Unlike many of the remaining few on what I’d call the Rational Left, or the Reality-Based Community if you like, I haven’t unsubscribed to the various Obamabot mailing lists in the wake of HCR; I think of it as a cheap way to watch the enemy camp. For the same reason I still read some of the especially egregious kool-aid drinking O-blogs, and I’m on a bunch of Dem party mass mailing lists.

So I got an email from ‘Barack Obama’ today. I’m not naive enough to think he wrote the mass spam, or even read it before it was sent in his name.. but his name is attached, so he’s ultimately responsible.

Responsible for a bunch of lies winding up in my inbox.

Let’s take a look:

John –

I’m writing to you on a great day for America.

This morning, I gathered with members of Congress, my administration, and hardworking volunteers from every part of the country to sign comprehensive health care reform into law. Thanks to the immeasurable efforts of so many, the dream of reform is now a reality.

So far, nothing factually untrue. “Reform” is a meaningless term, and I suppose you can call handing over the IRS as a bill collector to Wellpoint and Aetna a kind of “reform”.

I’m sure knowing that they can sic IRS agents on people who don’t get with the program warms corporate hearts in insurance land, at any rate.

The bill I just signed puts Americans in charge of our own health care by enacting three key changes:

It establishes the toughest patient protections in history.

It guarantees all Americans affordable health insurance options, extending coverage to 32 million who are currently uninsured.

And it reduces the cost of care — cutting over 1 trillion dollars from the federal deficit over the next two decades.

Ah, here we go. Deep in lie territory.

First, ‘toughest protections in history’ is a bald-faced lie, taken literally. Every other developed nation on Earth has more and tougher protections for their citizens than we get in this bill. Being charitable, our Wordsmith-in-Chief forgot the adjective ‘American’ before ‘history’. Which should then be capitalized. So perhaps it’s not a bald-faced lie so much as sloppy parochialism. Let’s give him that one for free.

Second, this bill absolutely does not guarantee affordable coverage for 32 million Americans. That is absolutely factually untrue. Millions more get Medicaid, and yes, that’s guaranteed. The rest get, instead of coverage, orders from the government to go out and buy it. If they’re lucky, they get some money to help them buy that. If not, they’re on their own. If they can’t afford coverage after the subsidies, they’re also on their own. If they have to choose between food and insurance, well, I guess it depends on how much they like the IRS visiting their homes. So this is definitely a lie.

Plus there’s the delightfully high out of pocket limits in the bill. Up to 11,900 dollars for a family. Yeah, that won’t drive anyone into bankruptcy. Truly “affordable”.

In addition to lying about coverage, Obama neglects to mention that, per the CBO, 4 million people will lose the employer provided coverage they have now under his plan, and be forced into buying pricier junk insurance on the Exchange. Oopsie.

As for the ‘reducing the cost of care’ and saving the American people line… the specific figure quoted is a lie, unless you believe in fairy tales. The bill relies partially on an insurance excise tax for funding. A tax that, on paper, generates a lot of revenue… and in practice, nobody expects many people to pay. It will either be pushed back in perpetuity, ala the Alternative Minimum Tax, or it will be avoided by employers forcing their employees onto shitty, high deductible plans.

In fact, that’s the entire idea.

Given the reality of the tax, the billions they expect to collect are a fantasy, and the ‘savings’ number up in the air at this point.

The rest of the email is spent touting the minimal immediate benefits of the legislation, like allowing people to try to afford high risk insurance pools with astronomical premiums until the state level Exchanges, of a type shown in the past incapable of bringing down costs come on line, or letting kids stay on their parents insurance until 26. (Because when the youngest and healthiest people can’t get decent coverage on their own you must be doing something right) There’s a cute cheerleady bit at the end, asking me to ‘co-sign’ this historic piece of dreck.

I managed, with effort, to avoid signing it ‘Get Bent’.

Barely.

Senator Feingold,

After last night’s passage of what is more or less the Senate’s version of HCR through the House, the reconciliation bill will soon come to the Senate. I am writing to implore you, both in the name of fiscal responsibility and fundamental human rights, to submit an amendment to the bill containing a strong public option.

As it stands, the price of health insurance for both families and the nation is too high, and under this bill will only get worse. By 2019, under this bill, the cost to America for health care will be over 20% of our GDP. One in five dollars will go toward our broken, dysfunctional, often lethal health care system. One in five. We simply cannot afford that while our competitors overseas pay a fraction as much of their GDP for true, universal coverage.

Simultaneously, under this bill, the cost to end consumers continues to rise, not fall. Our friends and neighbors cannot afford coverage today – maintaining the status quo is both reprehensible and unacceptable.

As well as all but guaranteeing the continuation of the uniquely American misery that is our health care system, this bill institutes a dramatic new tax of a nature never before seen in American history. Americans will be compelled, by law and enforced by the IRS, to purchase the products of a private industry. This is completely without precedent in our country. Since when do we have so little faith in the free market that we must write laws to subvert it, for the benefit of a precious few? Taxes were meant, by the Founders and all the generations between, to fund the government, to enact programs in the public interest, overseen by and run by dedicated public servants. That is not the case with this bill, to put it lightly. Now, with minimal and insufficient oversight, private companies will determine the coverage and care we receive and then they can send the IRS to force us to pick up the tab.

Fortunately, both of these glaring issues with the bill share a simple and overwhelmingly popular remedy: a robust public option. A robust public option, according to the CBO, would save 110 billion dollars over 10 years. That money could be spent on any number of worthwhile public programs, or simply used to pay down the deficit – either way, it would be a remarkable improvement, fiscally speaking. As well as being prudent spending, a robust public option would remove the severe moral hazard of legislating profit for private companies. I run a small business myself, I value private enterprise – and that’s precisely why I want it to remain *private*. If we must compel insurance ownership, then it is a public service, and public services are to be provided by the government. We don’t have private police or private firefighters. We don’t have a private army, though Blackwater takes us dangerously close. We shouldn’t have a private-only insurance system if the IRS is the bill collector. Let people choose how to spend their money on insurance, if they must be compelled to own it. Give them the choice of a well managed, nonprofit, federal program. A safety net against the greed and venality seen every day in our cruel and bloodthirsty health sector.

If they choose not to avail themselves of it, as most estimates say most people will, then so be it. They retain their freedom to choose, merely by having a choice, and merely by the presence of that choice, and the downward pressure on costs that it represents, America saves over a hundred billion dollars that would otherwise be wasted, poured into private coffers.

Thank you for your time,

John J Sears

PS: For more information, as well as a number of ideas on how to fix and improve this bill, please see Fire Dog Lake at http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/ and http://fdlaction.firedoglake.com/2010/03/22/signed-sealed-but-not-delivered-six-big-flaws-need-fixing-to-make-new-law-meaningful-health-care-reform/

Let’s start with the basics. Wellpoint is the largest US health insurer, and its CEO is a charming woman named Angela Braly. From the Wall Street Journal:

Mrs. Braly is the CEO and president of WellPoint, the largest U.S. commercial health insurer by membership. Her company’s affiliated health plans in 14 states cover 34 million people—or roughly one out of nine Americans. It contracts with 82% of the nation’s primary-care physicians, 84% of specialists, and 94% of hospitals. That scale lands her on the most-wanted list in President Obama’s Washington, though it’s tough to imagine a less likely villain than the very Midwestern Mrs. Braly.

(Ah yes. She must be a good person if she’s from the Midwest, right, right. That’s some quality WSJournamalism.)

Times are pretty good at Wellpoint, and even better for Mrs. Braly. In 2008 the company took in 61.2 billion, yes, billion dollars. Mrs. Braly took in almost 10 million herself in total compensation.

Keep that figure in mind when you read this next bit:

In 2007, just as Democrats took control of Congress, WellPoint pledged that its charitable foundation would spend $30 million over three years as part of a “comprehensive plan to help address the growing ranks of the uninsured.”

…

However, WellPoint’s public records indicate that from 2007 to 2009 the foundation gave less than $6.2 million in grants targeted specifically at helping uninsured Americans get access to coverage and care — barely one-fifth of what was promised and just 11% of the charity’s total giving over the last three years.

To simplify: Wellpoint pledged, out of the goodness of their black corporate hearts, to spend 30 million dollars to help the uninsured. Keep in mind that much of this money could have landed right back in their pockets if the uninsured in question were ‘helped’ to buy Wellpoint products. However, they didn’t *feel* like keeping their word, so they broke it. C’est la vie.

Meanwhile Braly, who found the time to to take her measly ten million even as her company couldn’t scrape together the money they promised to charity, has been making the rounds in the business press.

Who’s to blame for the current woes? Why, everyone but the insurers, of course.

It’s hard to see how WellPoint could be to blame for surging health spending, Mrs. Braly says, when 85 cents out of every premium dollar or more “is paid out in the actual cost of care, doctors, hospitals, suppliers, drugs, devices.”

Yes, it’s so hard to see how setting 15 cents of every healthcare dollar on fire and flushing it down the Wellpoint toilet would drive up costs.

Oh, speaking of driving up costs:

Details: Braly, like Williams, earned more money in 2008 ($9,844,212) than in 2007 (9,094,271), increasing her option rewards by nearly $1.5 million, and also receiving a $200,000-plus bump in base salary, from $922,269 to $1,135,538. Braly’s stock awards dropped from $2,160,159 to $1,750,015 because, according to the SEC, “performance-based restricted stock units awarded in 2008 were cancelled because our ROE target for 2008 was not met.”

Braly’s “other compensation” comprised use of a private jet for her and her family on business trips, just under $10,000 for legal services relating to her employment agreement and cash credits.

Yeah, I’m having trouble identifying any waste in Wellpoint’s corporate structure.

Since it’s not Wellpoint’s fault that costs are soaring, whose fault is it, Angela? Why, it’s those dastardly government types and the hospitals that are to blame.

Depending on the plan, WellPoint’s monthly premium for a 20-year-old in Indianapolis, where the company is based, ranges from $53 to $202. But the same young adult looking for similar coverage in Albany would face costs anywhere between $832 and $1,047. Obviously health costs vary across the country, Mrs. Braly says, but these disparities are almost entirely due to New York’s regulatory mandates. In a state with 19 million people, 88 New Yorkers between the ages of 18 and 24—88!—have bought WellPoint’s best-selling individual insurance product because insurance laws make it perfectly rational not to acquire costly coverage until people need it.

This scheme would have been, and might still be, imposed on the rest of the country. At the request of several congressmen last year, including some Democrats, WellPoint mined its own actuarial data to model ObamaCare and found that it would as much as triple premiums for the small businesses and individuals who are most of the company’s customers. The White House political shop promptly compared WellPoint to a tobacco company.

Which is completely unfair. Tobacco companies would never triple prices in such a short time period; it’d drive them out of business. After all, Obama isn’t going to compel people to purchase THEIR products.

Meanwhile, the dastardly hospitals are forcing Wellpoint to jack up prices:

Mrs. Braly suggests that the industry gambled politically in part because the cost problem seems so insoluble, and that the hand of the industry was forced because the market clout of doctors and hospitals is making it increasingly difficult to contain health costs. “Is there competition in the underlying delivery system,” she asks, “and is that lack of competition potentially driving up costs? . . . People have been talking about competition among insurers, and what they really need to be talking about is competition in the delivery of health care as well.”

Realistically, it’s not as if there’s a market that sets health prices. Instead, they’re negotiated between providers and health plans. Perhaps the doctors and hospitals who were largely exempted from the tepid cost-control provisions in ObamaCare shouldn’t have been.

“We know there’s a lot of redundancy, a lot of waste,” she says. “If we have a contentious discussion with a major hospital system that people want to have access to,” Mrs. Braly explains, and WellPoint doesn’t meet its asking price, “then the question is what do you do about that access?”

Aside from the hilarity of the WSJ admitting that there’s no free market in healthcare, think about Braly’s disjointed illogic here. Waste and redundancy in the medical system drives up costs. The solution is more competition in hospitals, doctors, device makers, etc. So if you have an area served by one large, wasteful hospital full of redudancy, your solution is.. to build another large, wasteful hospital full of redundancy to compete with it? And this will drive down costs?

We’ve heard this refrain before, as Jon Walker pointed out. Insurance companies, whose sole job is to set up efficient systems for reimbursement of medical care, admitting in public that they are completely unable to do so. Their manifest failure somehow demonstrates the need to hand them 30 million new compulsory customers. Rather than instituting some proven system that would actually reduce costs, like single payer with a central reimbursement negotiator. Someone who could, say, set the prices hospitals can charge for procedures, the prices that pharmaceutical companies can charge for drugs, etc, in order to control health care inflation.

Oh wait, I forgot. Obama bargained away a government insurance option and drug price negotiation in secret months ago. Silly me.

Not to fear, though. Braly recognizes there is a problem with health insurance in America:

Mrs. Braly concedes that some people with pre-existing conditions can find it difficult to find affordable coverage, especially if they lose their job, get divorced, move, etc. “It’s when people have no option that we’re really in trouble and need to find a solution,” she says.

That solution of course won’t involve cutting her sky-high pay, or honoring their pledges to charity.

With such a trustworthy and honorable ally, I’m sure Obama’s HCR will go far.