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THE UNFULFILLED PROMISE
Posted by Time for change in General Discussion (1/22-2007 thru 12/14/2010)
Mon Sep 14th 2009, 10:01 PM
Providing a windfall for the private insurance industry through a mandate to purchase private health insurance is bad enough. Added to that is the possibility that working and middle class Americans will bear the brunt of the cost, and worse, that th
I see three major potential problems with mandated health insurance. But before I get into those potential problems I first feel the need to talk about what is NOT wrong with mandated health insurance.

Simply put, I see nothing wrong with mandated health insurance in principle. In principle, a government mandate that people buy into a program is very similar to a government tax. Our local, state and federal taxes go towards paying for public schools, safe drinking water, Medicare and Medicaid, public roads, and myriad other things. Our taxes pay for these things whether or not we have children attending public schools, whether we use public drinking water, or whether or not we are enrolled in Medicare or Medicaid.

Yet progressives rarely complain about these things. We recognize that certain government services are necessary to the well-being of our communities and our country, and we rarely complain about the principle of being taxed to pay for them. Republicans whine about it as if government taxes are the work of the devil himself. But we rarely do.

In principle there is a very good reason to have a government mandate (or government tax) to help pay for health care. It is the same reason that we pay taxes for all the other things that we pay taxes for. Paul Krugman explained it as well as anyone I’ve heard during the 2007-8 primary season, when he criticized the Obama health insurance plan for not including a mandate, unlike the Edwards and Clinton plans, which did include a mandate:

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.

And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else. Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance – then sign up for it if they developed health problems later… As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.

There has been a lot of criticism on DU lately about President Obama’s recent words in favor of mandated health insurance. I see a lot to criticize about his plan. And indeed (as I discuss below), the decision to make health insurance mandatory could be very problematic – depending upon the details. But I get the sense that much of the criticism of health insurance mandates on DU is directed at the very principle of a mandate. I think that’s wrong, and it echoes Republican talking points. That concerns me because echoing Republican talking points will serve their purpose, not ours, will support them and divide us in our efforts to create a meaningful plan for universal health insurance.


PROBLEMS WITH MANDATED HEALTH INSURANCE

Although there is nothing wrong with government-mandated programs as a general principle, in practice there can be a lot wrong with them. Issues to consider in assessing the appropriateness of a government mandate include the value of the program to the American people and who has to bear the burden of its costs. With these issues in mind, I believe that there are some serious problems or potential problems associated with the pending health care legislation:


Inability of some people to pay for mandated health insurance

Some DUers have expressed the concern that mandated health insurance will prove to be unaffordable to them. Our economy is in a precarious state. There are many millions of Americans who live in poverty or on the brink of poverty. A requirement to spend money every month on health insurance could push them over the edge.

This is a legitimate concern. But we should keep in mind that it is a concern about a potential problem, not necessarily an actual problem.

President Obama said that subsidies will be provided to those who cannot afford health insurance. That’s great. But the question we need to ask is: How much subsidy? It is certainly possible that the subsidies will be sufficient to cover the whole cost of health insurance for all Americans who would otherwise have trouble paying for them. We simply don’t know at this point.

Paul Krugman discussed this issue during the primary season, in the form of combating Republican criticisms of health insurance mandates:

The second false claim is that people won’t be able to afford the insurance they’re required to have – a claim usually supported with data about how expensive insurance is. But all the Democratic plans include subsidies to lower-income families to help them pay for insurance, plus a promise to increase the subsidies if they prove insufficient.

If mandating health insurance proves to be a burden for Americans who cannot comfortably afford it, that will constitute a serious problem. In fact, that will not be acceptable. The major purpose of universal health care is to provide comfort and health to those who are currently on the brink of financial disaster. If the program turns out to make things worse rather than better for them, it should be categorically rejected.


Potentially unfair distribution of the burden of supporting the program

I said above that a mandated government program is similar in principle to a government tax. Then why not accomplish the same thing through taxation? Wouldn’t that be a lot simpler?

Yes indeed, it would be simpler. So perhaps we should be asking why the program should be accomplished by mandating that people buy into the plan, while offsetting the burden on them through government subsidies, rather than through a system of progressive taxation.

I can’t answer that question. Perhaps it has something to do with the fact that presidential candidate Obama promised that he would not raise taxes on anyone who makes under $250,000 annually. If his health care program is paid for through people buying into mandated health insurance programs rather than through taxation, that could allow him to technically claim that he has not raised taxes on those who make under $250,000.

If that is the purpose of mandating health insurance rather than paying for it through progressive taxation, then it is a dishonest ploy. We should not accept that, and we should call President Obama (and our elected representatives who support such a plan) out on that. We should hold him accountable for his campaign promises unless he can show damn good reasons for backing out of them. After all, isn’t it well past time time that the Bush tax cuts for the wealthy be reversed? Barack Obama did promise us that when he ran for president.

Of course we don’t know at this point in time whether or not the plan that Obama has in mind, or the plan that will be passed by Congress, will in fact constitute a tax on people making under $250,000. It could be that the government subsidies that President Obama has promised will offset the financial burden on those people to the extent that it can be argued that the government mandate will not cost them anything and therefore will not constitute a tax. We just don’t know at this time.


Subsidization of private, for-profit health insurance companies

Under Obama’s original health care plan – the one he ran on during the primary season – a public option for government sponsored health care would be offered to ALL Americans. Given all the extraneous costs that private for-profit health insurance plans entail, there is every reason to believe that, over time, the vast majority of Americans would opt for the public option over private health insurance.

Some argued that even if a public option was available to all Americans, such a plan would nevertheless constitute a government subsidy to the private health insurance industry. Those people argued that under such a plan, some currently uninsured people would use their government subsidies to purchase private health insurance. That is undoubtedly true. But I felt that it would nevertheless be misleading to say that such a plan constituted subsidization of the health insurance industry, since the competition provided by the public option would drain far more profits from the health insurance industry than they would gain from the few currently uninsured people who decided to use their government subsidies to purchase private health insurance. Indeed, that is why the health insurance industry is so adamantly against a public option for all Americans.

But in President Obama’s speech to Congress last week, he seemed to be backing away from his original plan BIG TIME:

An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Oh great! We go from a public option offered to everyone to an estimate that only 5% of Americans would sign up. Those of us who currently purchase private health insurance are penalized by making us ineligible for the public option plan. I’d like to know why. And why is it that only 5% of Americans would sign up? Is it because the public option plan would be so weak that it wouldn’t be able to compete successfully with private insurance plans? Would it be because the vast majority of Americans would be ineligible for it? We don’t know yet, because we don’t have enough details on it.

With a mandate to buy health insurance, and only 5% of Americans using the public option to satisfy their mandate, that means that the good majority of other Americans would be purchasing their health insurance from private for-profit companies. And what kind of competition would be provided by a program that involved only 5% of Americans? It seems to me that this would be a great boon to the insurance industry. It is theoretically possible that government regulation of the insurance industry could offset the additional money flowing into their coffers by virtue of the mandate that all Americans purchase health insurance. But how likely is that?


Conclusion

All in all, I’m disappointed in where we stand now with the possibilities for health care reform. President Obama has gone from a government sponsored health insurance option available to all Americans to one that most Americans are ineligible for, and which only 5% are expected to use. With that, the private insurance industry stands to be rewarded with massive government subsidies via consumers who are mandated to purchase private health insurance.

And what for? Clearly, President Obama feels the need to do everything he can to stifle opposition to his plan from the right. Saying “We believe that less than 5 percent of Americans would sign up (for the public option)” is a major part of his efforts to do that.

But was it really necessary to go that far? The right wing criticism of the public option plan has been hypocritical and phony to the core. It cannot possibly result in the things that they say it will. It involves no death panels, and health care is already extremely rationed in our country by private health insurance companies. The whole campaign against the public option has been a cynical attempt by the health insurance industry and their lackey politicians to maintain their currently obscene profit margins -- at the expense of the health of the American people.

A strong public option to compete with the health insurance industry was our best chance to provide all Americans with decent health care. Rather than dismantle it in response to right wing pressure, why not make a determined effort to explain to the American people why it is their best choice?

Providing a windfall for the private insurance industry through a mandate to purchase private health insurance is bad enough. Added to that is the possibility that working and middle class Americans will bear the brunt of the cost, and worse, that those at the lower end of the income scale will not be able to bear the costs without pushing them over the edge into financial collapse. We don’t know that this will happen. We don’t yet have enough details on the specifics of the plan that will eventually emerge. But we can be sure of one thing – The private health insurance industry will be working very hard to see that as much of the cost as possible will be borne by those least able to afford it.
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The Unfulfilled Promise
The Unfulfilled Promise of the American Dream: The Widening Gap between the Reality of the United States and its Highest Ideals




Time for change


Notwithstanding the lofty sentiments and purpose of the U.S. Declaration of Independence, the reality of the United States of America did not then – and never has – lived up to its ideal. Our nation remains today a long way from fulfilling the promise implied by those ideals. Yet, our Declaration was a great start, and it has long shone as a beacon of hope for people all over the world.

Throughout our history, while many have striven to close the gap between our highest ideals and the reality of our nation, others have focused on the accumulation of private wealth and power, at the expense of everyone else. In recent decades the latter have gained much ground, leading to increasing imperialism abroad and deteriorating democracy at home, characterized by routine (and legal) bribery of our public officials, the fusion of government and private corporate interests (corporatocracy), a corrupt election system largely in the hands of private corporations, a corporate controlled communications media, and the widespread acceptance of Executive Branch secrecy, routinely justified with little if any questioning, by the magic words “national security”. All of this is rapidly turning our country from the democracy proclaimed at our founding into a plutocracy (government by the wealthy and for the wealthy). The result is the most obscene wealth gap our country has ever known, the highest imprisonment rate in the world, rampant militarism, routine flaunting of international law, the least efficient health care system in the developed world, a pending environmental catastrophe that threatens to destroy the life sustaining forces of our planet, and myriad other problems that threaten to destroy our nation and tyrannize our people.

My new book, The Unfulfilled Promise of the American Dream – The Widening Gap between the Reality of the United States and its Highest Ideals, explores the roots and consequences of the demise of our democracy, and why most Americans have been unable to understand this process or even become aware of it. A good understanding of why and how we have deviated so greatly from the ideals of our nation is the first and necessary step towards getting back on the right track and revitalizing our society.

The book is currently being sold in electronic PDF format and can be purchased at http://www.unfulfilledpromise.com/Buy-the-... for $3.99. It will also soon be available in Amazon Kindle format. DU members who cannot afford to buy the book but would like to read it can pm me with your e-mail address, and I will send you a free PDF copy.

I’ve previously posted on DU a slightly earlier version of the introduction to the book, which is also posted at my site. Here is the Table of Contents, followed by a brief description of the three parts of the book:


TABLE OF CONTENTS

Introduction
Acknowledgements
Prologue – What is Wrong with the United States of America?

Part I – Root Causes of the Impending Demise of American Democracy
Chapter 1 – Legalized Bribery
Chapter 2 – Human Psychological Factors
Chapter 3 – Corporatocracy
Chapter 4 – Corporate Control of Media
Chapter 5 – Corrupt Election System
Chapter 6 – Government Secrecy
Chapter 7 – American Exceptionalism

Part II – A Sampling of Imperialist Actions
Chapter 8 – Slavery and its Legacy
Chapter 9 – Early U.S. Imperialism
Chapter 10 – U.S. Imperialism in Cold War
Chapter 11 – Iraq War and Occupation
Chapter 12 – Afghanistan War

Part III – Consequences
Chapter 13 – Election of George W. Bush
Chapter 14 – War and Imperialism
Chapter 15 – Class Warfare
Chapter 16 – Predator Financial Class
Chapter 17 – Shock Therapy
Chapter 18 – Contempt for Int. Law
Chapter 19 – The “War on Drugs”
Chapter 20 – Climate Change
Chapter 21 – “War on Terror”
Chapter 22 – Health Care
Chapter 23 – Unaccountable government
Chapter 24 – Response to 9/11 Attacks
Epilogue


PART I – Root Causes of the Impending Demise of American Democracy

It is somewhat difficult to separate the causes of our problems from their consequences, since they combine to form a long chain of cause leading to consequence, leading to more consequences, etcetera. Nevertheless, it seems worth while to identify the root causes of our problems, those that occur early in the chain and lead to so many of the tragic consequences we see today. The only chance we have of reversing the demise of our democracy is through addressing and attacking its root causes.

At the top of the list is the systematic bribery of public officials by the powerful corporations (Chapter 1) whom our government is charged with regulating in the public interest. Instead of calling it bribery, we call it “campaign contributions”, but what we call it isn’t as important as what it is. It is hard to fathom how democracy can survive when such a practice is legal and condoned.

Working in tandem with our system of legalized bribery is the nature of the people who inhabit our country. That is not to say that Americans are inherently substantially different than any other people. Human beings are imperfect, and that is probably a major reason why in a world where civilization began more than five millennia ago, the oldest written national framework of government in the world today – the Constitution of the United States of America – is only a little more than two and a quarter centuries old. Chapter 2 explores the roles of basic human needs, authoritarianism, psychological defense mechanisms used to prevent us from perceiving reality as it is rather than as we’d like it to be, and corrupted ideologies in causing us to passively accept the accumulation of power in the hands of ambitious and ruthless individuals who care about little else than expanding their own wealth and power.

When bribery of public officials is tolerated as an inevitable aspect of public life, government inevitably grows close to the wealthy interests that shower it with money in return for legislative and other favors. A malevolent symbiosis grows between the state and corporate power, resulting in rule by an oligarchy that is highly detrimental to the lives of ordinary people (Chapter 3). Using their accumulated wealth and power to manipulate our legislative process, the oligarchy grabs for more and more control of the communications media (Chapter 4) that are used to control the information available to and shape the attitudes of our nation’s people, in pursuit of their own narrow interests.

Since the 1980s an orchestrated campaign has been underway to demonize “big government”, thereby paving the way for private corporate control over more and more functions that were previously deemed intrinsic functions of government. Among those functions is the running of public elections (Chapter 5) – the function that symbolizes democracy perhaps more than any other single function. Consequently, the purging of selected registered voters from our computerized voter rolls has become a routine recurring event throughout much of our country, and without a doubt determined the results of the 2000 – and probably 2004 as well – presidential election. Just as bad, more and more of the counting of votes in our public elections have been turned over to private corporations, which count our votes using electronic machines using secret software to produce vote counts that cannot be verified by anyone.

Bribery, the fusion of government and private interest, fake and biased news, and corrupt elections are not things that government and its corporate allies want us to know about. Consequently, they construct walls of secrecy (Chapter 6) to keep us from obtaining information that sheds light on their activities. The perfect phrase for facilitating this is “national security”. When our government tells us that the “national security” requires that certain things be kept secret from us, the understanding is that to question such a pronouncement is unpatriotic, and to actually attempt to obtain the “secret” information may be treasonous.

But indefinitely maintaining secrets from the American people can be very difficult, because at least some people want to know what their government is up to. So in addition to the formal mechanisms of secrecy, informal mechanisms are constructed (Chapter 7) to keep vital information away from us. One of the primary methods for doing this is to make certain sensitive subjects taboo – that is, to create the widespread belief that discussion of these topics is so outside the bounds of acceptable human discourse that anyone who discusses them should be shunned by society, or worse. The most common issue that falls into this category is any discussion that sheds light on the disparity between American ideals and the reality of life in our country today.


PART II – A Sampling of Imperialist Actions in U.S. History

Notwithstanding the fact that our founding document says that “all men are created equal” and speaks of the inalienable rights of humankind, the United States has throughout its history partaken of massive exploitation of other peoples.

It is estimated that at the time of our birth, 18% of our population was black slaves. In our expansion westwards during the late 18th and 19th centuries, we decimated the original inhabitants of our continent, and often treated them with great cruelty. In 1846 we manufactured an excuse for war with our neighbor Mexico, in which we continued to expand our country westwards and southwards. In 1893 we began our overseas imperialism with the conquest of Hawaii. Our overseas expansion was greatly accelerated in 1898 with our participation in the Spanish-American War, which led to our conquest of Cuba, Puerto Rico, and the Philippines. With our arrival at world superpower status at the end of World War II, we began the Cold War, which led to and served as a rationalization for covert and/or direct military actions against myriad foreign nations over the next 46 years. With the September 11, 2001 attacks on our country, we declared a perpetual “War on Terror”, which served and continues to serve as an excuse to invade and occupy Iraq and Afghanistan, nations that posed no threat to us. We do not know when or if this perpetual war will ever end. We don’t know how many additional imperial conquests it will lead to.

Most Americans don’t think much about all this. Many of these actions are done in secrecy, and the American people don’t find out about them until many years later – or we never find out about them at all. Those that we do know about are spun into the most favorable light, to make them seem benign or even noble.

But these actions come at great costs: in the lives of our soldiers; in the ruined lives of the peoples of the victim countries; in trillions of dollars cost to our people and their future generations; in our international reputation; in anti-American hatred leading to terrorism; and, to our democracy itself. For how can a nation claim to believe in the inalienable rights of humankind specified in its founding document, while making a mockery of that belief in the way it treats other peoples? For that reason alone it is worth while to take a brief look at our long history of imperialist actions.


PART III – Consequences

In the Prologue I give a brief account of what I see as some of the worst and tragic consequences of the root causes that I discuss in Part I – to enable the reader to see where this book is heading. When elections of our public officials are for sale to the highest bidder… when our public officials are so addicted to the “campaign contributions” of their wealthiest constituents that they develop a symbiotic relationship with them… when our communications media are owned and controlled by an oligarchy of wealthy elites… when our citizenry lack the ability to differentiate propaganda from reality… when we allow machines provided by private corporations to count our votes using secret electronic software… then we should expect that the consequences will not be pretty or comfortable for the vast majority of our citizens.

In Part III, I explore those consequences in much greater detail, in the hope that the reader will agree with me that these are very serious problems, and that they must be successfully addressed if our country is ever to fulfill the promise of its ideals, or even make progress in that direction. When enough Americans recognize our problems as problems, stripped of the gloss and spin put on them by our oligarchy, they will rise up and do something about them. Until then there will be no progress, and we are very likely to head in the direction of all the former empires of our planet, ending in chaos, widespread catastrophe, suffering, and ignominy.

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