November 22, 2011 · 1 Comments
By Jane Prettyman:
Let’s not throw out the public mandate — a key to single payer — with the bathwater of the private commercial mandate.
On Nov 16, 2011 the New York Times (11-16-11) ran a “news analysis” by Sheryl Gay Stolberg regarding the so-called “mandate debate” which focused on the mandate’s role in the Obama health care reform bill (Affordable Care Act) which forces most adult Americans (with some exceptions) to buy commercial health insurance policies on various convoluted exchanges, etc, to make them seem like a good deal but nonetheless profit-making commercial products whose prices will not be well controlled. The article also speculated on the pending Supreme Court decision and mentioned polls showing a large majority of Americans not at all happy about the individual mandate.
Follow the Times discussion carefully and you’ll notice it skims over the surface of the mandate issue without delving into details of what sort of mandate we’re talking about, referring to “a provision requiring nearly all Americans to buy coverage or pay a penalty” but not emphasizing what kind of coverage. The ACA is calling for commercial coverage by a corporate product with the priority of making a profit. This might seem obvious and benign but the effect of handling the “debate” this way is that the concept of a mandate is being generalized in all its forms (there are other forms of mandate) as a bad thing we might be inclined to avoid — such as when we might want to consider single payer which also depends on a mandate. In fact, as discussed below, “universal coverage” as a concept when Medicare was invented was possible only by means of a mandate with no opt-outs; it was set up this way so there was enough cash in the system to make it all work properly. Private insurers (with the help of free-market geniuses at the Heritage Foundation) co-opted the mandate concept to apply to private insurance products to create long-sought “universal” coverage” but at the highest possible price (profit), making commercial insurers a monumental fortune in a captured, forced market of commercial purchases — not really a competitive market anymore but a little dictatorship effectively holding up the American people, “Your money or your lives” at the highest profits they could muster.
This kind of private mandate sounds bad and it is. But single payer — a publicly funded, privately delivered medial care system like Medicare for All — also functions on a mandate of “everybody in” and we don’t want people to object to the concept of a mandate in general when — someday — publicly mandated single payer becomes an important option economically and politically.
While the exchanges might have a few non-profits on them, the vast majority will be for-profit. Remember that corporate Blue Cross (which dropped patients arbitrarily right and left in CA) was supposedly “non-profit,” yet they raised premiums sky high, so it depends on what “non-profit” really means. We’re not experts on non-profit status but largely the ACA system is not non-profit and there is no public option which would have been truly not-for profit.
One wonders why most news reports (this Times story a perfect example) fail to be clear about the distinction between types of mandates in the mandate debate. There’s a private mandate (like Obama’s corporate-generated, commercially based health insurance product we’re forced to buy where profits take priority and benefit health insurance corporation stockholders and those in the public who can afford it) and there’s a public mandate (like single payer Medicare we all pay into, a non-commercial form of health coverage with no profits involved, human beings take priority and the whole public benefits).
Corporate interests with large investment portfolios and all sorts of intertwined relationships with highly profitable private commercial insurance corporations — including large news media corporations like The Times — might not be avid to point out the clear distinctions in the mandate debate in the interest of preserving the dominance of the profit-oriented commercial health insurance system for their investment portfolios. This is speculation but one wonders.
In any case, it’s curious that The Times so carefully straddles the issue and avoids specifying the two different types of mandate — public and private — so that the reader is left with the impression that allforms of mandate are bad news and possibly even unconstitutional. This kind of misimpression serves the advantage of private insurers who do not wish to be replaced by the public mandate of non-commercial single-payer/Medicare for All. Commercial insurers run the risk of losing the private mandate (which they never had before ACA anyway except in the relatively recent and privatized Medicare Part D commercial drug plan) while we run the risk of losing the public mandate of Medicare which we’ve had for decades and vitally need for our elders — indeed for all of us. Is that the strategy? Let the SC come up with that rationale for overturning Medicare’s public mandate rather than argue against Medicare directly? It’s probably not conspiratorial but one wonders why such a concerted omission campaign has been going on in the newsmedia against the public mandate of single payer.
The Times does mention a distinction between the “individual mandate” and the “employer mandate” but for purposes of this diary, this amounts to an artificial distinction between two forms of privatecommercial mandate, the second one a soft-landing provided by employers who pay a portion of the premium for employees (incurring increased overhead and less competitive flexibility) originally as an inducement for hiring.
Here’s an “omission” example in the Times article (the missing distinction in brackets):
“The theory behind the [private] mandate, according to its proponents, is this: Requiring [private commercial] coverage brings both sick and healthy people into the pool . . .”
Then there’s this gem:
“Obama advisers regarded the [private commercial profit-oriented] mandate as a conservative notion.”
Indeed it certainly is a conservative notion, born at the Heritage Foundation as a cunning conceptual PR trick to sell “universal healthcare” to increase coverage (increase market sales) not by building a non-commercial single payer system by mandating — forcing — all Americans to buy (probably in the form of a tax as Medicare is done) the least expensive coverage in the form of single payer, saving individuals, families and businesses billions of dollars, but instead by mandating — forcing — everybody to buy far more expensive commercial insurance policies, a perfect coup of corporate profits was achieved, selling their product to a universal population(“all”) population who had no choice but to buy it. Meanwhile the term “universal” had the effect of making it sound like a benign single-payer-style system “covering” everyone but not emphasizing the fact this universal coverage would be achieved by forcingeverybody to buy a commercial (not non-commercial) corporate product. This was the concept package that was ultimately sold to Romney in MA and then Obama sold the same package to the entire American population in what might someday amount to the greatest financial windfall to private corporations in American history.
The term “universal healthcare” appears to have been co-opted by the private insurance industry to mean something that many average citizens (and even newsmedia and many politicians) mistakenly thought was non-commercial, not-for-profit single payer. It wasn’t. It was a corporate windfall of monumental proportions which Obama flipped over to embrace in his Affordable Care Act. Average Americans will be forced to buy these poorly regulated, poor-quality, high-premium health insurance policies (with few controls on premium rises and no public option which Obama dealt away early in the game) in a recession which will likely be continuing if not worsening by the time the ACA kicks in after the 2012 elections. It’s a cruel system Obama is allowing in the door, no matter how prettily he paints the picture.
Private health insurers are avid to preserve the private mandate as it guarantees them a ready-made forced market –- which should be held unconstitutional. But let’s be sure we are clear that a public mandate for single payer (such as Medicare for All) is not unconstitutional. Let this question get close to Chief Justice John Roberts and he might do what he did with the Citizens United case -– harm a major portion of our lives by leading the Supreme Court to rule that all mandates –- public and private –- are unconstitutional. That would be extremely unfortunate. But if the public is misled into believing that all mandates are bad -– public and private -– such a move by the Roberts Court could be accepted by the people as reasonable instead of outrageous in part because newsmedia like The Times misled us there.
The distinction between public and private mandate is not clearly made by The Times report yet the public seems to be aware of it. For example, notice this poll finding reported by The Times in the same article:
“Polls show that the individual [private] mandate is unpopular. The Kaiser Family Foundation, which tracks public opinion on the health measure, reported in March that 74 percent of Americans would keep, rather than repeal, the law’s provision barring insurers from discriminating against people with pre-existing conditions. But only 27 percent would keep the [private] mandate.”
This result suggests that citizens are looking for justice and fairness (getting rid of of discrimination against pre-existing conditions) that just happen to underlie the elegant essence of single payer (altho most average Americans don’t realize this because it is so seldom reported). If we have fully universal non-commercial single payer coverage, pre-existing conditions become moot. Does The Times point this out? No, of course not. It is apparently not in The Times’ (financial?) interest to point out the benefits of single payer.
Where The Times could have brought non-commercial single payer forward in the discussion as a helpful alternative we hear . . . crickets.
“Chris Jennings, a former health policy adviser to Mr. Clinton [said], “Health reform without an individual requirement is like driving a train without tracks; you can still move, but you can’t get to your coverage destination and it will be a rougher and far more costly trip.”
Wow, this is disingenuousness wrapped around itself. Getting to “your coverage destination” is easiest and least expensive for all parties (individuals, families, government and businesses) with single payer,not with an individual private mandate with poor premium price controls, by far the “costliest trip” (and most profitable trip for private insurers and their investors) all around.
The Times points out there are other ways to expand coverage, saying:
One option is “auto enrollment” in which the government would automatically enroll citizens in insurance plans, but give them the chance to opt out.
First of all, this “auto enrollment” does not make clear these are private insurance plans that people would be automatically enrolled in, functioning like another form of private mandate. But then the idea undermines itself by allowing opt-outs which would eventually hollow out the system financially as why would people opt back in unless they had to when they got sick? This contradicts the core principle of insurance itself. Somebody was not thinking clearly in this paragraph. But The Times doesn’t seem to mind and never gets off the track of commercial health insurance.
Finally, this NYT article is not about single payer per se and yet it indirectly is, because single payer relies on a mandate of its own while we steam about the ACA’s private mandate and both are balled up together in this article, endangering single payer’s “good mandate” (public non-commercial) while castigating (by several but not all quotes in the article) ACA’s “bad mandate” (private commercial) in a classic whipsaw without ever making the distinction between them. So it’s worthwhile pointing out other newsmedia avoidance of coverage of single payer (and its public mandate), specifically in California where a single payer bill (in its initial outlines) passed the legislature twice but Republican Gov. Schwarzenegger (who accepted huge campaign financing from the private health insurance industry) vetoed the single payer bill each time with little public hoopla since most of the public had no idea the single payer legislation even existed or how it worked. This was because only two LA Times news stories about the bill appeared in each round, one when the legislation was introduced and one when it was vetoed (with a year of time in between during debate in the CA legislature when lots of other stories could have been written but none were), so that the public in Southern California (and similarly in Northern California where SF, Oakland and Sacramento news coverage was just as thin) was never educated by the newsmedia in any depth on the benefits of single payer and heard only slurs and slogans likening single payer to “Soviet-style medicine” (Schwarzenegger’s favorite phrase). Thus Schwarzenegger had little political blowback from the public against his decision to veto single payer. The LA Times, blaming “lack of space” and working via omission, actively helped that failure to occur.
The NY Times appears to be working in the same mode now, via omission. It’s all about keeping single payer -– and the public mandate -– unmentioned and undiscussed as much as possible.
Or so it seems.