Dr. Angell on Obamacare: Poison Pills for All!

If anyone starts giving you a hard time about “not letting the perfect be the enemy of the good” and how important it is for our Congress people to go ahead and hold their noses while they vote for the President’s Trojan horse of a health care bill in the name of incremental progress, consider some serious warnings made by Dr. Marcia Angell (first woman editor-in-chief of the New England Journal of Medicine and currently a lecturer at Harvard Medical School) in a recent Bill Moyers' interview.

Dr. Angell asserts this bill is a step in the WRONG, not right, direction. She laments the profound lack of leadership shown by the President for health care reform. She warns that this bill would pour hundreds of billions of dollars of public money into health care companies in the next decade. At the same time, our hapless citizenry will be forced to pay whatever exorbitant rates will be levied by avaricious, profit making insurers. Given the obscene, record-making profits 4 of the 5 largest insurance megacorporations made last year, in these very troubled times for the rest of us, Dr. Angell’s warning deserves serious consideration:

Dr. Angell:

Fighting for the wrong things and too little, too late. He [Obama] gave away the store at the very beginning by compromising. Not just compromising, but caving in to the commercial insurance industry and the pharmaceutical industry. And then he stood back for months while the thing just fell apart. Now he's fighting, but he's fighting for something that shouldn't pass. Won't pass and shouldn't pass.

What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they'll do that.

Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster.

Dr. Angell also dismantles Obama’s defense of the CBO's positive regard of the bill in terms of cost-cutting.

So if they can save money in Medicare, then they come out ahead, no matter what happens out in the private sector. And so that's what he's talking about. It will take money out of Medicare and put it into the private sector. Medicare is the source for a lot of the funds that are going to go to subsidize the private health insurance industry...

Dr. Angell does praise the bill for raising the age of health care dependents to 26. She also expresses appreciation for its intention to expand Medicaid.

Yes, yes. And one of the things about the Obama plan that I do like is that it expands Medicaid up to 133 percent of the federal poverty level and that's fine. The problem is that could have been a stand alone measure. You didn't need to have it incorporated in this massive Rube Goldberg apparatus.

Dr. Angell contends that this bill will ferociously increase costs. She asks what should have been the centerpiece question for all the health care reform "deciders" in Washington:

"Why is it that we spent over twice as much per person on health care and yet don't manage to cover everyone?"

She provides the answer:

And the reason is that we have chosen, alone among all advanced countries, to leave health care to for-profit industries, to leave health care to businesses that then distribute health care as a market commodity according to the ability to pay and not according to medical need.

So if you look at what's causing the problem, the causes are not being targeted in this plan. They're not being addressed. Maybe some of the symptoms of the causes are being addressed like let's stop excluding people from pre-existing conditions. But it doesn't stop the insurance industry from raising its premiums.

Dr. Angell soberly dismantles another talking point used by President Obama to coax citizens into trusting his willingness to sustain the status quo of privitization and commercialism of health care. This man who ran on the promise of change, now seductively assures the citizenry that they can keep the plans they (not all of the citizens, by a long shot, sadly) are satisfied with – those often untested plans the holders count on, provided from a medical industry that pours billions of dollars into promoting that warm and fuzzy degree of trust through advertising, promoting a brand image that belies a ruthless and covert reality -- profits uber alles, profits over patients!

Dr. Angell:

Well, if you get-- I think it was Senator Rockefeller who said, I mean, that was a wonderful comment he made in the summit last week. Senator Rockefeller referred to the private insurance companies as rapacious, rapacious, and said, "Like sharks, they swim under the water, and you don't know they're there until you feel their teeth." Now there are not many people in America who would disagree with that description and so what this plan does is says, "This is a terrible industry, so let's force people to buy their commercial products. And let's subsidize it and put a lot of money into it."

And what do you think they're going to do? If you were an insurance company, you would say, "Well, thank you, Santa Claus. I've got all of these captive customers. Young ones are healthy. They probably won't even use the insurance. There's nothing to stop me from raising my premiums. I have all of these subsidies coming in." Don't you think that the prices would go up? I think it would be remarkable if they didn't.

When I look at the Senate bill and the President's suggestions, almost every paragraph, there is a poison pill for someone. I think sometimes they're unintended. Let me give you one example. They allow for insurance companies to charge three times as much for older people as for younger people.

So from the point of view of the insurance industry, this is a god-send because either way, they win. Either the 55-year-olds cough up three times the premiums, and that's good. Or else they can't, and that's probably the more likely situation. They can't, and then they're fined. And the insurance companies don't have to take care of people who might actually get sick. They're left with all of the thirty-year-olds, who are less likely to get sick, but who are required to buy their products.

So this sets up a situation which probably all plans, for 55-year-olds, are high priced. So they can't afford to buy it, or if they do buy it, they have to pay an excise tax on it. This is a real poison pill for these older people. It's a gift for the insurance industry.

Near the end of the interview, Moyers asked Dr. Angell if, say, mandated purchasing were removed from the bill, would she then support it. Dr. Angell maintained she could not conceive of such a compromise being entertained by the all powerful insurance industry:

No, no. If you take out the mandate, then the private insurance industry says, "No, we're out of here." This Congress will do what the private insurance industry wants it to do. If you look at the money that has flowed into Congress over the last year, and particular to people who were crafting this bill, you can see that the pay masters get what they want.

In a much earlier Moyers' interview with Dr. Sidney Wolfe of Public Citizen, Dr. Wolfe shared Dr. Angell's sensibility:

Money buys Washington, as you know. So I think we need a whole new culture there, we need a culture of courage, as opposed to a culture of cowardice. We need people who feel the pain of families who lose 20 thousand, 18 thousand people a year. And those are probably conservative estimates, which are probably much higher right now. This is a serious thing. It is a war on the American public being conducted, orchestrated, and thus far won by the health insurance industry.

I like the sound of that, “culture of courage”. We as proactive citizens, not victims of the oligarchy and their bribed political operatives, but awakened and fighting survivors of the moral challenge of our time, have to step up and be the new, greatest generation. If we don’t, we will doom our descendants with our defeatism. Our "just hold your nose and vote for it" settling for health care that should be a human right, not a privilege for a wealthier minority. Comprehensive health care. If we don't fight for what we know in our hearts is right, and I think we know that our leaders know it, too, otherwise they wouldn't ignore us, who are calling for it, so thoroughly, we will pass a daunting legacy to our descendants, an exponentially escalated economic and spiritual oppression. We will sabotage their quality of life. We will betray our duty to them.

I think of how our government leaders so easily ask young Americans to die for their country in highly questionable wars. And yet, for campaign financing, for the sake of their job security in 2010 or 2012 or whenever (when I am sure they are not living paycheck to paycheck like some of us, and we are comparatively the lucky ones -- considering the ever increasing ranks of the unemployed, the homeless, the uninsured, the 45,000 who will prematurely die this year and how many in subsequent years due to lack of health care) they will not fulfill the moral imperative of their offices.

Maybe the health insurance executives don’t take an oath to protect the rights of the American citizenry, but our Congressional and Presidential leaders do. Are they solemnly honoring their sacred duty to protect our welfare, or are they protecting their financial mentors -- their own job security -- at an awesomely high cost for so many of the rest of us, as they and their families continue to enjoy -- for life -- premier health care coverage paid for by our tax dollars?

[cross-posted: http://www.correntewire.com/dr_angell_obamacare_poison_pills_all ]