I am in the process of working on a broader piece regarding the split between the so-called activists versus the more incrementalist wonks on the health care bill (focusing particularly on the ludicrous notion of a possible netroots and tea party convergence -- holy fucking dimestore Marxism, Batman!). In this narrative, it's the true-blue lefties as embodied by Jane Hamsher and others at Firedoglake, the kosacks, Glenn Greenwald, the Huffpost, and (maybe) Atrios versus the more tepid and technocratic -- Ezra Klein, Matt Yglesias, Josh Marshall, and Nate Silver, among others.
Now although I read and enjoy to varying degrees each of the above, I have always identified a bit more with the activists group -- largely because of my own propensity for hot rhetoric and a certain visceral pleasure in the brotherhood (and sisterhood) of outrage. But I have to say, my frustration with large aspects of the activists group continues to grow, not simply because we have come down on a different side on the merits of the current health care bill, but because I have found their arguments to be fanciful, evasive, and extraordinarily badly reasoned on both practical and policy grounds. (And let me repeat -- I am in favor of single payer and think it would be the best outcome -- but it is not going to happen now or in the foreseeable future -- there are not even close to 50 votes for it in the Senate.)
Recently, both Nate Silver and Ezra Klein have posted pieces in which they pretty much eviscerate the arguments of the activists. Read them both -- I can't add much. I was ready to move on to the broader issue above, when I read this piece by Marcy Wheeler at Firedoglake and it made me cringe anew. It's just filled with disinformation and demagoguery and completely disconnected from reality.
Wheeler (whose work during the Scooter Libby case I quite liked) rips the Senate Health Care Bill for requiring the American peasantry to pay feudal tribute to our insurance company overlords. The offense -- a hypothetical family of four with a total income of $66,150 would be expected to pay $540 a month for insurance. Now, I am not minimizing the burden of this, but what the fuck does Wheeler think said family is paying now for insurance? I was just bargaining a contract today where the health care provided to union members on a composite basis (under a self-insured non-profit plan) is $12,500 a year, which is oddly enough, a good deal. As an employer, I can tell you that my law firm is shelling out closer to $1,500 a month to cover our employees through private insurance. In other words, being able to get insurance for a family of four at approximately $6,500 a year is a substantial improvement over the status quo. And it's the status quo to which the bill needs to be compared. Because if the "kill-billers" have their way, that's where we will be -- not in some future health insurance utopia, but the ugly reality of now, with 45 million or so uninsured and costs pressuring our employer based system to its limits.
Similarly, Wheeler's fulminating about out of pocket expenses and copays is also misplaced. Right now, there are simply no legal limits on these items -- under the Senate bill there will be such limits, even if they are not as low as one ideally would like. Once again, the comparison needs to be to the actually existing world if no health care bill is adopted.
Wheeler also claims that insurers would make profits of up to 15 to 25% on the premium dollars of our hypothetical family. She does not show her work. Her assumption seems to be that every dollar not spent on reimbursing health care providers is "profit" to the insurer. I hope that isn't the case, because it would be tragically stupid. All insurers, including not for profits, have certain overhead costs that are associated with paying claims. For instance, the salaries of the people who pay the claims, the people who audit the claims payments, the people who open the mail, sweep the floors, sign up doctors and hospitals, negotiate discounts with same, process appeals, process premium payments, keep the highly sophisticated claims payment computers and software up and running, insure compliance with privacy regulations, process COBRA notices and premiums -- well, you get the idea. Ah, you say, well with "Medicare for all" we could avoid these costs. Um no -- who do you think pays Medicare claims? Well, the same private insurers who act as government contractors to process Medicare claims. (No, government employees do not do this.)
I have worked with self-insured, union health plans for 25 years. They do not make profits, they do not pay exorbitant CEO salaries, they don't advertise -- nonetheless they typically have administrative costs that are at least 10 - 15% of the premium payments. It's just that labor and information intensive an endeavor.
Now I am opposed to for-profit health care insurance. I consider it a waste. But it is not an industry in which 25% profit margins are being made.
Wheeler also conflates out-of-pocket expenses to payments to the insurance companies. But such payments go to providers, not insurers. They may be part of the overall health care burden an individual faces, but they are not profit to the insurers.
Lastly, Wheeler objects to the fact that health insurance payments for these subsidized families will exceed what they are paying in federal income taxes -- up to 9.8% of their gross income -- what she describes as a "tithe" to private insurers. Again, what percentage of income does Wheeler think such families are paying now? The workers with whom I net today are paying roughly 25% of their income for health insurance. (Well, their employers are paying it, but to most employers this money is fungible -- if they have to pay it for health costs, they don't pay it in wages.) To allow the uninsured to obtain coverage for between 2% and 9.8% of income is a huge net plus to these people. Similarly, the massive expansion of Medicaid (government run health care) and community health care facilities (government provided health care) under the bill should be viewed as a major victory for progressives.
It's depressing to see so many good people react to their understandable frustration with the Senate and the power of industry by resorting to magical thinking and inaccurate arguments. The ability to count to 60 and to think in a linear fashion should not be deemed the qualities of a sell-out, but rather essential components of anyone who wants to fight in this arena.
Killing this bill would be an enormous disservice to tens of millions of our fellow Americans who desperately need relief. We will regret it for decades to come if it happens.
