Occam's Razor

President Obama may be our Great African American Hope, but it is hard to avoid the feeling that our great country’s best days are behind it. Politicians will not admit it, of course. From their lips, like it came from Ronald Reagan’s, it is always Morning in America. If you need more proof our best days may be behind us, look no further than the current health care “debate”. It is a sad political debacle in which “compromise” apparently means everyone’s needs will be satisfied except for the people who actually need and use health insurance in the first place.

Democrats, as usual, are busy imploding now they have returned to full power. There are few things that Democrats do better than control both Congress and the White House and then quickly splinter into disunity. We saw it happen to Bill Clinton’s Democratic Congress, and before that to Jimmy Carter’s. This time, it’s the Blue Dog Democrats (who represent conservative and southern districts) vs. the Congressional Progressive Caucus. House Blue Dogs, who consistently represent more underinsured constituents than elsewhere, nonetheless cannot seem to summon the will to vote for the mere option of a universal public health insurance plan. The House Congressional Progressive Caucus, a somewhat larger body of Democrats, won’t vote for a bill without a public option.

Meanwhile, over in the Senate, alleged “Democratic” Senator from Montana Max Baucus, who is also chairman of the Senate Finance Committee, and whose reelection campaign is largely funded by the health insurance lobby, tried mightily to create a “bipartisan” health care bill. He did so by systematically excluding input from all but a handful of personally selected senators on his committee. “Bipartisan” meant trying to be inclusive to three Republicans, only one of whom (Olympia Snowe) may actually vote for his “bipartisan” bill. Baucus hopes that taxes on “Cadillac” health insurance plans plus murky promises to reduce future waste and fraud in Medicare will help subsidize health insurance for the working poor and the middle class. Everyone will be required to have health insurance, but will have to buy their plans from the same insurance companies that keep raising their premiums and dropping them as customers for sins like not disclosing that they had acne. With premiums alone currently running $13,000 a year for a family, and with subsidies anticipated to pay for only a small part of the premium, it is unclear where these already stretched families will find the dough to buy health insurance, but they risk a fine if they do not. The sad reality is that if the Baucus bill becomes law, most families will opt to pay the fine because they still will not be able to afford health insurance.

The winners, naturally, will be health insurance companies who will get plenty of new customers, many of whom are younger and thus less likely to get sick. While insurance companies will not be allowed to deny people insurance based on preexisting conditions or kick them off the plan when their care gets too expensive, they can keep raising premiums as much as they want. No insurance commissioner will be policing their premium rate increases. An independent commission may make recommendations for providing more efficient health care, but these are likely only to apply to Medicare, Medicaid and maybe physicians. A public option may or may not survive. It is likely to pass the House, but the assumption is that the Senate won’t pass it and they hold the trump card.

This is as close to health care reform as we are likely to get. In short, if you have insurance you cannot be dropped. If you don’t have it, you cannot be denied it even though you may not able to afford to do so. In addition, nothing serious will be done to slow the escalating costs of health insurance, meaning that it will only become more unaffordable as time goes on.

When a nation cannot find a pragmatic way to solve a pressing national problem that a majority of Americans earnestly want solved, you know government is becoming dysfunctional. Yes, the seeds for the eventual unraveling of our country are being planted through myopic and reckless acts of self-interest like these. Rather than be the United States of America, we are becoming the Divided States of America. You can see it in the senior citizens attending health care rallies, determined to protect their Medicare benefits at all costs while somehow blissfully unaware they are using socialized medicine. For those younger than them who cannot afford health insurance, well, screw ‘em. They got their government bennies first and they’ll be damned if anyone else will get any at their expense.

What would real health insurance reform look like? For one thing, we would mercilessly tax the things that are driving up health care costs, like we have been doing with tobacco and alcohol. There would be a ten cent per can surtax on every sugary beverage sold, from Coca Cola to a Starbuck Carmel Frappuccino. This alone would pay for much of our health care costs, but we could also do the same with any food the Surgeon General determines is unhealthy. We would give premium discounts to people who maintained a healthy weight. We would offer subsidies so the overweight and obese can enroll in successful weight loss programs like Weight Watchers. We would provide these companies bonuses for keeping people at healthy weights and physically active. We could require employers provide gyms and basketball courts and make sure their white-collar workers get cardiovascular exercise during the day.

No doubt, Republicans would scream about more socialism and higher taxes, and the food industry would oppose any reforms. And of course, they would win because this is America. In America, the interest groups that can best influence Congress (and these amount to those who have the most money, which is generally corporations) tend to get their way. Moreover, based on arguments recently before the Supreme Court, it looks like conservatives on the court will give corporations permission to spend unlimited amounts of money on campaign related advertising and propaganda too. We can look forward to even more government of, by and for the corporation.

Most sensible governments like the rest of the first world came to a reasonable solution a long time ago. A good American model would look a lot like Switzerland’s, where everyone buys private health insurance but niggardly insurance regulators set all sorts of conditions on premium increases and quality of care standards. However, we could not do that here, you see, because that would be “socialism” and might affect health insurance company executives and their $500M a year salaries.

Sadly, America has a long tradition of capitalism triumphing over common sense. Moreover, many of us will gleefully applaud policies that will only make us unhealthier and kill us faster. It’s the American way! From our growing guts, to our obsession with drugs, to our addiction to SUVs we cannot get beyond our own short sighted interests and pragmatically deal with the longer term problems that are crippling not only ourselves but destroying our great country.

I get the sense that we are doomed. I doubt even our Great African American Hope can pervade over such entrenched, self destructive and selfish dynamics. Shame on us.