State of the Union

President Obama's recent capitulation on health care reform puts him in good company. For the better part of a century, illustrious heads of state from Theodore Roosevelt through Harry Truman, Lyndon Johnson, and Bill Clinton have tried and failed to create a comprehensive national system of health insurance. Many of these Presidents had party-aligned Congressional majorities, and still couldn't make it stick.

What is so unique about the United States that makes it the only industrialized nation in the free world (other than Switzerland, which has a blended system) to hang on to its privatized health insurance system? Some of it rests on Americans' - or at least their representatives' - pride and insistence on clinging to their free enterprise traditions, which, at least until the great Wall Street induced crash of '08, served them pretty well.

But surely there are other forces at work to have created such a persistent outlier, for so long. Could it be that those who have had the power to enact change, the legislators in the two houses of Congress, have had competing interests from those of the public (and their nominally-elected President)? Perhaps it's no accident that two of the most profitable industries in America - the pharmaceutical and health insurance industries, plus the organization that represents the highest paid group of individual earners in the United States - doctors - also just happen to be among the three largest spenders of lobby funds directed toward elected officials.

Cynical? Tell that to Billy Tauzin, who as the previous chairman of the House committee that regulates the pharmaceutical industry, passionately (and successfully) fought to deny passage of a bill that would have permitted the federal government to negotiate lower drug prices for Medicaid recipients. As a consequence, prices paid by insurers, and eventually the taxpayer, are considerably higher under federal-state Medicaid programs serving the poor—which also generate hundreds of millions of additional dollars each year for the large drug companies. Mr. Tauzin, who at the time argued that his actions were motivated purely by his fervent belief that the bill did not serve the public interest, was rewarded for his efforts by a grateful pharmaceutical industry shortly after he retired his seat in Congress with the chairmanship of their largest lobby group, which pays him an annual salary in excess of two million dollars per year!

Surely Mr. Tauzin was the exception to the rule? We should be so lucky. Lobbyists representing private insurance companies, hospitals, and the pharmaceutical industry spent over 380 million dollars in the last few months leading up to the combined Congressional vote on the new health care bill. Much of that money went directly into the pockets of those in the most influential positions: $1.5 million went to the Chairman of the Senate committee drafting the law, and other members of the committee received hundreds of thousands of dollars each. While it's true that this money was paid into the campaign accounts of these legislators, not directly into their personal accounts, how do you think these elected officials get re-elected so often? No wonder the House/Senate compromise bills were watered down so much - and eventually had the 'public option' pulled altogether. (What I still don't understand is why President Obama didn't honor his commitment to have these deliberations televised live, so that we could witness the behind-the-scenes scheming straight-up. Perhaps if he had, the legislators would have been less inclined to sell out to corporate interests. We’re still waiting for an explanation on that one, Mr. President.)

Unfortunately, the recent Supreme Court ruling abolishing limits on campaign contributions from public companies will only escalate this malfeasance. In fact, it's sometimes hard to imagine the United States as a legitimate democracy, where the vote of the citizen ultimately rules the land. Those individual votes may still determine who gets elected , but they sure don’t have much chance of influencing meaningful 'change' on a legislative level - apparently narrow corporate interests continue to rule the day there.

So for now, America is stuck in the mud, with little ability to adapt and move forward with the times. Let's hope this disease doesn't extend to some of the other critical issues of the day, like energy, jobs, and environmental policy; otherwise, the country risks becoming increasingly marginalized, an economic and demographic backwater, (ironically) overtaken by its more nimble competitors like Communist China.

God Bless America - they're gonna need all the help they can get.


[Next up: The implications for the future of the U.S. healthcare system, and for the doctor-patient relationship.]