By Lambert Strether of Corrente.
Tonight I want to focus on only two topics: First, ObamaCare apologists, Democratic operatives, and career “progressives” have been peddling the Big Lie that ObamaCare is universal. WaPo’s Sarah Kliff has a story today: Left behind: Stories from Obamacare’s 31 million uninsured; I’ve been saying 30 million, but heck, who’s counting? Enough with the “universal,” already! At least for these United States. Because anybody who’s been paying attention to the heath care reform debates knows that there’s already a truly universal, proven system, on this very continent, in a country with a culture and a political system very much like our own, and called, amazingly enough, Medicare:
The Canadian single payer system.
We also know that although Obama did verbally support single payer in 2003, he was already backing off by 2006. We know that In the 2008 campaign, Obama ran “Harry & Louise”-style ads attacking Clinton for supporting the individual mandate, which Krugman called him out on. (This matters because if you accept the premise that people should be forced to buy a health insurance, even though it’s a defective product, then the mandate is the only way to achieve universal coverage; universality, therefore, has never been Obama’s priority.) We know that once elected, Obama and his administration dissed single payer at every opportunity, including mocking its advocates, censoring Town Hall coverage, and cancelling his own family doctor’s appearance at a forum after it became known that he was going to advocate single payer. Kathleen Sebelius says Obama’s goal is to block single payer permanently. So when you hear ObamaCare apologists, Democratic operatives, and career “progressives” say they want ObamaCare to evolve in the direction of universal coverage, take that with a dose of salts, because they will not advocate, and hate to even mention, a proven system that achieves that goal. Based on their track record — and I know this will come as a surprise to you — they’re lying.
But there’s an even simpler way to tell that universal coverage is not a priority for Obama, or the Democrats:
You know how the Democratic nomenklatura is always whining that the Republicans keep introducing bills to repeal ObamaCare (40 at last count), even though they don’t have a hope of passing them in the Senate? How they’re grandstanding and throwing red meat to the base? Well, how come turnabout isn’t fair play on this? How come Nancy Pelosi hasn’t thrown her own base some red meat by putting John Conyers’ single payer bill, HR676, on the floor 40 times? And so what if the Republicans suppress it, or vote it down? And how about the Senate? Bernie Sanders had a single payer bill, S703, in 2009; so why not at least do a little grandstanding for the base and introduce that bill on the Senate floor? And if 40 times is too much for the stately processes of The World’s Greatest Deliberative Body, then how about once? Or if Harry Reid wants to take some luster from the Kennedy name, how about he re-introduces Kennedy’s bill to reform Medicare by progressively lowering the eligibility by five years, every year, ’til all are covered? Just once? Or if the Democrats just have to have a poorly architected, complex, and Rube Goldberg-esque health care proposal, why not write another 2000 pages of bug fixes for a bill that really does guarantee universal coverage, and put that on the floor 40 times?
The simple answer: Priorities. The Congressional Democrats — or at least Obama’s rump faction of that party — don’t introduce any bills to guarantee universal coverage because that’s not their priority; once they’ve serviced their constituents and handed out the walking around money, their interest is at an end. And the Congressional Democrats don’t introduce single payer bills because that’s not their priority: Like Obama, they hate it. That’s because they’re owned by the health insurance companies, and their priority is to preserve the health insurance industry by guaranteeing them a market. If you get coverage from that effort, that’s a happy side effect and not the goal.
Second, I’d like to focus on the idea of ObamaCare as an experiment. From an article by Henry J. Aaron and Kevin W. Lucia (credentials omitted) in this month’s New England Journal of Medicine:
[T]he ACA has set in motion a large number of pilot programs, , and demonstration projects involving new methods of paying for care and organizing providers. These innovations include bundled payments and accountable care organizations. Not all these innovations will succeed. But if some do, the exchanges will be in a position to encourage or require their adoption. And if exchanges cover a sizable fraction of the insured population, they will have the clout to change the delivery system.
The authors say “experiment” and “innovation” like those are good things. And I suppose, if you are funded to do them, they must be good. However, if we’re designing an entire health care system, we don’t need to experiment, because the Canadians already did that for us. Take a look at this chart (originally from Ian Welsh):
Notice how US and Canadian costs are similar until 1970, and then diverge? That’s when the Canadians adopted their single payer system. Looking at the same data, Yglesias writes:
This is the chart that I think ought to dominate the conversation about public-sector health care spending in the United States, and yet it is curiously [BWA-HA-HA-HA!!!] ignored. The data show government health care spending per capita in the United States and Canada. The United States spends more. And that’s not more per person who gets government health insurance, it’s more per resident. And yet Canada covers all its citizens, and we don’t. That should be considered shocking stuff, and yet I rarely hear it mentioned.
Even odder [BWA-HA-HA-HA!!!] is that the most recent time I heard it mentioned was Valerie Ramey talking at the American Economics Association conference in San Diego and her conclusion was that this showed U.S. health care needs free-market reforms. The more straightforward interpretation, I would think, is that the U.S. needs to make its system more like Canada’s. It’s important to note that the example here is Canada. Not some radically different society. Not some far-off distant land. And the gap is actually growing. …
Canada’s public-sector health care system—conveniently called “Medicare”—is available to people of all ages, and thus has even more bulk purchasing power than its American analogue. That allows it to obtain services at a much lower price, which reduces spending.
Again, we don’t need to experiment. (I don’t want to say that Aaron and Lucia are running a scam, but feel free to think it.) The Canadians have run the experiment, and we have the results. Unfortunately, the political class suppressed them, at the behest of the health insurance companies.
Now, the medical profession is very well aware of the word for experiments that are performed on people without their informed consent. That word is unethical. And ObamaCare is an experiment; Aaron and Lucia admit as much (and give several other reasons in their article besides the passage I quoted). Have the American people given their informed consent to this experiment, which will affect not only their personal economies, but their health and even their lives? No. Obama and the Democrats mock, censor, and suppress single payer advocates (see paragraph three, above), and refuse to seriously legislate for it, or even grandstand for it, exactly in order to deny Americans informed consent. That makes them, in medical terms, unethical. “First, do no harm.” How does advocating for experimental solutions while keeping silent on proven solutions comport with the words of Hippocrates?
Summing up, I’ve been trying to work up an ethical critique of ObamaCare (and, necessarily, of its advocates). Here goes:
1. ObamaCare purports to be universal, but is not. This is unfair.*
2. ObamaCare coverage depends on “the luck of the draw.” This is unfair. People are equal in their suffering, and should have access to care that eases their suffering equally.
3. ObamaCare is an experiment performed on the health of the American people without their informed consent. This is unethical.
NOTE * Also too, lying is bad, and Big Lies are worse.