Wednesday, December 30, 2009

A Fairy Tale to Failure

By Sandy Prisant

Do you believe in fairy tales? How about “The Emperor’s Suit of Clothes”? You have to decide right now, because just at the moment the whole Washington establishment, is madly spinning a new suit of clothes for the Emperor, in the form of a Health Care fable for the nation.

It feels like 2nd grade. We’re all gathered around as most of Washington---pundits and politicians full of self-congratulations—opens the big storybook and spins the fable.

Just as in Hans Christian Andersen’s story, some of us are dubious about what the Emperor’s minions are telling the people. So Washington has come up with a new twist on Andersen, meant to thwart all possible opposition. It’s the ultimate defense: “It doesn’t matter what’s wrong with this bill; don’t think about all the self-serving riders the insurance industry added,” Washington says, “anything is a good, first baby step.”

Really? Real-world history says things don’t work that way. The well-documented record of legislative bodies (elected and unelected) confirms: nations, including the US, rarely build effective programs in steps, bill by bill. Especially when (unlike Medicare and Social Security) the very architecture of this bill leaves little room for expansion and true reform.

Many individual Acts by the President or Congress have included expansion of policy in planned stages, but usually the main milestones for such expansion are set down in a single document and decision.

Policy ideas that were weak compromises--often sold to the nation as “good first steps”--have not been:

}It took over half a century for the Supreme Court to move from the “Separate But Equal” baby step to real equality through “Brown vs. Board of Education.”

}Drafting the Constitution quickly produced the Bill of Rights, but in general, human rights have not expanded for Americans in the ensuing centuries. And bills like the Patriot Act have actually set them back. For all our proud independence, we still do not have the right to privacy fixed in law. Nor total sexual freedom among consenting adults. HIPAA laws limiting access to medical records seem to now keep them only from the patients themselves.

}It took over a century from the creation of our democratic republic to move from voting by certain classes of men, to voting by certain women. And then another half-century to finally establish voting by everyone.

When the country is really serious about something, it takes clear action: for the most part, wars, financial regulation (
Glass-Steagall Act (1933), that Patriot Act, and the abolition of slavery each were enacted in one fell swoop.

So when someone tries to tell you the current Health Bill is “a great first step”—or even “a great baby step we can build on”, think about whether legislative history suggests these are credible claims.

And think about what would happen if we let this step-by-step fantasy play out. Look at the challenges facing such a scenario:

1. First, everyone will say we must be sensible and see how this bill works out. It’s in-built timetable assures we won’t have a new system “up and running” to know what’s not working until at least 2025. That’s four Presidential elections and at least 3 Presidents from now.

2.Last week, National Public Radio reported the results of a cost study on the current draft bill. According to the Henry J. Kaiser Family Foundation, the average employer-provided health insurance policy is currently on track to cost about $31,000 in 2019. The Foundation projects average family income at $50,000. This is not a misprint. Over 60% of income will go to pay health premiums based on the current Congressional drafts.

3. Put aside the 30 million extra premium payers in this bill for a moment. What stakeholder with leverage will stand up for the final 8-12% uninsured in 2025, to meet this President’s pledge of universal coverage?

4. What stakeholder with leverage will stand up for an absolute cap on health spending growth in 2025 when the President promises the failure to control overall costs will destroy our recovery before then?

5. What stakeholder with leverage will get health professionals to make the slightest financial sacrifice to achieve affordability in the system?

6. What stakeholder in 2025 will stand up and say ‘60% health premiums that deny us food and shelter must be cut in half’?

7. Finally, what stakeholder with leverage will ever say: ‘This country is based on competition. American health reform MUST include competition, not within, but independent of existing health insurers’?

Now ask yourself: is it realistic to think any of this scenario could retroactively fix the structural flaws that make it impossible to expand or build the current drafts into an efficient, American-style solution, through baby steps.

Is it ever likely we’ll achieve health reform success in parts? Effective, economic national health systems exist on every inhabited continent. All were created whole-cloth, through single acts that did not cost an arm and a leg. Please remember that in the late 40’s, when Britain was still on rations and on its knees, an affordable, universal health system with cost controls, was set up in a very short time. This is fact, not fable.

Why is America the only nation incapable of looking over a score of long-successful health systems and choosing one that’s already proven and adapt it to best suit us?

Either we do this or we are doomed to a failure we cannot afford. Think not? Eerily, over 170 years ago, Hans Christian Andersen sent a message for our time:

Andersen wrote in his fairy tale: “What a splendid idea," thought the Emperor. "What useful clothes to have. If I had such a suit of clothes I could know at once which of my people is stupid…”

Bottom Line: What’s happening now is a distraction. This is not about Congressional negotiations. With great sadness, we must face these facts. Will the Emperor prevail or will we be as wise as the people at the end of the fairy tale, by seeing the truth...

And starting over.


"Health Cuts With Little Effect On Care,"The New York Times, December 30,2009

1. "Comparing the House and the Senate Health Care Proposals: Public Plan," The New York Times, December 19, 2009

"The House Bill and the Senate Bill," The Now! Blog, December 21, 2009

"Why We Need a Public Health-Care Plan," The Wall Street Journal, June 24, 2009

"Why a public health insurance option is key to saving costs," Economic Policy Institute, June 25, 2009

2. "Assessment of Affordability Provisions in the Exchange in House (H.R. 3962) and Senate (H.R. 3590) Health Reform Bills," Health Care for America Now

"Finishing Reform Right: Fixing affordability before the President signs a health care bill," The Now! Blog, December 22, 2009

"Comparing the House and the Senate Health Care Proposals: Individual Mandate," The New York Times, December 19, 2009

"The House Bill and the Senate Bill," The Now! Blog, December 21, 2009

"Senate health bill is launch pad," Jacob Hacker, December 22, 2009 http://www.po/

3. "Comparing the House and the Senate Health Care Proposals: Abortion," The New York Times, December 19, 2009

4. "Comparing the House and the Senate Health Care Proposals: Paying for the Proposals," The New York Times, December 19, 2009

"Comparing the House and the Senate Health Care Proposals: Insurance Regulations," The New York Times, December 19, 2009

"H.R. 3962, Affordable Health Care for America Act," Congressional Budget Office, November 20, 2009

"Patient Protection and Affordable Care Act," Congressional Budget Office, November 18, 2009

"REPORT: How the Senate Bill Compares to Other Reform Legislation," Think Progress, November 19, 2009

1 comment:

  1. Please reformat your blog template to white background, black type. I would love to read what you have to say, and this style is a deterrent. Reversed type is only readable for a lead paragraph, and then the eye fatigues...
    I read your comment over at the Telegraph article "America Slides Deeper...", and popped over here to see more of what you have to say.

    Thank you,