Posted by Wendell Potter on August 17, 2009

Over the coming weeks, Americans will find out whether the man they elected their president is just a great orator and politician or whether he is also a great leader.

Of the central features of candidate Barack Obama's health care proposal, he said one thing was essential -- a public insurance option to compete with the private insurance industry that is now dominated by a cartel of Wall Street-driven, for-profit behemoths. Another thing Obama said he would not support -- a requirement that all of us be forced by law to buy overpriced health coverage from private insurance companies.

Many of the people who voted for Obama did so because they believed his health care proposal was the best among the field of Democratic candidates and -- no contest here -- far better than the insurance industry-backed plans advocated by the Republicans.

Obama was not alone in calling for a public insurance option. So did Hillary Clinton, among others. About the only thing that distinguished Obama's plan from Clinton's, in fact, was his opposition to forcing all of us to buy health insurance. "Why should we force people to buy something they can't afford?" he asked repeatedly on the campaign trail.

After listening to the speeches he made in Montana and Arizona and to comments made by Health and Human Services Secretary Kathleen Sebelius and Obama's press secretary, Robert Gibbs, on the Sunday morning talk shows, I'm wondering what happened to the guy Americans elected.

Having worked in the health insurance industry for nearly 20 years, I know Obama and Clinton were right in insisting that a public health insurance plan is vital to reform. A public plan not only will serve to "keep the private insurers honest," as Obama used to say before he started waffling, but it will also provide millions of people who now have no insurance at all with good coverage at a more affordable price. That's because the big for-profit insurers waste increasingly big chunks of your premium dollars on nonessential things like exorbitant CEO salaries and profits for the big institutional investors who own them. A public plan would not waste your precious dollars that way.

But unless I missed it -- and I even read the transcript of his comments to make sure I didn't -- Obama never even mentioned the public insurance option in his opening remarks in Montana, where he stood just a few feet away from one of the insurance industry's biggest friends in Congress, Senator Max Baucus.

The president finally seemed obligated to mention it in the Q&A session. In response to a question from a man who lost his insurance when he lost his job, Obama said this of the public insurance option, using language that would make you think some well-meaning but naïve freshman congressman just recently came up with the idea:

And one of the options that's being debated is, should there be a public option, all right? (Applause.) And I want to -- I want to just explain this briefly, because this is where the whole myth of a government takeover of health care comes from. And not everybody -- not even every Democrat -- agrees on the public option, but I just want at least people to be informed about what the debate is about.

The idea is, if you go to that marketplace and you're choosing from a bunch of different options, should one of the options be a government-run plan that still charges you premiums? You still have to pay for it just like private insurance, but government would not -- this government option would not have the same profit motive. It would be obviously like a non-for-profit. It would have potentially lower overhead, so it might be able to give you a better deal, should you be able to choose from that option among many others. That's what the debate is about. (Applause.)

Now, what the opponents of a public option will argue is, you can't have a level playing field; if government gets into the business of providing health insurance, they will drive private insurers out of the health insurance market. That's the argument that's made. (Applause.) And I -- that is a legitimate, it's a fair concern, especially if the public option was being subsidized by taxpayers, right? I mean, if they didn't -- if they could just keep on losing money and still stay in business, after a while they would run everybody else out. And that's why any discussion of a public option has said that it's got to pay for itself, it's not subsidized by private insurers.

I don't know about you, but to me that sounds an awful lot like a guy who is trying to talk himself -- and us -- out of the best idea he and many others in the Democratic party have come up with to reform our badly broken, profit-driven health care system.

Less than 48 hours after setting us up for his soon-to-be-even-more-obvious capitulation to the demands of the insurance industry, the New York Times reported in its online edition that the Obama administration had begun sending signals "that it has backed away from its once-firm vision of a government organization to provide for the nation's 50 million uninsured and is now open to using nonprofit cooperatives instead."

Secretary Kathleen Sebelius said on Sunday morning that an additional government insurer is "not the essential element" of the administration's plan to overhaul the country's health care system. "I think there will be a competitor to private insurers," she said on CNN's State of the Union. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing. We need some choices, we need some competition."

Her less-than-forceful insistence on a government insurance organization was paralleled by Robert Gibbs, the president's press secretary. "What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," he said on CBS's Face the Nation.

Not only is Obama clearly ready to throw the public option overboard, he is embracing the requirement that we all be forced to buy insurance from private insurers. That means your tax dollars and mine will be used to pay subsidies to the big insurers to provide coverage to people who can't afford to buy their policies, because the big insurers charge far more than they should because Wall Street investors demand that they do.

One of the people who undoubtedly talked Obama away from the public option and into supporting this mandate is his new BFF, Aetna CEO Ron Williams. Williams, who made $65 million off of Aetna's policyholders' premiums over the past two years and who was the mastermind behind Aetna's shedding of eight million members a few years ago to meet Wall Street's demands, is the insurance industry's leading champion of requiring us all to buy insurance. And, of course, without a public option, we'll all be forced to buy coverage from Aetna or one of the other private insurers.

According to a recent article in Forbes, Williams has been to the White House a half a dozen times recently to advise the president and his staff on health care reform. That same article quoted a Wall Street analyst as saying that Aetna likely will dump about 600,000 policyholders during the coming months to satisfy its investors' unrelenting profit demands.

During his speech in Montana, Obama talked a lot of trash about the insurance industry. Don't be fooled by that tough talk. It's all part of a strategy to try get us to believe we'll get the reform he promised during the campaign. Industry leaders are in fact delighted he's denouncing their behavior, because they believe most of his supporters -- who were hopeful the stars might finally have aligned for real reform -- will be fooled into thinking the reform bill that reaches his desk will benefit them more than the special interests with their armies of lobbyists. And they know the nonprofit cooperatives Sebelius and Gibbs are now trying to sell us on don't have a prayer of succeeding. The big for-profits will never let them get off the ground in any meaningful way.

Sadly, I believe the fat cats are winning and that the bill Congress sends the president will be one that gives an industry with an unsustainable business model a new lease on life and a guarantee of unprecedented future profits.

So I hope the president's aides are buying lots of lipstick. He'll need all he can get to put on that pig of a bill.


Wendell Potter is the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin. A version of this article originally appeared on the Huffington Post.

Comments

This is the only word I can use to describe how I feel, not only about healthcare, but of this country: Despair.

I can't tell you how upset I am with Obama and both parties. Obama made a big issue about his mother's last days, and how all she worried about was how she was going to pay the bills.

It's as if he used his own mother's memory to sucker us.

I have sent dozens and dozens of emails to my representatives (who really don't represent me); I have participated in rallies and held protest signs. All to no avail.

One thing is for sure: If this plays out like we think it will, I will vote only on issues, not for people. Democrats are worse than republicans because they repeatedly fool us into voting for "hope". I'm so tired of all of it.

Face it, America: You are a fascist country, run by corporations. The people are too stupid, too lazy, and too preoccupied with chasing after the next buck or the next hot stock. It's all about "me"; it's all about getting rich quick, getting yours, and not caring about millions of people who go bankrupt over health issues, or who die because they can't afford to get well.

This is truly the sickest country in the world.

Ran-
You better save your energy for the next civil war, coming soon to a neighborhood near you. Not a war of words -more like 1862 America.
It might be the sickest country in the world in your eyes, but it's about to eat its young- and we the people are those young. We are not only an ignorant nation- but a well armed and ignorant nation. It's not the government that you need to fear- it's hillbilly Bob down the street , who's running out of Thorzine and who's getting a little agitated by the words of Glen Beck on FoxNews.

The revolution will not be terrorized.
The answer is to stop playing the game.
Step down, walk away.
Your health is in your own hands and always has been.

They will try to rope you in, and if you are dependent on THEM you will tie the knot yourself.

Obama has three health care principals:

http://my.barackobama.com/page/content/health-care-action-center/?source=feature

o Reduce costs — Rising health care costs are crushing the budgets of governments, businesses, individuals, and families, and they must be brought under control

o Guarantee choice — Every American must have the freedom to choose their plan and doctor – including the choice of a public insurance option

o Ensure quality care for all — All Americans must have quality and affordable health care

Some of us suckers are even out there working for Organizing For America getting signatures that say they support him on these three principals. The audacity to have us hitting the pavement for signatures and not stand behind us is too much to take.

Public Option was 33% of the only guidance he's put forth to Congress. If he craps out on us then he's dead politically. The GOP would love to get rid of him, and no true progressive is going to lift a finger to help him come 2012. Why would we help this guy if he turns out to be a horrible liar.

Thank you for clearly and accurately articulating the problem with Obama's wishy-washy spineless behavior lately. We have to keep him honest. He's getting corrupted and needs us to call him to the carpet.

Of course my biggest concern is that without a public option, this nation is dead. I firmly believe we have to have single payer, but at the very least public option was an acceptable compromise for the time being.

Wendell, I too grew up in East TN and am very familiar with the mentality there and in many other parts of America. Now I live in the NYC metropolitan area and have experienced that point of view as well.

The thing is, I do think a public option would unfairly compete against private healthcare companies. I'm not sure that is a bad thing, but I do think it is true.

I keep wondering where medicaid comes into this equation. Could we not simply create a sliding scale for people to buy "medicaid" coverage? Or would this basically be the same thing as a "public option." It just sounds to me like we are re-inventing the wheel here, adding yet another "option" when we already have public healthcare (medicare and medicaid.)

I am all for healthcare reform and getting everyone insured. We are all paying for the uninsured anyway either with high costs at the hospital which cover those who are not insured or taxes to subsidize public healthcare. I am just not sure we have not botched this attempt by rushing and caving in to too many special interests and crazy radio fanatics.

Thanks for speaking out and helping get things on the right track.

OK --- now we are making some sense!! Thank you. Medicare and Medicaid have
worked well so far and a sliding scale relevant to income, circumstances etc. is a good idea. Has anybody been denied care?? Not in our area that I know of-- the local hospital runs the clinic and good physicians are available.

Let's get back to basics --- the practice of medicine is supposed to be a service ----
and the problems started when the practice of medicine became a business!!

Corruption spreads like a virus.

Many reformers recognized roughly 30 percent of all health-care spending in the U.S. -some $700 billion a year- might be wasted on unnecessary tests and treatments, and payment reform could solve this problem. Is this claim an overstatement?

Provided the American people pay around double the amount of efficient systems, the result is still well below them, the ratio of waste might be estimated to far more than 50% in the U.S.

Let's be conservative regarding the ratio. If 10% of savings apply to the combined Medicare and Medicaid cost of $923.5bn per year, as of July, the savings of $923.5bn over the next decade are possible.

And when these savings add to the already allocated $583 billion, the savings of wastes involving so called "doughnut hole" , the unnecessary subsidies for insurers, abuse, exorbitant costs by the tragic ER visits etc, the concern over revenue might be a thing of the past.

As a matter of fact, with the promising redesign in the pipeline, some patient-focused clinics in 10 regions have already achieved 16% of savings in Medicare while their quality scores are well above average.

Please be sure to visit http://www.nytimes.com/2009/08/13/opinion/13gawande.html?hp for credible evidences !

Thankfully, the provisions in the reform include more expansive, systematic policies including 'a patient's outcome-based payment system' than they have. I for one firmly believe this American innovation, 'a patient's outcome-based payment system' , is capable of turning profit-oriented practices into patient-focused system / value.

Dr. Armadio at Mayo clinic says, "If we got rid of that stuff (waste), we save a third of all that we spend and that is 2.5 trillion dollars on health care. A third of that and that is 700 billion dollars a year. That covers a lot of uninsured people."

Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed info.

Thank You!

"waste increasingly big chunks of your premium dollars on nonessential things like exorbitant CEO salaries and profits for the big institutional investors who own them. A public plan would not waste your precious dollars that way".

Do you really believe that statement? Ok, maybe not waste it on CEO salaries and institutional investors, they will invent new and astonishing ways to waste our precious dollars..

I think a regulated exchange WITHOUT a public option is closer to a real-world solution.

...they will invent new and astonishing ways to waste our precious dollars.

Really? Such as...? Oh wait...they wouldn't be "new and astonishing" if you could think of them, would they?

Come on. That's the flimsiest last-ditch argument I've yet seen against the public option. We really do need the public option.

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