Dr. Stephen R. Keister : Health Care, Congress and the Inquisition

It's pure torture:
Reviewing the House Health Care plan

By Dr. Stephen R. Keister / The Rag Blog / November 15, 2009

See 'Healthcare-NOW on the House Health Care bill,' Below.

In his excellent review in TheRag Blog, Alex Knight discussed Silvia Federici's new book Calaban and the Witch: Women, the Body and Primitive Accumulation.

Caliban and the Witch is a study of women accused of witchcraft, and their ultimate fate of being burned at the stake, in Europe and America during the 16th and 17th Centuries. It details the collusion between state and church in relegating women to a secondary place in society. The author notes:

"Frederici goes on to show how female sexuality, which was seen as a source of women's potential power over men, became an object of suspicion and came under sharp attack by the authorities. The assault manifested in new laws that took away women’s control over the reproductive process, such as the banning of birth control measures, the replacement of midwives by male doctors, and the outlawing of abortion and infanticide. Federici calls this an attempt to turn the female body into 'a machine for the reproduction of labor,’ such that women's only purpose in life was supposedly to produce children.’”

In my morning newspaper an Associated Press dispatch:

"WASHINGTON -- The call came in from Rome, just as House Speaker Nancy Pelosi and her top lieutenants were scrambling to round up scarce votes to pass their sweeping health overhaul. Cardinal Theodore E. McCarrick, the former archbishop of Washington, was on the line for Pelosi, calling to discuss adding strict abortion restrictions to the House bill. It was just one element of an intensive lobbying effort orchestrated by the nation's Catholic bishops, who have emerged as a formidable force in the health care negotiations. They used their clout with millions of Catholics and worked behind the scenes in Congress to make sure the abortion curbs were included in the legislation -- and they are now pressing to keep them there."

Thus, the last minute motion by Rep. Bart Stupak that places a strict anti-abortion clause in the House health care bill. Rep. Stupak, as revealed by Rachael Maddow. is a member of The Family, a group of extreme right wing fundamentalist protestants that inhabit 311 C Street and many other residential facilities in and around Washington, D.C.

(Be sure and read Jeff Sharlet's The Family: The Secret Fundamentalism at the Heart of American Power, and Sherman DeBrosse's Rag Blog article on this subject.)

The Stupak Amendment goes much further than the long standing Hyde Amendment which forbids federal funds to cover abortions. This one "mandates that no federal funds can be used to pay for an abortion or 'cover any health care plan' that includes coverage of abortion, except in cases where the mother's life is in danger or the pregnancy was the result of rape or incest. Rachael Morris, writing in Mother Jones, continues:

"The first part of the amendment isn't new. The 1976 Hyde Amendment already prevents the use of federal dollars to pay for most abortions. Where pro-lifers won big was on the second part which would significantly limit the availability of private insurance plans to cover the procedure. That's because Stupak's amendment doesn't just apply to the public option. The House health care bill will also provide subsidies to help people and small businesses purchase plans at an exchange. This represents a lucrative new market for insurers: anyone earning less than $88,000 for a family of four qualifies for assistance, as well as certain small companies. But to gain access to these new customers, insurers will have to drop abortion from their plans."

In short this indicates that even if you pay for the plan with your own money, abortion coverage will be excluded.

Another excellent piece on the subject was Barbara J. Berg's Rag Blog article entitled "The House Health Care bill: Compromising away women's rights".

An already farcical "health care” bill has been made even more absurd by the forces that oppose a woman's right to chose. Again we are faced here -- in a nation founded on the belief that there shall be no established state religion -- with forces wishing to impose medieval theological values on our society. Will the next step be a return of the Inquisition?

A personal note. I am an 88-year old secularist who feels, as my friends know, that one’s religion should have nothing to do with friendship. I prefer to judge a person by his/her ethical character and intellect. I find religious proselytizing to be objectionable, whether it be from Christian, Buddhist, Jew or atheist. I ask of others that they not try to force their beliefs upon me as I will not force mine upon them. That is not to say that I do not enjoy listening to, or joining in, an intelligent discussion of theology, just as I am content to listen to physicists discuss the theory of thermodynamics. We can always learn, and some of my best informal teachers have been Jesuits or Rabbis.

Not only does the Pelosi health care bill face self immolation with the introduction of theological fiat, but it has deserted the concept of a public option for all. The Socialist Worker from Nov. 3, 2009, points out that

"According to a Congressional Budget Office study of the House bill, only 6 million Americans would be enrolled in the public option by the time it is fully phased in, in 2019. That's just 2% of the 282 million Americans younger than 65 (who are not covered by Medicare). The CBO explains that the low numbers are in large part because the plan would typically have premiums that are somewhat higher than the average premiums for the private plans.”

In other words, as pointed out in The Nation, the rates would not be tied to Medicare rates but tied to those of the big insurance companies. That is a big victory for the insurance industry and it will undermine the ability of the public option to compete and create pressure for reduced costs. Also, the bill eliminates the state single payer option, that is alive and well in Pennsylvania for instance, while forcing most people to buy private insurance.

Force them to buy insurance! As The New York Times points out:

"A survey by the Commonwealth Fund found that 73% of the adults who tried to buy insurance on the open market over a three-year period never bought a plan -- because they could not afford it, could not find a plan that met their needs, or were turned down. Pending legislation would help some of them by preventing rejections or high charges based on health status and by setting minimum benefit requirements. But many people who might find the premiums too high will face an agonizing choice: buy insurance or pay a penalty of hundreds or even thousands of dollars per family if they still decide to forego insurance."

Never has there been a greater boon to the profits of the insurance industry than the House health care bill, and one can be assured there will be little effort in the Senate to correct this. In my previous columns in The Rag Blog I have referred to an article by Karl Manheim, a professor at Loyola Law School in Los Angeles questioning the constitutionality of legislating the mandatory purchase of health insurance.

The advocates of the bill keep making the point that the insurance carriers will be required to insure those with preexisting conditions. Great, we insure those folks -- but in view of the fact that the prime purpose of the health insurance industry is profit for the executives and stockholders, and not patient care, the insurance industry will merely raise rates for the current subscribers. In the House bill there are absolutely no price controls on the insurance industry.

Another cry I hear comes from the elderly, who fear that the legislation will take money "from my Medicare." I have found this difficult to understand; however, recently while watching the series of ads on TV I have come to the realization that these poor folks are discussing Medicare Advantage plans -- private insurance plans that incorporate the name of Medicare, but which actually are not administered by the Medicare program.

These plans were a creation of the Bush administration, circa 2003, to privatize Medicare (since they had failed in privatizing social security), and thus, under the first rule of neoliberal economics, to deplete the Medicare trust fund. In short, the elderly are conned into signing up for these programs, they sign their Medicare rights over to a private insurance company, and are covered by the rules and regulations of that specific insurance company.

The private insurance companies are currently being paid, for each subscriber, the estimated amount that it would require to attend to that person under Medicare per se, plus an extra 17%. The current house legislation now anticipates reducing that 17% overpayment in an effort to preserve Medicare in the future.

By a slight of hand the insurance carriers convince the subscribers that they are receiving an enhanced program, while indeed, the purpose, once again, is to increase insurance company profits. An example: these plans promise "dental care,” perhaps a yearly dental examination or cleaning. Watch what happens when a $1000 gold tooth capping is suggested!

The carrier allows choice of physician, but from a group of physicians on their panel. Many physicians refuse Medicare advantage patients, because of the low fees paid initially (the remainder is compensated by a higher co-payment than under Medicare, payed by the subscriber). Or if the doctor accidentally treats a patient from a specific Advantage program, and receives payment, he is thereafter, without signing a contract, considered under contractual obligation to that insurance company.

Under regular Medicare I can go to the Mayo Clinic if desired, and without question; However, if the Medicare advantage subscriber mentions the Mayo Clinic he will probably be told that it is “out of area” and cannot be paid. A local contracting substitute will be approved. One will encounter the same problem in requesting specialist consultation.

The Advantage program permits only specified “specialists,” and only those referred by the primary physician who is possibly being rewarded by the insurance carrier at year’s end, for avoiding specialist consultations. Under regular Medicare I can see any specialist I desire, though I might have to wait for an appointment. A Google search will show a significant number of Medicare fraud cases against the Advantage carriers.

As noted in Market Watch, "Following a series of Medicare Advantage sales scandals, seven companies -- United health Care, Humana, WellCare, Universal American Financial, Coventry Health Care, Sterling Life Insurance, and Blue Cross Blue Shield of Tennessee --voluntarily suspended their marketing of private fee-for-service programs." We might note that they are back in business...

Another big issue with The Republicans is “medical liability.” As a physician, I agree that this must be addressed; however, I am not sure that it should be included in a health care bill. I think Congress should take a close look at the Canadian system of handling malpractice claims on a national basis. Both physicians and trial lawyers seem to find it equitable.

Also, I find little in the summaries of the House Bill regarding the specifics of physician payment. As pointed out by both the American College of Physicians and Physicians for a National Health program, the United States is in severe need of more primary care doctors, internists, family practitioners and pediatricians. This matter is not addressed nor is reasonable payment for these specialties given in depth consideration.

In short, a current review of the House legislation offers little encouragement. It fails to address the matter of 45,000 deaths a year from lack of medical attention, or the high rate of child poverty and excessive death rate for children -- especially as contrasted with the Western European nations. It does not address the matter of long term care as opposed to that provided in Western Europe. To date it would appear that those Americans who looked for something really better have been sold out to the great corporations once again.

Finally, to those who feel that this is a first step, the political reality of the Obama administration's handling of the economy, of much of our foreign policy, of civil rights, of gay issues, does not bode well for a more liberal consensus in the congress in the near future. It would seem that presently the White House is playing directly into the hands of the tea-baggers.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

Healthcare-NOW on the House Health care bill

It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry.

On Saturday, November 7, 2009, the House passed H.R. 3962, the Affordable Health Care for America Act, to much celebration by the Democratic party. Healthcare-NOW!'s view, however, is that the House bill is a gift to the insurance industry at the further expense of the people of this nation.

The bill's advocates claim it will cover an additional 36 million people, subsidize the cost of insurance for families up to 400% above the poverty level, increase Medicaid coverage to 150% above the poverty level, close the Medicare donut hole by 2019, place a surcharge on individuals making more than $500,000 and couples making more than $1,000,000, will end rescissions and pre-existing conditions.

What the Democrats fail to mention is the bill leaves millions of people uninsured, allows medical bankruptcies to persist, criminalizes and fines the uninsured, increases the number of underinsured, does nothing to contain the sky rocketing costs, blocks women from their reproductive rights, transfers massive public funds to private insurance companies strengthening their control over care, protects pharmaceutical companies' superprofits at patient expense, fails to reclaim the 31% of waste in our system, expands Medicaid without regard to the state budget crises, discriminates based on immigration status and age, and sets up several levels of care covering less for those without the ability to pay. Those who have coverage will increasingly find care unaffordable and will go without. The whole system will inevitably fail from being fiscally unsustainable.

So is the House bill better than nothing?

"I don't think so," writes Marcia Angell, M.D. , former editor of the New England Journal of Medicine. "It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right."

Given that the bill does nothing to contain or reduce rising costs or end the private health insurance industry's dominance, we hoped that the Progressive Caucus would stand strong. But they did not. All but two of H.R. 676's cosponsors voted for H.R. 3962 -- Rep. Eric Massa [D-NY] and Rep. Kucinich [D-OH].

Rep. Massa stated, "At the highest level, this bill will enshrine in law the monopolistic powers of the private health insurance industry, period. There's really no other way to look at it."

Despite telling single-payer advocates that Congressman Weiner's single-payer amendment could not go to vote because it would open the floodgates for regressive amendments on abortion and immigrant access, the Democratic leadership allowed votes on both. Prior to the vote on H.R. 3962, the Stupak Amendment passed that will prevent women receiving tax subsidies from using their own money to purchase private insurance that covers abortion and in many cases will prevent low-income women from accessing abortion entirely.

"The House of Representatives has dealt the worst blow to women's fundamental right to self-determination in order to buy a few votes for reform of the profit-driven health insurance industry," writes Terry O'Neill, President of National Organization for Women. "We must protect the rights we fought for in Roe v. Wade. We cannot and will not support a health care bill that strips millions of women of their existing access to abortion."

Healthcare-NOW! fought to win a fair and open debate on healthcare reform including the merits of a single-payer system. This has not yet happened, but the advocacy for this system has greatly impacted the debate in meaningful ways.

We need to continue to build the grassroots movement for single-payer, not-for-profit, national healthcare. We look forward to much brain-storming at our upcoming national strategy conference in St. Louis this weekend, and the opportunity to move forward with renewed energy, creative ideas, and resolve.

Meanwhile, we have the opportunity NOW to continue to support the Sanders' Single-Payer Amendment to be introduced in the U.S. Senate, Congressman Kucinich's efforts to get the state single-payer amendment back in when the House and Senate bills are reconciled, and the efforts of the Mobilization for Health Care for All.

-- Healthcare-NOW

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