This diary is a very difficult one for me to write. As a recent convert to the Obama camp from the Edwards camp, a
decision I made out of practicality not out of an actual preference, I am particularly troubled by what I see as a weak and poorly defined healthcare plan.
It was not my desire to write a hit diary, especially for the only remaining candidate who I believe has a real
opportunity to bring a progressive agenda to the Whitehouse. However, my personal top issue is healthcare, so, for me,
no examination of the available candidates can leave that particular stone unturned.
Now that I have upturned that stone and begun examining in detail what scurries away, I feel it's my duty to report my
findings to the Dkos community below the jump.
One of the biggest problems with health insurance is not just it's cost, or it's availability, or even exclusions for pre-existing conditions. It's what it does not cover and the arbitrary way in which coverage decisions are made. With half of all bankruptcies in this country being the direct result of healthcare costs including costs incurred by supposedly insured Americans, it is surely this element that is the most pernicious.
To that end, I decided to do a little digging. In researching all three of the front running democratic candidates plans I have found Obama's plan to be the weakest. While he will make available the Federal Employees Health Benefits Program to all Americans, if one looks at the plans contained within that program you see the same crooked organizations that have been ripping off and murdering Americans by spreadsheet for years.
These companies, all of them, systematically refuse payment or refuse full payment for treatable conditions often in direct conflict with the decisions made by attending physicians. This leaves the "insured" at the mercy of bean counters who's only real interest is in saving money, not in providing care.
As we saw in the case of Nataline Sarkisiyan, there is litterally no limit to how far they are willing to go to withhold coverage for medically necessary treatment. Indeed, if the patient dies, so much the better, as they won't have to deal with any further medical expenses.
Obama's plan will be "similar" to the FEHB program and states that "The plan will cover all essential medical services, including preventive, maternity and mental health care." The problem here is that little word "essential". Who determines what is "essential"? Indeed this same word can be found throughout insurance company healthplan literature today. It represents no fundamental shift from the current corrupt system to anything better. All this plan does that is different is to force insurance companies to accept all comers.
Since these are the same vampiric for-profit insurance mega-coroporations that we have today, we don't have far to look to get an idea how they are likely to react. Indeed, it seems likely that it will be business as usual except that since they now have to accept everyone, they will have to find some way to withhold benefits even more than they do now to insure that their profits are not reduced by loads of new high-risk clientelle.
If past is at all prologue, it's a pretty safe bet that will come in the form of denial of coverage for "non-essential" services. If a plan like this is to work, then the power to make the decision about what is essential or not must not be left in the hands of the insurance companies. I don't see anything at all in Obama's plan that addresses this issue.
Clinton's plan, conversely would make a plan modelled after traditional medicare available to all, and Edwards would simply expand actual medicare itself to be available to all. Traditional medicare has the distinction of managing costs BETTER (pdf file) than private insurance and leaving the decisions as to what is essential service in the hands of attending physicians rather than in the hands of for-profit corporate beancounters.
Barack Obama needs to be challenged on the details of his plan, specifically as regards how "essential" treatment is determined and by whom. That little word could be the difference between real reform and business as usual.