A Step In the Right Direction

By Becky O'Malley
Thursday January 07, 2010 - 08:35:00 AM

To everyone who’s asked why there’s been nothing in this space for the past couple of weeks: right after finishing an editorial for the Dec. 17 paper I went off to Kaiser for what turned out to be, after some hours of discussion and a cat scan, an emergency appendectomy. This experience provided me with ample opportunity to appreciate the efficiency and skill of the current crop of Kaiser health care providers, and renewed my dedication to working to make sure that all Americans will eventually have access to this kind of care. It looks now like the Congress of the United States is poised to pass a long overdue step in the right direction.  

On Monday the U.S. Department of Health and Human Services announced with some fanfare that spending on health care in 2008 was up only 4.4 percent from the previous year. That seemed to some observers like an achievement, since the rate of growth in 2007 was 6 percent, and there was an average increase of 7 percent a year in the decade from 1998 to 2008. But the problem is that there was no decline in the cost of health services or of insurance—it’s just that in a bad economy a lot of people simply couldn’t afford to pay for what they needed, regardless of price. 

I shudder to think what I would have been charged for this emergency operation if I hadn’t been a (35-year) Kaiser member. The co-payments alone (doctor visits, labs, scans etc.) came close to $500, but without insurance the tab would surely have been in the tens of thousands. If I hadn’t been sure that most of my costs would be covered, I’d have been sorely tempted to delay getting medical care until the last possible moment. With appendicitis, that would have put me at risk of a burst appendix followed by much more severe, even life-threatening, infection.  

Many years ago I had an emergency operation with inadequate insurance—Caesarian section birth when the fine print on our graduate student’s insurance said that it only covered “normal” deliveries. I left the hospital with what seemed like an insurmountable debt for the operation and the six days in the hospital believed to be necessary in those days. We eventually managed to pay it all off, but it was difficult on a graduate student’s meager stipend, even though the total bill was just in the hundreds, not in the thousands. 

Now the Congress must settle down to the difficult task of producing a viable compromise between the House and Senate health care bills to help people in such situations. I have yet to find a reliable source for comparing the details of the two versions, and I suspect that even members of Congress are having difficulty with this task. It looks like formal public reconciling will be bypassed in favor of miscellaneous negotiations at the committee level. This annoys open government advocates, but it might actually lead to improvements in the low-level details if smart progressive staffers are on their toes. 

This doesn’t stem the tide of robot letter-writing campaigns from diligent left-leaning groups which are flooding e-mail boxes, both this paper’s opinion mailbox and personal boxes, with denunciations of the process. Many e-mails invoke the language of betrayal and deceit, implying that President Obama’s seeming inability to Deliver It All Now verges on criminal negligence. This is yet another manifestation of a problem I’ve seen throughout my long interest and involvement in politics: Our Side Just Can’t Count. As I was saying before I was rudely interrupted: Lieberman, Lieberman, Lieberman! 

It’s probably unfair to blame one egregious jerk for the inadequacies of the whole political system, of course. The fact that Senate acceptance of this less-than-perfect compromise hinges on one vote from a guy who swings both ways does not excuse a system which gives a relatively small number of people in Nebraska just as many votes in the Senate as all of us in California get. Even worse, the election to replace Teddy Kennedy is Jan. 19, and if enough progressives were to sulk that one out the Massachusetts vote might be lost too. 

As long as the Senate has the power to hold up the show, it’s just not realistic to expect that the high profile contested topics will make the cut on this round. Nothing precludes the possibility of passing better versions of the health care bill in future congresses if progressives hop to it and get some better senators elected next year.  

It’s a more familiar posture for people like us, sadly, to kvetch, kvetch, kvetch, a habit which started way back with Lyndon Johnson’s offenses against good taste and developed legs during the Reagan, Nixon and Bush regimes, but we should resist the temptation. A much more productive tactic would be to look for and praise the several victories which the current health care legislation represents, and to seek voter support to strengthen the congressional majorities in the next election.  

Highlights of what’s on the table now: 30 million more people get some kind of health care; financial advantage goes to the poorest people; “pre-existing condition” tricks used by insurance companies to exclude many from coverage are banned. Left for later: a whole laundry list of things, notably single-payer, abortion coverage, better cost control of insurers and the public option. For a more complete scorecard, check out what Paul Krugman and Robert Reich and Frank Rich and Brad DeLong and the Daily Kos correspondents have to say on the web, but none of these has so far predicted the final deal. 

Berkeley’s own Professor Reich did himself knock the president for invoking a version of an old Silicon Valley cliché, “the best is the enemy of the good.” But clichés take hold because they resonate with a lot of people. In my experience marketing leading-edge technology development, I learned that no software would ever have gotten into the hands of end users if the programmers’ desire to make just a few more improvements before product release had been honored. It’s instructive to think of this legislation as being much like a new software product: Call it Release 1.0. There’s every reason to hope that 2.0 and 3.0 can be better, and that perhaps by the time we get to Release 5.0 we might actually have a system that does what we want it to. Another apropos cliché: the journey of a thousand miles begins with a single step.