and/or especially cozy with the " disease-care " industry -- who are now

complaining about the limited potential for savings (It's enough to make your

head spin).

 

 

 

Just consider the " public insurance option. " While progressives were

promised a " robust " public insurance program that would be open to all comers,

what emerged from the Senate HELP Committee and from the leaders of three House

committees was a pale shadow of what had been touted during last fall's campaign

season.

 

 

 

Instead of insuring as many as 130 million Americans as candidate Obama

suggested his public option would, lawmakers restricted eligibility for the

program in such a way that the CBO's preliminary estimate suggested that just 10

million Americans would be enrolled in the public insurance plan by 2019.

(That's out of about 30 million who could buy insurance -- either public or

private -- through the publicly run insurance exchanges.) This was a nod to the

power of the insurance industry -- nothing more, nothing less.

 

 

 

In designing a (pretty good) system, but then tightly controlling who

could gain access to it, the potential for cost-containment -- through greater

economies of scale, more bargaining power with providers and a decrease in the

shuffling of paperwork that's estimated to account for about 30 percent of our

health spending -- has been greatly diminished.

 

 

 

So, next time you see some congressional meat-puppet on TV discussing how

much a plan will cost, or lamenting its limited potential for cost containment,

keep in mind that it's his or her ideology that is directly to blame for those

shortcomings.

 

 

 

It's only because of pressure from industry groups, Republicans and Blue

Dog Dems that congressional leaders took single-payer off the table (and threw

advocates out of the room) and gave us a limited public insurance option -- a

pale shadow of what reformers had been promised.

 

 

 

Now, those same forces are bent on killing an already-watered-down

proposal. If they succeed, we can expect more human suffering, more outlandish

increases in premiums, more people being denied care, an increase in the numbers

of uninsured and a continued drag on the American economy.

 

 

Joshua Holland is an editor and senior writer at AlterNet.

 

© 2009 Independent Media Institute. All rights reserved.

View this story online at: http://www.alternet.org/story/141627/