Saturday, October 24, 2009

David Van Os On The Hogs At The Trough

A few days ago my newspaper contained a heart-wrenching article about a young woman who died of cancer after her insurance company denied a treatment that her doctors recommended. We have all heard of or personally observed such tragedies. The denial of doctor-recommended treatment to persons who have health insurance coverage is one of the greatest causes of public outrage about the greed of bean-counting insurance companies.

You would think that any health care reform legislation would do something about this problem, right? Wrong. The bill that recently passed the Senate Finance Committee does not regulate treatment coverage.

You would also think that any health care reform legislation would regulate how much insurance companies can charge for health insurance. After all, it is the high cost of premiums that is the main obstacle for individuals who do not have health insurance - they simply cannot afford it. And it is the high cost that deters small businesses from purchasing group health insurance for their employees. However, the current approach of both the President and the Congress does not regulate the cost of health insurance.

The bills do provide financial assistance for those who cannot afford health insurance. But in the long run what good is that without direct regulation of the premiums charged by the insurance companies? If the insurance companies are free to raise costs as much as they like whenever they like, the need for government assistance will simply keep going up and the ever-increasing cost to the federal treasury will continue being a football in a political game that the people who most need assistance cannot win.

Several days ago an Obama administration spokesman stated during an NPR radio interview that the administration "hopes" the system envisioned in the health care legislation will control costs. In fact hoping is all anyone can do, because the bills don't regulate what health insurance companies can charge. In fact the bills regulate very little about health insurance industry conduct.

The fundamental flaw in the current approach to health care "reform" from both the White House and the Congressional leadership is that it is market based. You would think that after the proven failures of the cult of the "free market" at the big business level our political leaders would have finally stopped worshipping at the false altar of this relic of the failed Reagan-Bush era. But they have not. The entire thrust of the present Washington approach to so-called health care "reform" rests on the premise that the insurance "market" will reform itself if lawmakers provide the right incentives and disincentives. Even the "public option" - which I support as the most preferable alternative in the present deplorable context - is based on the idea of providing competition so that the "market" will work according to the assumptions of corporate Reagan-Bush dogma.

What the current approach will really do is make the insurance industry cartel even stronger than it is today, which will be an amazing accomplishment considering it is already one of the dominant oligopolies disrupting our Constitutional democracy. If you think the health insurance industry charges too much money for its products today, you haven't seen anything yet. Just wait until these hogs are handed the ultimate captive market of the government compelling every person to purchase their products. They won't just be wallowing in the trough; they will own the trough and everything in it.

Entrepreneurial free enterprise is one of the greatest strengths of our society because it promotes invention, creativity, risk-taking, resourcefulness, talent, and individual freedom. But monopoly corporate power is not free enterprise. It is the opposite. It stifles individual freedom through control and domination. Maybe that is why the magnificent original Bill of Rights of the Texas Constitution declares in Article 1, Section 26 that monopolies are contrary to the genius of free government and will never be allowed.

The real solution to the health care crisis is not to rely on corporate free-market dogma. Giving the health insurance barons even more oligarchy power than they already have will in broad terms only worsen the severe socioeconomic crisis threatening the egalitarian underpinnings of Constitutional democracy; and in specific terms, it won't cure the health care crisis.

The real solution is to apply a concept that is much simpler and much more straightforward than the bills that are being considered today. Rather than merely hoping to control costs, why don't we actually do it? Why aren't we talking about direct regulation, pure and simple? As far back as the 19th century we Americans have regulated big business when the public interest so dictated. At the state level we Texans also regulate automobile and homeowners insurance (though very poorly under Slick Rick Perry). Every outrage imposed on people by the giant health insurance companies, from charging unaffordable premiums, to blocking doctor-recommended treatments, to relying on pre-existing conditions, to denying insurance coverage could be addressed through direct regulation. The same goes for the outrages of the pharmaceutical companies and other health care related robber barons. While writing such legislation would entail all the complexities of the lawmaking process, with a host of details to be resolved, the fact is that enacting regulatory legislation is a normal activity for the U.S. Congress. While they are at it, an important piece of such legislation would be to repeal the exemption from antitrust laws that Congress gave the health insurance industry in 1946 in a particularly bad display of corporate welfare.

The biggest thing standing in the way of the direct regulatory approach is the lack of political courage to confront the corporate free-market propaganda that has dragged we the people ever deeper into the economic mud over the last 30 years or so.

At this very moment, various public interest organizations are encouraging their followers to flood Congress with phone calls for "real health care reform", but without specifying what "real" reform should consist of. This may be misplaced energy. The essential problem is that the "market-based" philosophy favored by the free-market cultists who surround President Obama and the congressional leadership is NOT reform. REAL reform would be to regulate the economic behavior of the health insurance and health care industries just like many other industries are and have been regulated. REAL reform would be not to try to sweet-talk the hogs out of the trough, but to evict them and lock them out.

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