In Praise of Dennis Kucinich

Thank God for Democratic Congressman Dennis Kucinich.

The plain speaking former Presidential candidate from Cleveland was the only proponent of health care reform to vote against Nancy Pelosi's Heath Industry Profit Assurance Act  (or as it is officially but misleadingly named, the "Affordable Health Care for America Act").  Amid the orgy of Democratic self-congratulation that followed the passage of this bill, which squeaked by with a majority of only five votes,  Kucinich issued a statement explaining why he had voted against it.  Other Democrats, especially those who profess to belong to the “liberal” or “progressive” wing of the party, would do well to read it.  So too would Barack Obama, whose abject failure to provide leadership on health care reform, and whose willingness to cut back-room deals with health industry lobbyists, in large measure explain why the House bill falls so far short of the expectations the President himself created by his overblown campaign rhetoric

The bill seeks to reduce the number of uninsured through two means - by expanding Medicaid, the government health insurance program for the poorest Americans, and through the creation of a "health insurance exchange" in which individuals without employer-provided health insurance would be able, indeed required,  to purchase coverage.  The bill would create a self-funding public health insurance plan, the so-called "public option", which would participate in the exchange.  Low and moderate income families buying insurance in the exchange would be entitled to "affordability credits" to subsidize the premium cost.

Many voters, who haven't had the time or inclination to wade through the bill's 1,990 pages, could be forgiven for assuming that this much-heralded public option is the "Medicare for All" solution that many reform proponents have been advocating.  Unfortunately it's nothing of the kind.  Anyone eligible for employer-provided insurance would be ineligible to participate and employees won't have the right to "trade in" their employee coverage for the public plan. Health care providers participating in the public option would be paid negotiated rates, rather than the prevailing Medicare tariff, meaning that the cost of the public option - and therefore premiums - will be higher than under a "Medicare for All" approach.  To its credit, the Pelosi bill would permit the government to negotiate lower prices for drugs. However, this runs counter to the deal Obama cut with the drug companies in return for their promise of support, and Big Pharma is already promising to throw all of its considerable weight against the bill if the House doesn't join the Senate Finance Committee in following the White House marching orders.  The Senate version is likely to prevail in the final bill, further increasing the cost of the public option.

The Congressional Budget Office estimates that Pelosi's public option will in effect become a residual plan for the highest risk individuals, with the consequence that the premiums it charges will actually be higher than the private-sector health insurance companies, even though its administrative costs will be much lower.

Clearly the insurance companies would prefer not to have a public option, but with or without it they stand to make out through the millions of additional policies they will write.   Most employers will be required by law to provide insurance, and all individuals who don't receive employer-provided benefits and don't qualify for Medicare/Medicaid will be required to buy it for themselves.  If they don't, the Obama Adminisration will fine them.  The Congressional Budget Office estimates that the proposed insurance exchange will attract 30 million customers, with only 6 million enrolling in the public option; that's 24 million new customers for the insurance companies.

There are other problems.  According to the CBO the bill would reduce the Federal deficit.  However opponents, including many state governors, point out that the expansion of Medicaid, which is funded partly by the states and partly by the Federal government, will impose an additional financial burden on states already struggling to balance their budgets.  Unfunded mandates are a convenient way for Congress, which for years has lacked the collective backbone to raise enough in taxes to pay for the services the Federal government provides, to pass the buck on healthcare costs.  State governors are right to be unhappy. If Congress believes that the Federal government has an obligation to provide universal health care, it should pick up the tab.

And it gets worse.  Only after the House bill was passed did it become widely known that one of the prices Pelosi had paid to buy the votes of conservative "Democrats" was the so-called "Stupak amendment".  This provision, included at the behest of the U.S. Conference of Catholic Bishops and its Congressional mouthpiece, Rep Bart Stupak, would effectively prohibit any insurance plan that participates in the insurance exchange from offering abortion services.  This restriction goes far beyond existing law, which already prohibits direct Federal funding of abortion services, because it would apply to private insurance plans in which the individual policyholder pays all of the premium.  This amendment, arguably the most significant abridgment of women's reproductive rights in recent years, may well prove the downfall of the bill.  Womens's groups will certainly mobilize against it, while the bishops have threatened to do all in their power to block health care reform if the Stupak amendment does not survive - an extraordinarily arrogant affront to the separation of church and state and and an acknowledgment that the Church's support for the "right to life" does not extend to the estimated 46,000 Americans who die each year because they lack adequate health insurance.

The Stupak Amendment aside, the fundamental problem is that the House bill, together with its equally unsatisfactory Senate counterpart, will preserve and indeed strengthen the very worst aspect of the current system, creating a Gordian knot of mandates and tax subsidies binding together employment and  health care insurance.  It will also increase reliance on a for-profit system in which the primary obligation of those who provide and fund health care is to their shareholders, not their patients.  To quote Congressman Kucinich: 

“We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care.  We cannot fault the insurance companies for being what they are.  But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem."

The fact that health industry lobbyists have even had a seat at the table reflects a belief by many of those we elect to represent us - including Barack Obama - that they an equal or greater obligation to the health insurance industry.  As previously predicted in these pages, Obama's much vaunted skills of persuasion will be dedicated not to "knocking heads together" on Capitol Hill in order to get a better bill (as Rep. John Conyers recently urged) but to convincing the American public that the existing bill is something it is not - genuine health care reform.  I think this time he's underestimating the intelligence of the electorate and exhausting the patience of many of those who supported him.

So what is a good Congressional Democrat to do when the final bill comes up for a vote?  Vote yes, on the basis that something is better than nothing, or vote no and hold out for real reform.  After reading the House bill, I am coming to the conclusion that the latter may be the better option.  Accepting this bill will likely kill any chance of real reform for a generation.  If it passes, Barack Obama, Harry Reid and Nancy Pelosi will cynically declare victory and move on to other less challenging issues.  But the Democrats' willingness to accept a deal dictated in good measure by health industry lobbyists (and, if the Stupak amendment prevails, by the Conference of Catholic Bishops) will disenchant the progressive base that turned out in large numbers in the 2008 election, thereby virtually assuring a low Democratic voter turnout, and big Republican gains, in next year's mid-term elections.

If Democrats do vote for a watered-down reform bill, they should visibly hold their collective noses while they do so.  They should make clear that, to paraphrase Winston Churchill, this vote is not the end of the end in the battle for health care reform, or even the beginning of the end, but merely the end of the beginning.  Regardless whether the bill becomes law, Democrats must contest the next election on a platform of a single payer or "Medicare For All" solution.  The so-called "bluedogs" in the party, many of whom have resolutely opposed any form of health care reform, need to decide which side of the aisle they really want to sit on.  If they are not wiling to support the program on which Barack Obama was elected,  they shouldn't get a penny in campaign funding from the DNC, and the party should actively seek out progressives to run against them in primaries; the same should be true for Barack Obama himself, whose credentials as an agent of change look more suspect with each week that passes.

On a more immediate note, the sanctimonious Joe Lieberman, who has already announced he will collaborate with Republicans in attempting to ensure that the bill doesn't even come to a vote on the Senate floor if his paymasters in the insurance industry don't like it, should be stripped of his committee chairmanship and expelled from the Democratic caucus.   The "big tent" theory is all well and good, but it is no substitute for a party that actually believes in something, and has the will and ability to keep its promises to the voters.   In short, the Democrats need fewer time-serving bought-and-paid-for political hacks like "Traitor Joe" Lieberman and more honest mean and women like Dennis Kucinich.

Kucinich is the type of politician the right-wing windbags at Fox News et al love to hate.  He is an old-fashioned Liberal and isn't ashamed to admit it.  His policy position are driven by principle, not expediency.  He isn't afraid to answer tough questions, and he answers them  directly.  You don't have to peel away layers of nuance and double talk to figure out where he really stands on the issues.  Unlike his pompous and self-promoting House colleague Alan Grayson (the self-styled "Congressman with guts"), Kucinich doesn't descend to Republican-style attack politics to make his point on health care.  And unlike Barack Obama, he unerstands that the best way to counter the likes of Fox News is not to boycott them but to take them  on head-to-head.   Unfortunately Dennis Kucinich is unlikely ever to win the Democratic nomination - we have seen repeatedly that the hollow traits of "charisma" and "pragmatism" invariably trump brains and conviction, and that rhetoric beats outsubstance every time.  However, I hope he keeps trying.  He reminds people of the values that the Democratic party supposedly stands for.  Unfortunately there aren't too many others that do.