ObamaCare: Worse Than Doing Nothing?

Keeping the Insurance Companies in Command by RUSSELL MOKHIBER


That’s the conclusion of single payer advocate Dr. Quentin Young, national coordinator for Physicians for a National Health Program (PNHP), in his just released autobiography – Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause.

“Had I been in Congress, I would have unequivocally voted against Obamacare,” Young writes. “It’s a bad bill. Whether it’s worse than what we have now could be argued. We rather think because of its ability to enshrine and solidify the corporate domination of the health system, it’s worse than what we have now. But whether it is somewhat better or a lot worse is immaterial. The health system isn’t working in this country — fiscally, medically, socially, morally.”

Young rejects the idea that President Obama should have compromised on single payer in the face of industry opposition.

“I don’t have any sympathy for the idea that the president had to compromise because his opposition was strong,” Young writes. “Winning is not always winning the election. Winning is making a huge fight and then taking the fight to the people — re-electing people who are supporting your program and defeating those who aren’t.”

Young first met the young Barack Obama in the mid-1990s at social gatherings.

At the time, Obama was lecturing at the University of Chicago Law School and practicing law.

“We did not become bosom buddies after a few of these social gatherings — I just viewed him as a nice, bright guy living in the neighborhood,” Young says.

When Obama ran for the Illinois Senate, Young supported him.

“I was happy with his views on health care,” Young writes. “He recognized that major reform was necessary and indicated support for a single-payer approach. No blushing friend, I took every opportunity to solidify his position. While not an official adviser, I tried to influence him as much as I could. My colleagues and I sent him notes touting the advantages of single-payer and the form it might take and talked with him and his staff about it whenever I had the chance.”

“I felt I did influence him,” Young said.

When Obama ran for the Senate in 2003, Obama told the Illinois AFL-CIO:

“I happen to be a proponent of a single payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

But just a year later, Obama had flipped and came out against single payer in Illinois.

“I was very disappointed by his move to the right to keep the insurance companies in command,” Young told the Springfield State Journal Register in 2004. “I’m not accusing him of lying or misconduct. I’m accusing him of a lack of courage.”

But despite Obama’s “lack of courage,” Young supported Obama in his run for U.S. Senate and later for president. Young was just setting himself up for more disappointment.

At a town hall meeting in Portsmouth, New Hampshire in August 2009, Obama was asked whether he supported a universal health care plan.

“First of all, I want to make a distinction between a universal plan versus a single-payer plan, because those are two different things,” Obama said.

“A single-payer plan would be a plan like Medicare for all, or the kind of plan that they have in Canada, where basically government is the only person — is the only entity that pays for all health care. Everybody has a government-paid-for plan, even though in, depending on which country, the doctors are still private or the hospitals might still be private. In some countries, the doctors work for the government and the hospitals are owned by the government. But the point is, is that government pays for everything, like Medicare for all. That is a single-payer plan.”

“I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive. So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet. And I would be concerned about the potential destructiveness of that kind of transition.”

“All right? So I’m not promoting a single-payer plan,” Obama said.

In March 2010, Congress passed the Affordable Care Act — Obamacare — by a narrow margin.

“PNHP’s policy experts did a line-by-line examination of the bill and, while acknowledging that it contains some modest benefits that make changes around the edges of our existing system, basically gave it two thumbs down,” Young writes. “To this day, much to the chagrin of many of our friends who wanted reform, I remain adamant in my rejection of Obamacare.”

“Why? We want a system that excludes the private insurance companies,” Young writes. “ We demand such exclusion not because these companies are good or evil (although we think they’re pretty evil). Rather, the reason to exclude them is that they don’t address the needs of the American people.”

Young also rejects the idea of a “public option,” pushed by Democrats such as Howard Dean. A public option “would not have made any significant difference on the overall impact” of Obamacare “contrary to the view of many progressive who believed that it would,” Young says.

“Since WWII, we have learned a lot about disease and certainly have had dramatic improvements in what we can do,” Young writes. “I’m talking about surgery of the heart, vaccination, nutrition issues. All these things have been largely defined in the last half-century. We’ve had something approaching a 12-year life expectancy rise just from scientific intervention.”

“We have all this knowledge, all these options, but we have a very backward financing and delivery system and the result is a great deal of human suffering,” Young says. “And that’s why we remain opposed to the Affordable Care Act. We think we have a winning proposition despite the reality in Congress. Polls repeatedly vindicate our position. A solid majority of the public and 59 percent of doctors support the single payer approach.”

“President Obama could have made it happen,” Young says. “He could have stuck to all the virtues of single payer. And I won’t deny he may have been defeated in the first round. There’s no question that this fight has been dirty and it’s going to get dirtier.”

People Want Full Medicare for All

Time for Single Payer
by RALPH NADER


Freshman Senator Ted Cruz (R-Texas), who somehow got through Princeton and Harvard Law School, is the best news the defaulting Democratic Party has had in years.

As the Texas bull in the Senate china shop, he has been making a majority of his Republican colleagues cringe with his bare-knuckle antics and language. His 21 hour talkathon on the Senate floor demanding the defunding of Obamacare made his Republican colleagues gasp. His Nazi appeasement analogies, and threats to shut down were especially embarrassing.

After listening to his lengthy rant on the Senate Floor on Tuesday and Wednesday, one comes away with two distinct impressions. Ted Cruz cannot resist inserting himself here, there and everywhere. And nothing is too trivial for Senator Talkathon. He likes White Castle hamburgers, he loves pancakes; he talked about what he liked to read as a little boy, where he’s traveled, what clothes he wears and other trivia.

You’d think he would have used his time to talk specifically about the suffering that uninsured people and their children are going through, especially in the Lone Star State. Or about what could replace Obamacare other than his repeated “free market” solution, which is to say the “pay or die” profiteering, tax-subsidized corporate system.

It was puzzling why he never mentioned that during his two days of talking, over two hundred Americans died, on average, because they couldn’t afford health insurance to get diagnoses and timely treatment. (A peer reviewed study by Harvard Medical School researchers estimated about 45,000 die annually for lack of affordable health insurance every year.)

The other reaction to Senator Cruz was that many of his more specific objections to Obamacare – its mind-numbing complexity, opposition by formerly supportive labor unions, and employers reacting by reducing worker hours below 30 hours a week to escape some of the law’s requirements – are well-taken and completely correctible by single-payer health insurance, as provided in Canada. Single-payer, or full Medicare for all, with free choice of physician and hospital has been the majority choice of Americans for decades. Even a majority of doctors and nurses favor it.

Single-payer’s advantage is that everybody is in, nobody is out. It is far more efficient, allows for better outcomes, saves lives, prevents injuries and illnesses, relieves people of severe anxieties and wasted time spent figuring out often fraud-ridden, inscrutable computerized bills and allows for the collection of pattern-detecting data to spot harmful trends.

For example, in Canada, full Medicare covers everyone at half the per capita cost that Americans pay even though 50 million Americans are still not covered. The U.S. per capita figure is almost $9,000 a year and over 17% of our total GDP. In Canada, administrative costs are much lower.

Symbolically, the single-payer legislation that passed in Canada over four decades ago was 13 pages long, compared to over two thousand pages for Obamacare.

Critics of Canada’s system charge it with delays for patients. For some elective procedures, provinces that were under-investing have experienced some delays until Ottawa raised its contributions. Canada spends just over 10% of its GDP on healthcare, by comparison.

But in the U.S. not being able to pay for treatment is the biggest problem. And in the U.S., who hasn’t heard of delays in various areas of the country due to lack of primary care physicians or other specialties? I have many friends and relatives in Canada who have not complained of delays for routine, essential or emergency treatments.

For those who prefer to believe hard-bitten businesspeople, Matt Miller, writing yesterday in The Washington Post, interviewed big business executives – David Beatty who ran the giant Weston Foods and Roger Martin long-time consultant to large U.S. companies in Canada. They were highly approving of the Canadian system and are baffled at the way the U.S. has twisted itself in such a wasteful, harmful and discriminatory system.

Mr. Beatty wondered why U.S. companies “‘want to be in the business of providing health care anyway’ (‘that’s a government function,’ he says simply).”

Mr. Martin, an avowed capitalist, who has experienced healthcare in the U.S. and Canada, according to Mr. Miller, called Canadian Medicare “incredibly hassle-free,” by comparison. (In Canada, single-payer means government insurance and private delivery of healthcare under cost controls). Now Dean of the business school at the University of Toronto, Mr. Martin told reporter Miller: “I literally have a hard time thinking of what would be better than a single-payer system.”

So why the U.S. is the only Western country without some version of a single-payer system?

Most concessionary Democrats, including Barack Obama and Hillary Clinton, have said in the past that they prefer single-payer, but that the corporate forces against it cannot be overcome. (They use phrases like “single-payer is not practical.”)

But with the Cruz crew in Congress going berserk against Obamacare, now is the time to press again for the far superior single-payer model. Or at least get single-payer into the public discussion. Unfortunately, even some of the major citizen groups organized for single-payer, behind H.R. 676, are keeping quiet, not wanting to undercut Obama and the Congressional Democrats.

Go to Single Payer Action and connect with the movement that does not play debilitating politics and seeks your engagement.

Beyond Obamacare: How a Single-Payer System Can Save US Health Care

Wednesday, April 24, 2013 by Common Dreams
by Dave Dvorak, MD

As physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage while saving billions of dollars? A growing number of physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans’ administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every person could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system’s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation’s economy—twice that of other wealthy democracies—48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans—which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate “job lock,” in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system—up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for “state innovation waivers” to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont’s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

Beware the 'Grand Bargain': Post-Election Deficit Deal Threatens Medicare and Social Security

Tuesday, October 9, 2012 by FireDogLake
The solution is Improved Medicare for All
by Kay Tillow

 

After the November election, there will be a major effort in Congress to pass a budget deal that will make cuts in Social Security, raise the Medicare and Social Security eligibility age, and perhaps more–unless we act to stop it with a solution that is close at hand.

There is agreement from the Wall Street Journal’s David Wessel to liberal economists Dean Baker and Paul Krugman that the pressure will be on to reach a Simpson/Bowles type of compromise.  Such a bipartisan plan would damage our most cherished programs and excuse the dastardly deed by asserting that the cuts are small and necessary because of the deficit. 

Those who relentlessly scream at us and finance ads to persuade us that the deficit threatens our grandchildren are obscuring the truth.  The fact is that the transfer of wealth from public funds and the rest of us to the super rich is the real crisis.  But those who have gorged themselves on this massive transfer of wealth also seek to undermine the Medicare and Social Security which are our grandchildren’s heritage from generations of struggles for a better life.

The projected cuts are not minor but very harmful.  Even a small decrease in the Social Security Cost of Living Adjustment would deliver an ever increasing downward push on benefits while corporations continue to threaten secure pensions by turning them into lump sums that will fade with the stock market.

Raising the Medicare age to 67 would be disastrous.  There will be no affordable health insurance for those in their 60’s.  The Affordable Care Act allows private insurance companies to charge premiums three times higher based on age.  Under popular pressure, there were regulations placed into the health care reform bill to stop insurance companies from charging higher premiums based on pre-existing conditions.  But the companies were allowed to charge three times the premium based on age.  

Because of this allowed age discrimination, the Kaiser Foundation estimates that an individual of age 60 in 2014 with an annual income of $50,000 will pay a health insurance premium of  over $10,000, or over 20% of income.  That does not include out-of-pocket costs which can add up to an additional $6,000 annually.  That brings the total to 32% of income—a bankrupting figure. 

There is a solution that the single payer movement must place on the nation’s table.   Even Bill Clinton said that we could save $1 trillion a year if we adopted the health care system of any of the other developed countries in the world.  No more stewing over the deficit!

An Expanded and Improved Medicare for All, HR 676, would save Medicare, end the uncontrolled, gargantuan rise in all health care costs, ease the deficit pressure, and actually bring universal health care to the nation. 

This single payer legislation, HR 676, introduced by Congressman John Conyers and co-sponsored by 76 representatives, would divert $400 billion annually from profits and waste generated by the private health insurance industry into care for all.  Care would be expanded and costs bought under control through bulk purchasing, global budgeting, and the elimination of administrative expenses forced upon our system in the pursuit of profit.

Doctors would be freed from insurance industry interference with care.  Patients would be freed to choose their physicians.  Dental, eyeglasses, hearing aids, prescription drugs, long term care, doctors, hospitals, home health, mental health—all medically necessary care would be included. 

Our health care costs would stop driving us over the cliff and level off just as Canada’s did when that country fully implemented their single payer health care.

Co-pays and deductibles would be banned ending today’s growing problem that health insurance policies are so miserly that even the insured forego care because they can’t afford it.

Our country spends about twice per capita what other industrialized nations spend on health care, yet our health care system lags far behind at number 37 in the world. 

So why are we even debating cuts to Medicare, Social Security, and Medicaid when the solution is at hand that would bring us both better care and cost controls?  HR 676, an improved Medicare for All, is sitting in the Congress, awaiting the rising of a movement that will insist upon its passage.

Healthcare Jujitsu: A Path to Medicare for All

Tuesday, March 27, 2012 by RobertReich.org
by Robert Reich


Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Behind this judicial foreplay is the brute political fact that if the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling.

But with a bit of political jujitsu, the President could turn any such defeat into a victory for a single-payer healthcare system – Medicare for all.
Here’s how.

The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising.

Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large healthcare costs.

This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it.

But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.

Those who are defending the law in Court say the federal government has authority to compel Americans to buy health insurance under the Commerce Clause of the Constitution, which gives Washington the power to regulate interstate commerce. They argue our sprawling health insurance system surely extends beyond an individual state.

Those who are opposing the law say a requirement that individuals contract with private insurance companies isn’t regulation of interstate commerce. It’s coercion of individuals.

Unhappily for Obama and the Democrats, most Americans don’t seem to like the individual mandate very much anyway. Many on the political right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

The President and the Democrats could have avoided this dilemma in the first place if they’d insisted on Medicare for all, or at least a public option.

After all, Social Security and Medicare require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. But because Social Security and Medicare are government programs financed by payroll taxes they don’t feel like mandatory purchases.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

Requiring citizens to buy something from a private company is different because private companies aren’t directly accountable to the public. They’re accountable to their owners and their purpose is to maximize profits. What if they monopolize the market and charge humongous premiums? (Some already seem to be doing this.)

Even if private health insurers are organized as not-for-profits, there’s still a problem of public accountability. What’s to prevent top executives from being paid small fortunes? (In more than a few cases this is already happening.)

Moreover, compared to private insurance, Medicare is a great deal. Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

Can We Have Health Reform Without an Individual Mandate?

Saturday, August 13, 2011 by The Nation
Yes, It's Called 'Medicare for All'
by John Nichols

 

The essential vote on the 11th Circuit Court of Appeals panel that ruled that the individual-coverage mandate in President Obama’s healthcare reform is unconstitutional did not come from a reactionary Republican appointed by Ronald Reagan or George W. Bush.

Rather, it came from respected jurist whose two appointments to the federal bench—first as a judge for the Northern District of Georgia in 1994 and then to the 11th Circuit in 1997—were made by then-President Bill Clinton. No, Judge Frank Mays Hull is not a raging lefty, but nor is she a right-wing judicial activist. A former law clerk for Judge Elbert Parr Tuttle, who as the chief justice of the US Court of Appeals for the Fifth Circuit from 1960 to 1967 led the court in issuing a series of epic decisions on behalf of civil rights, Judge Hull has a reputation as a moderate defender of the rule of law who has earned reasonable marks for her pragmatic and decidely mainstream interpretations of the Constitution.

So why did Hull join with another member of the appeals court panel (Chief Judge Joel Dubina, an appointee of George H.W. Bush) to form the 2-1 majority that rejected the individual mandate while affirming the rest of the law? Perhaps it was because one can favor sweeping healthcare reforms—including an expansion of Medicare—while still believing that it is wrong to require Americans to buy insurance from for-profit insurance companies.

Hull telegraphed her thinking with repeated questions during June oral arguments in Atlanta regarding the case. Noting that “the panel spent a significant amount of time discussing whether the mandate is ‘severable’ from the rest of the law,” Politico pointed out that: “Hull in particular asked the federal government three times where the line should be.”

Ultimately, Hull and Dubina came to the conclusion that the individual mandate could, and should, be removed from an otherwise constitutional plan.

Why? Because, as the judges wrote in their majority decision: “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”

Those of us who favor fundamental healthcare reform have always been uncomfortable with the individual mandate. So was candidate Barack Obama, who distinguished himself from Hillary Clinton (a mandate backer) by saying in a February 2008, interview: “Both of us want to provide health care to all Americans. There’s a slight difference, and her plan is a good one. But, she mandates that everybody buy health care. She’d have the government force every individual to buy insurance and I don’t have such a mandate because I don’t think the problem is that people don’t want health insurance, it’s that they can’t afford it. So, I focus more on lowering costs. This is a modest difference. But, it’s one that she’s tried to elevate, arguing that because I don’t force people to buy health care that I’m not insuring everybody. Well, if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t.”

Candidate Obama was right.

The individual mandate was always a bad idea. Instead of recognizing that healthcare is a right, the members of Congress and the Obama administration who cobbled together the healthcare reform plan created a mandate that maintains the abuses and the expenses of for-profit insurance companies—and actually rewards those insurance companies with a guarantee of federal money.

Those who think that the for-profit (or even not-for-profit) insurance industry has to control any healthcare reform initiative have every right to be upset with the 11th Circuit’s ruling—which almost certainly will send the case of the Obama healthcare plan to the US Supreme Court.
But those of us who have no desire to perpetuate the insurance industry can and should recognize that the proper—and entirely constitutional—reform is an expansion of Medicare to cover all Americans.

There is no question that Medicare is a sound and popular program. (Just ask House Budget Committee chair Paul Ryan, R-Wisconsin, who took an epic political beating when he proposed a scheme to replace the successful single-payer system with a voucher scheme designed to enrich insurance firms.)

While Medicare is exceptionally popular, polling shows that the individual mandate is not—according to recent surveys, roughly 60 percent of Americans oppose it.
It also passes constitutional muster.

As former Labor Secretary Robert Reich notes: [No] federal judge has struck down Social Security or Medicare as being an unconstitutional requirement that Americans buy something. Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.”

“So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, “ says Reich, “I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.”

The insurance companies would, of course, scream.

But let them complain.

Americans don’t need mandates. They need healthcare.

And they have every right to ask, as activists with Physicians for a National Health Program have,  that Medicare be expanded to cover all Americans —affordably, efficiently, capably and constitutionally.

Corporate Demands, Federal ‘Reform,’ Keep Shifting Healthcare Costs to Workers

Friday, May 13, 2011 by In These Times

by Roger Bybee 

 

Despite its $14.2 billion in profits last year untouched by federal income taxes, General Electric is now demanding that its unionized workers accept a new high-deductible “Health Choice” health savings account plan.

GE’s demands are particularly obscene because it is sitting on $25 billion in savings and is threatening to close more U.S. plants, i.e. move more jobs to Mexico, China and elsewhere. And they're particularly dangerous because GE is modeling bad behavior for other corporations to emulate.

As UE-GE Conference Secretary Steve Tormey has said, “Nobody is more symbolic of the assault on workers than General Electric." The United Electrical workers union, one of a handful of unions now negotiating with GE, warned its members:

...numerous studies of these high-deductible plans...reveal that employees forced into plans like Health Choice are “significantly more likely to avoid, skip, or delay healthcare because of costs” than those with more comprehensive insurance. ...
What GE is really saying with Health Choice is that medical expenses are no longer primarily their responsibility, but that of GE employees.

But GE is only the latest entrant among employers trying to establish a new healthcare normal by thrusting heavy additional costs onto the backs of working families. And the much-trumpeted federal healthcare "reform" legislation may actually exacerbate this race to the bottom.

(Of course, public employers—like the state of Wisconsin, led by labor's arch enemy Gov. Scott Walker—have also been pushing to make public workers take up even more of the burden of healthcare costs. This despite the fact that, as David Cay Johnston has pointed out without managing to dent mainstream media coverage, public employees have always been paying 100 percent of their benefit costs. When they gained improvements in health and retirement benefits, they had to sacrifice on wage increases.)

How federal healthcare 'reform' helps drives the race to the bottom

The race to the bottom is, unfortunately, likely to be intensified as we get closer to fully implementing the Affordable Care Act in 2014. In fact, the ACA may well tend to establish a bare-bones, high-deductible policy as the new norm. The taxation of perversely mis-labeled “Cadillac” benefits has the very real potential of putting the squeeze on union-won healthcare benefits, especially in high-cost states.

Despite the efforts of AFL-CIO Richard Trumka and others to limit the damage created when the Obama administration suddenly adopted John McCain’s regressive idea of taxing better benefit plans to fund expanded healthcare coverage for the uninsured, it may not take long before fast-rising medical inflation pushes the dollar value of union-won health benefits up to the Cadillac level, as IUE-CWA Local 201 President Jeff Crosby has noted.

As Dr. David Himmelstein and Steffie Woolhandler wrote recently,

The insurance required under the federal ACA is no better than Massachusetts’ bare-bones plans. And as employers emulate this inadequate coverage, the race to the bottom leaves an increasing number of Americans UNDER-insured. Public workers are just the latest group to see their coverage downsized.

What used to be called “health insurance” is now labeled “Cadillac coverage” – and reserved for those who drive Mercedes.

Himmelstein and Woolhandler remind us that the Democrats’ ACA plan was based on the Massachusetts model passed in 2006 with Gov. Mitt Romeny's signature, and whose “achievements” are much less than splendid. Bankruptcies caused by catastrophic medical costs, which account for over half of all bankruptcies, are still rising in Massachusetts, they state:

While only 4 percent of the state’s residents remain uninsured, much of the new coverage is so skimpy that serious illness leaves families with crushing medical bills.

For instance, the cheapest (and most commonly purchased) coverage available to a 56-year-old Bostonian through the state’s health insurance exchange costs $5,616. Yet, if you’re sick, the policy doesn’t start paying bills until you’ve paid a $2,000 deductible. And even after that you’re responsible for 20 percent of the next $15,000 in medical expenses.

Insurers try blackmail

By basing itself on the Massachusetts plan which keeps for-profit insurers as the parasitic middlemen at the core of the healthcare system, the ACA sacrificed the potential for comprehensive, high-quality benefits covered from the first dollar.

This potential has been underscored in the fight over retaining ACA’s requirement that 80 percent of premium revenue be used by insurers to provide healthcare and improve quality, freeing up 20 percent for profit, bureaucratic overhead, and sales and promotion.

No less than nine states are seeking waivers from the 80 percent requirement, falling prey to insurers’ blackmail demands. Insurers are threatening to stop selling individual coverage in a number of states unless they can spend, in several cases, just 65 percent on paying for healthcare and quality improvements.

Both the states and the Obama administration are petrified by this coercive technique. The Obama administration’s timid mentality was revealed in this statement by Robert Laszewski, a consultant to the health care industry and a former insurance executive. "The last thing the Obama administration wants is the Des Moines Register writing about 500 people who lost their health insurance in Iowa because of the Obama health plan," he chortled.

Single-payer destiny?

The emerging situation is not pretty. Major corporations and right-wing state governments are fighting furiously to shift more costs onto workers and their families. Instead of setting a new, higher standard, ACA effectively serves to reinforce a new lower standard of “acceptable” coverage. Given this, the limitations of the ACA may become very obvious very quickly both to the public and Congress.

There may even be a possibility that that the essential need for maximum-strength single-payer or “Medicare for all” healthcare system—unburdened by for-profit insurers—will become evident much faster than most have imagined. (Sens. Bernie Sanders (I-Vt.) and Rep. Jim McDermott (D-Wash.) introduced  single-payer bills in Congress this week; Vermont has now passed its own single-payer system into law.)

Himmelstein and Woolhandler make the case concisely:

While the ACA can’t live up to its “affordable care” moniker, a single-payer reform could save $400 billion annually on administrative costs, enough to offer every American first-dollar, comprehensive coverage. While U.S. insurers fight tooth and nail against the 20 percent limit on overhead, Canada’s single-payer program runs for 1 percent.

End Corporate Domination: More Than Advocacy We Must Resist

Monday, December 20, 2010 by CommonDreams.org
by Margaret Flowers

On December 16, 2009, I stood in the atrium of the Hart Senate Office Building with about a dozen single payer supporters. We were holding signs and standing vigil on the eve of the first time in U.S. history that a single payer bill would make it to the floor of either body in Congress. Senators Sanders, Brown and Burris introduced an amendment that would have substituted a national single payer health insurance for the health bill being created in the Senate at that time.

We celebrated that night because it was a victory, though a small one. Despite all of the corporate dollars and the teams of industry lobbyists opposing single payer, our persistence in pushing for the amendment, which included lobbying, letters, emails and protests at the Senate building, had paid off. The amendment was introduced on the floor of the Senate on December 17th, although it was pulled before it came to a vote.

One year later to the day, I am standing in the snow with hundreds of people, my arms linked behind the bars of the fence in front of the White House. Inside, the President is holding a press conference to report the progress being made in Afghanistan which we know is based on lies. Outside, we are protesting to end the wars in the largest veteran led act of civil disobedience since the beginning of the war on Afghanistan. In all, 131 people were arrested.

We can make some progress working within Congress, but we will never achieve our goals of peace and social and economic justice this way. There are a few like Senator Sanders who are willing to speak out against injustice, but their voices are mere whimpers against the giant winds of the corporate political and media machines. No politician, no matter how strong their understanding of and desire for real social change, can succeed in this hostile environment.

To succeed in creating the social change that we desperately need will require acts of protest and civil disobedience, a new culture of resistance as called for by leaders such as Mike Ferner of Veterans for Peace. It is time to recognize that our advocacy for peace, jobs, education, health, housing, human rights and environmental and economic justice is insufficient. We face the same fundamental obstacle: corporate control of our country.

Together we have the strength and the resources to shift power away from the rich corporations to the people and we can demand social justice. We have the solutions, but they are not being heard. We must cause enough disruption that our voices and our solutions cannot be ignored. And we must organize actions of nonviolent civil resistance. Otherwise growing public discontent in this nation may turn to violent means.

That is why I stood in solidarity with the veterans on December 16th, 2010 and joined them in the action that led to our arrest. As I sat that day in handcuffs on the cold concrete floor of a holding area in Anacostia, a veteran turned to me and said, “It means a lot to me that you are here doctor because you don’t have to do this.”

The truth is that I do have to do this. For me it is a matter of professional integrity to refuse to cooperate with the current system that results in the growing wealth of a few at the cost of great human suffering and death at home and around the world. I call on you, if you love your country, if you want a peaceful and healthy future for your children and grandchildren, to join in the culture of resistance.

Speak out about injustice wherever you see it. Join or organize actions of nonviolent protest to demand the change that we require. Speak out against the wars that cause so much human suffering and undermine our economic and national security. You can fight foreclosures, the closing of health centers, the closing of schools and poisoning of our air, land and water by factories and power plants. There is much to do. Your voice is needed.

Single Payer Later

Duck-and-Cover Politics
By RUSSELL MOKHIBER

What’s happening in California is the best argument to dump the Democrats.

Forever.

And start anew.

It’s the only option.

The state legislature in California has twice passed the California single payer bill.

And twice, Governor Arnold Schwarzenegger has vetoed it.

Earlier this year, the Senate passed it for a third time.

And the Assembly was about to pass it for a third time.

But the Democratic Speaker of the Assembly pulled the bill at the last minute.

Why?

Because it’s an election year.

Jerry Brown, who’s in a dead heat race for Governor, doesn’t want to face the music.

And the California Nurses Association, which supports Brown for Governor, has told single payer activists — back off.

Don’t pressure Brown to make a public statement on single payer.

If the Democrats would have passed single payer for a third time, the Terminator would have vetoed single payer for a third time.

This is exactly what single payer activists want.

Keep the pressure on.

But the Dems — and their union backers — want to play hide and seek.

“The Democrats should have put it up for a vote in the Assembly,” said Don Bechler of Single Payer Now. “California has been the wind in the
sails of the single payer movement. Each time the legislature passes it, we get stronger. We have more people in our movement than ever before. Passing it for a third time would have built the momentum.”

“The California legislature has twice before said that they are for having a universal health care system minus the insurance companies,” Bechler says. “We can be proud of winning that little battle.”

Brown was overheard earlier this year telling someone that if he is elected Governor, he will sign the single payer bill into law.

But he refuses to lead on the issue.

“Brown is saying — if everybody else is for it, I’ll be for it,” Bechler says. “But if you are a leader, you have to lead the troops, not follow.”

“Brown’s strategy so far in this campaign has been to say nothing about the issues, to run with duct tape over his mouth,” Bechler says.

Bechler is not convinced that with this follower strategy, Brown can win the Governorship.

Nor is Bechler convinced that even if he becomes Governor, Brown will sign the single payer bill into law.

Even if he does sign it, it’s only the beginning of the fight for single payer in California.

Bechler says the minute Brown signs it, the insurance industry will begin gathering signatures for an initiative to overturn it.

“And they’ll spend more to get it passed than Barack Obama spent to become President,” Bechler says.

And even if the single payer forces win that initiative fight, the legislature will have to fund the single payer law — with a two-thirds vote of both houses.

Right now, single payer forces have about 25 out of 40 Senators (62 percent) and about 45 out of 80 members of the Assembly (56 percent).

So, it’s an uphill battle.

Especially with Democrats playing duck and cover.

Single-Payer is Inevitable (?)

Progressives and Conservatives Agree ...
By ROB STONE, MD

“The new health care legislation is a step toward elimination, by slow strangulation, of private health insurance and establishment of government as the ‘single payer.’”

- George Will, in his weekly newspaper column, Sunday July 11, 2010

Everyone loves to pick on the Affordable Care Act (ACA), and well they should. This 2,000+ page contraption, this heap of handouts to the special interest lobbyists with a few shiny baubles thrown in to placate the common folk, was not only written by the for-profit health insurance industry but now will be implemented by former WellPoint/Anthem Vice President Liz Fowler who actually penned much of the law in her role as Max Baucus’ chief healthcare counsel for the Senate Finance Committee. You don’t have to make this stuff up, as Sam Stein reported in the Huffington Post July 16, titled “Obama Administration Defends Hiring Of Ex-Health Insurance Exec To Oversee Reform”

But what about George Will’s fine whine that the insurance industry faces strangling regulation? Robert Pear wrote in the New York Times on August 2 that the new law will lead to more regulation of the industry, and “the transition is full of risks and uncertainty for all involved.” If the Obama administration is going to "regulate the industry for the benefit of consumers," he noted, then “they can't help but destabilize or disrupt the existing market.”

Wall Street doesn’t like uncertainty. It detests being destabilized. Stock analysts are not missing out on this. The brokerage firm Edward Jones “downgraded the ratings on the stocks of the three health insurers it covers - UnitedHealth Group, WellPoint and Aetna -- to ‘sell’ from ‘hold’ late on Friday [7/30]. Those companies are the three largest U.S. health insurers.” (Reuters 8/2/10)

This new blow comes after legendary investor Warren Buffett pulled the plug on WellPoint, selling all Berkshire Hathaway’s holdings in the insurance giant during the first quarter of 2010 (“Buffett bails on WellPoint)

Speaking in Virginia, former House Speaker and presumed presidential candidate Newt Gingrich said on May 14, "The employer-based system will collapse because [the ACA] encourages businesses to drop health care coverage and incur the fine. When employees realize the high costs of the health care exchanges, they will demand a nationalized health care system," according to the Washington Post.

It only gets worse, or better, depending on your perspective. According to Gingrich, the business community is going to lead the call for single payer Medicare for All.

And well they should. Gingrich wasn’t making this up. On May 6, CNN Money released documents showing that “many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government… AT&T revealed that it spends $2.4 billion a year on coverage for its almost 300,000 active employees, a number that would fall to $600 million if AT&T stopped providing health care coverage and paid the penalty option.”

Is the Affordable Care Act unaffordable? Isn’t it at least a step in the right direction?

Those questions can only be answered by considering whether the ACA ends up strengthening or weakening the health insurance corporations. Progressive critics of the bill point out that the new legislation hands over $350 billion in government subsidies to the private insurers while mandating consumers to buy the industry's shoddy products. That, combined with a lack of price controls means the ACA could prove to be a bonanza for the corporate stakeholders in the medical-industrial complex.

On the other hand, the changing marketplace is full of perils, even if the conservative icons quoted above are exaggerating them to stir up fear of Socialized Medicine (and maybe scare up some donations).

If we stand back and rest on our laurels, believing that the ACA will save us, then we are doomed. The industry lobbyists are working overtime to take the best parts of the bill and weaken them, while destroying any good that is in the bill (see Wendell Potter in the Huffington Post on July 27, Health Insurers Leaning on State Insurance Commissioners to "Reform" Reform).

“We believe that Medicare for All is inevitable in the United States. It is up to all of us to determine when the inevitable becomes the reality.”

- Representatives Dennis Kucinich (D-Ohio), John Conyers (D-Mich.), and U.S. Senator Bernie Sanders (I-Vt.), statement for Medicare’s birthday, July 29, 2010

If you’re not inclined to believe George and Newt, then how about Dennis, John, and Bernie: “It is up to all of us to determine when the inevitable becomes the reality.”

The reality is that single payer, Medicare for All, is not inevitable, nor is there any guarantee the ACA won’t bankrupt us while enriching the corporations that lobbied for it.

It reminds me of a slogan we have in Indiana, “Healthcare Reform: We’re Still For It, and We’re Not Done Yet!”

From California to Vermont, Medicare for All advocates are working for bills to create state single payer systems. The grassroots are pushing up thru the disappointment of the Affordable Care Act.

Nationally, with the growing recognition that the health insurance giants stand as the greatest barrier to affordable healthcare for all, investors are beginning to see that this is not an industry socially responsible stockholders should be in (Huffington Post May 12, Napalm, Big Health Insurance, and Divestment).

I went to medical school to take care of sick people. The insurance companies fulfill their fiduciary responsibility to their investors by finding ways not to pay for the care of the sick. All their innovation and creativity go to this goal of not paying for care. No other sector in our crazy healthcare system operates under this incentive.

It will take a mass movement, like those for women’s suffrage and civil rights. It will take a divestment campaign like the one against apartheid in South Africa. We must keep the pressure up, shine a light on their nefarious deeds, drive down their stock prices, and expose them for what they are: parasitic middlemen who add no value while sucking billions out of our economy.

An Historic Confirmation of Corporate Power

Closing Time

By CHRIS FLOYD

It looks like heaven but it feels like death;
It's something in between, I guess:
It's closing time.

-- Leonard Cohen

Official transcript of remarks by President Barack Obama after the March 21 vote in the House of Representatives on H.R.3590: Motion to Concur in Senate Amendments to Patient Protection and Affordable Care Act:

My fellow Americans. As many of our more serious commentators have noted, Democrats and progressives have sought genuine reform of our broken, bloated, unjust health care system for almost a hundred years. Today, I am proud to say that we have brought that century-long struggle to a close. Together with our visionary partners in the House and the Senate, we have finally killed genuine health care reform for many years to come -- perhaps even for another century!

The struggle is over, the deal is done, the fix is in, and corporate power -- unbridled, unchallenged, coddled, protected, and larded with the endless pork of government-guaranteed profit -- has triumphed at last. This is an historic achievement. This is a mighty legacy we will bequeath to future generations.

This, my friends, is what change looks like.

Now, you know and I know that such change never comes easily. It never comes without opposition. It never comes without controversy. Even in this hour of victory, we know that the doom-sayers will be out in force.

And I'm not speaking here of the Republicans, whose opposition has simply been a lurid, baseless "Red Dawn" fantasy about "communism" coming to America. "Communism" -- in a bill that has been written by our visionary partners in the corporate community, by our hyper-capitalist friends and patrons on Wall Street, by the lobbyists and bagmen of Big Money! It's true there is a tinge of socialism in the bill, but it is, of course, the only kind of socialism that is tolerated in America: socialism for the rich, where the masses shoulder the risks -- and the costs -- while the wealthy reap the profits for themselves. The health-care barons, the bailed-out banks, the farm-devouring agriconglomerates, the war profiteers ... we've got plenty of boardroom bolsheviki out there -- but it sure ain't "communism" like Castro used to make! So let them hoot and holler down this false trail all they like; for as I learned back in my Senate days, when I was considered part of the "anti-war" faction, opposition without substance only entrenches the status quo.

No, what we must look out for are all those -- or rather, those very few -- nattering nabobs of negativism who have opposed our historic corporate empowerment bill out of -- get this -- principle. Like barnacles hanging onto the butt of the Titanic, they have clung to the idea of truly universal, equal, single-payer health care, a system that is less expensive, more efficient, more secure, more democratic, more popular and more effective than the heroic measure we have passed here today.

These poor wretches -- who now must face the wrath of Kos and the wroth of Rahm for their tragic apostasy -- are simply not savvy enough to see that our 2,000-page boondogglepalooza, riddled with fine-print exceptions, toothless regulations (which we will 'enforce' every bit as rigorously as Wall Street has been regulated all these years), impenetrable phase-in and phase-out schedules, and mild benefits that won't even begin kicking in for years -- and that even after a decade will still leave millions of people uncovered -- is much better than a simple, streamlined system that could be implemented by the end of this year, bringing genuine relief from intolerable, life-degrading financial burdens and medical problems to millions and millions of people in dire need right away.

Or as that avatar of negativity, Ralph Nader put it:

"The health insurance legislation is a major political symbol wrapped around a shredded substance. It does not provide coverage that is universal, comprehensive or affordable. It is a remnant even of its own initially compromised self — bereft of any public option, any safeguard for states desiring a single payer approach, any adequate antitrust protections, any shift of power toward consumers to defend themselves, any regulation of insurance prices, any authority for Uncle Sam to bargain with drug companies, and any reimportation of lower-priced drugs."

Hey, Ralph, thanks for reciting my credits! All those "berefts" you cited were the result of my own super- savvy negotiations! It's 11-dimensional chess, man, a really heavy-duty Matrix Zen Jedi Master use-the-Force kind of thing, where you win the game by giving away everything you have in the opening move! But you're too much a dinosaur to understand. 'Anti-trust protections!' Hey, Teddy Roosevelt -- your horse-and-buggy is waiting! Just listen to this guy:

"Most of the health insurance coverage mandated by this legislation does not come into effect until 2014, by which time 180,000 Americans will die because they were unable to afford health insurance to cover treatment and diagnosis, according to Harvard Medical School researchers."

Well, what can I say? 180,000 is a lot of dead people. This is a very hard choice, but the price — we think the price is worth it.

Then there's this Chris Hedges guy. He used to be a "serious" journalist, reporting on the imperial wars for our corporate partners in the stovepiping community -- what old-timers and barnacles still like to call the "news media." But he went off the rails a long time ago and joined the carpers and cranks on the sidelines, those malcontents who, unlike so many of our progressive partners today, have never imbibed the timeless wisdom of Warren G. Harding: "Don't knock, boost!"

Just get a load of Hedges here, making the big-whoop observation that our historic bill is just a bloated version of the already-failed, Republican-created Massachusetts plan:

"Take a look at the health care debacle in Massachusetts, a model for what we will get nationwide. One in six people there who have the mandated insurance say they cannot afford care, and tens of thousands of people have been evicted from the state program because of budget cuts. The 45,000 Americans who die each year because they cannot afford coverage will not be saved under the federal legislation. Half of all personal bankruptcies will still be caused by an inability to pay astronomical medical bills. The only good news is that health care stocks and bonuses for the heads of these corporations are shooting upward. ..."

Again with the credits! Stocks going up, corporate heads filling their pockets, pols gorging on backroom baksheesh, Big Money controlling the debate ... Earth to Hedges: That's what we're here for! That's the whole point! You're an old Seventies guy, aren't you, Chris? You remember ZZ Top? "Jesus Just Left Chicago"? (If you'll pardon the immodesty.) What do they say? "Taking care of business is his name." They got that right.

So who cares if the plan "fails"? Who cares, if, as you say,

"[the plan] will not expand coverage to 30 million uninsured, especially since government subsidies will not take effect until 2014. Families who cannot pay the high premiums, deductibles and co-payments, estimated to be between 15 and 18 percent of most family incomes, will have to default, increasing the number of uninsured. Insurance companies can unilaterally raise prices without ceilings or caps and monopolize local markets to shut out competitors."

Listen, Hedgie: If the plan was to reform the health care system for the benefit of the people, then we would have, like, reformed the health care system for the benefit of the people. You follow? The plan was, is, and will always be to appear to be reforming the system -- to make the rubes believe that something is being done to alleviate their pain -- precisely to avoid really reforming the system, which is just too good and greasy for too many of us at the top of the imperial pyramid.

And when this plan fails -- as it will, as it will -- then you rig up another boondoggle, another "great debate" full of sound and fury, signifying zilch, to keep the rubes at bay. Meanwhile, we can get on to the real job our corporate colleagues and patrons want us to do -- bringing that other old dream of social amelioration for the common folk to an end at last: Social Security. Scalpel, Nurse! The doctor is in!

Single-payer by attrition

So, I found an interesting article that alludes to how we might eventually wind up having single payer healthcare reform by way of the Supreme Court. I watched some political talking head show that said if health care reform were passed, the Republicans would challenge the constitutionality of its mandate in the courts, all the way to the Supreme Court.

According to this article from this past January, that would probably backfire on the Republicans, because the court would agree that the mandate was unconstitutional, but they would rule that a single payer form of health care would have to take its place. Read on:

Conservatives should embrace the health-insurance mandate
Jan 15th 2010
by The Economist

I'VE posted before on the perverse results that would be generated by a Supreme Court ruling that a mandate to buy health insurance would be unconstitutional. Yesterday Ezra Klein made the same point. Basically, a lot of Democrats would love to establish a single-payer system for universal health insurance, like Canada's, or a single-payer system for basic insurance with private supplementary insurance, like France's. They've shied away from attempting such a reform because it's agreed that America's private insurance industry is too powerful, and American political culture makes it easy to demagogue any national centralised system (though this rests on a mighty rock of cognitive dissonance—Americans like their Medicare and Social Security just fine).

Hence, Democrats have spent the past two years working out a private-sector universal health-insurance reform plan that's similar to those of Switzerland and the Netherlands: private health insurance with community rating and a buyer mandate. But that kind of system is impossible without a mandate; it would get ripped apart in a vortex of adverse selection. A Supreme Court ruling that the mandate is unconstitutional would mean that the only kind of universal health insurance America can have is the British, Canadian or French kind, where the government runs the whole show (for basic insurance, anyway). It seems perverse that America's constitution would mandate a more socialist approach to universal health care than the Netherlands has. It's also, as Mr Klein says, a disaster for free-market conservatives, in the long run.

But it's also worth thinking about exactly how this would play out. The clearest way to explain it is that right now, what we have already is a system that's getting ripped apart in a vortex of adverse selection. Health spending is rising at 8% per year. PriceWaterhouseCooper says medical costs will grow 9% in 2010; health insurance premiums generally rise even faster than costs. Premiums now amount to 18% of the average household's income, up from 11% in 1999. As insurance costs rise far faster than wages, unsurprisingly, the number of uninsured keeps rising too, to 46.3m in 2008. And those who aren't uninsured are increasingly insured by the government. Medicaid added 3m people to its rolls in 2008. The Children's Health Insurance Program (CHIP) picked up another 1.5m. As this process continues, federal spending on health insurance keeps climbing; it grew 10.4% in 2008. Sick people, poor people, and older people are increasingly unable to afford insurance, and many are winding up on the government's dime. As premiums rise, people at higher and higher income strata find they cannot afford them, drop out of private insurance, and end up being covered by the government or not covered at all.

This is single-payer by attrition. The health reform measure in Congress now proposes to use tax subsidies to get America's working poor into private insurance plans. If it is ruled unconstitutional, the country will face a choice: allow the numbers of uninsured to continue shooting up, or enroll more and more people directly in taxpayer-funded government insurance plans. It's not impossible that America will choose the former, and become an increasingly bimodal two-class society where the working class simply doesn't get adequate health care. But it seems more likely that, after whatever number of years elapses between health-care reform efforts, universal health insurance will be back on the agenda of some future Democratic president. And this time, it will be single-payer, because nothing else will be constitutional.

***

So, is it possible Obama's plan is that he is counting on the current health care reform bill to be ruled unconstitutional by the Supreme Court, thus setting up a single payer system administered by the govt. because since it is closest to what exists in limited form currently (only for poverty level Americans too poor and/or too sick to afford to provide their own insurance), the court would have to revert back to the current plan and increase its enrollment for all those who could not afford the mandate? Wow, that's ingenious! It is the epitome of the back door plan. I will be impressed if that was the overall plan. It seems very conniving and dishonest, so it must be politics 101. Wow...

Kucinich flips to ‘yes’ on health bill

After months of opposition, Kucinich flips to ‘yes’ on health bill with no public option

By Sahil Kapur
Wednesday, March 17th, 2010

Under intense fire from Democratic leaders and some reform activists, the sole remaining progressive against the health care bill has reluctantly reversed his opposition, bringing his party one crucial vote closer to its passage.

"This is not the bill I want to support," Rep. Dennis Kucinich (D-OH) said at a press conference Wednesday morning. "I do not think it's a step toward anything I've supported in the past." But "after careful discussions with President Obama, Speaker Pelosi, my wife Elizabeth and close friends, I've decided to cast a vote in favor of the legislation."

Kucinich's announcement comes after months of staunch opposition to the current package. In January, he told Raw Story his party's concessions to insurance and pharmaceutical companies were acts of "madness." Last week, he said he'd be willing to cast the deciding vote against it.

His refusal to support any bill that didn't contain at least a robust public option was well-received by some progressives. The liberal Web site FireDogLake reportedly raised over $17,000 for his campaign chest. Founder Jane Hamsher now says, "We’ll be asking him to return it."

Kucinich reiterated his many concerns with the bill, primarily that it does not reign in problematic insurance company practices he has persistently assailed. "I do not retract those criticisms," he said.

While maintaining his belief that a single payer system is best way to reform the system, the congressman said he'll "support it in the hopes that we can move towards a more comprehensive approach."

"I know I have to make a decision not on the bill as I would to see it, but as it is," he lamented, acknowledging the "historic" nature of the fight for universal health care in the United States.

In response to a question, the Ohio congressman alleged he received "no Nebraska or Louisiana type deal" in return for his vote. He said his support "wasn't about the kind of deal-making that is essentially self-defeating."

"I take this vote with the utmost seriousness," a somber Kucinich said before reporters, adding that "the president's visit to my district [on Monday] underscored the urgency of this moment."

CNN notes that the congressman's announcement "has reduced the bill's opponents in the House to 204, now 12 votes shy of the 216 needed to prevent President Obama from scoring a major victory on his top domestic priority."