Six small-state U.S. senators sitting around a table and munching chocolate-dipped potato chips are about to chop off the two pillars of health care reform that would most protect consumers. The three Republicans and three Democrats who are hashing out the Senate Finance Committee's health reform proposal are leaking the news that they won't require employers to provide health insurance. And they won't allow Americans to choose a publicly run health insurance option--a competitor to private, for-profit health insurers.
Will they later offer up a "Twinkie defense"? How else to explain what they've done, when ordinary Americans will be forced to buy insurance from the same insurers who jack up premiums, co-pays and deductibles, then deny treatment as soon as a disease gets expensive.
It'll be an insurance company dream if Finance Committee Chair Max Baucus of Montana, his Republican counterpart Charles Grassley of Iowa, and four others carry through with this amputation. Here's why:
1. If there's no Medicare-style public option--only toothless, undersized regional and state "purchasing co-ops," nothing will force insurance companies to be more efficient, to cut the 25% and more of premiums that get spend on administration and profit.
2. If employers are not required to offer insurance, their low-paid employees will require government subsidies and their middle-class employees will have to buy their own individual health policies (the least efficient, most profitable form of health insurance) or face tax stiff penalties.
3. The result is to turn government into a customer-delivery system for private health insurance companies, with no effective curbs on what they can charge or guarantees that mandatory policies will be more than a bare-bones joke. If the deductible is $4,000, who can afford to go to the doctor? If pregnancy is an excluded "condition," who can start a family?
And one final question: How do six Senators with fabulous, taxpayer-supported health insurance get to make these decisions while taking insurance company bucks--especially the case with Baucus. It seems bizarre that Baucus, who represents a rural, conservative state with less than one-third of 1% of the U.S. population, gets to be the big cheese on the future of U.S. health care. (The whole group of six represents less than 3% of the U.S. population) The lawmakers can toil as hard as they want, but they're small-state senators bombarded by corporate lobbies that have destroyed health care reform ideas since Harry Truman was president.
The politics of this battle aren't yet settled. Despite continued infighting by Republicans and conservative Democrats who've been spouting the insurance industry's lines and taking the insurers' money, a House version of health reform may still end up stronger. And much will depend on how much power President Obama is able and willing to wield in the final closed-door fight for a combined House-Senate bill.
Those two key legs of effective reform--employer insurance and especially a public health care choice--could still be sewn back on. If not, we'll all watch the medical and insurance lobbies high-fiving the potato-chip caucus in the Senate (members below).
The Potato-Chip Caucus in the Senate Finance Committee:
Max Baucus, Montana (pop. 967,440)
Kent Conrad, ND (641,481)
Jeff Bingaman, NM ( 1,984,356)
Charles Grassley, Iowa ( 3,002,555)
Michael Enzi, Wyoming (532,668)
Olympia Snowe, Maine (1,316,456)
U.S. population: 304,059,724
Source: U.S. census bureau, 2008