Call it the nightmare before Christmas or Santa’s lump of healthcare coal. Either title captures the disastrous qualities of the healthcare reform bill passed by Senate on Thursday. After months of media coverage, a summer of wild town hall meetings and all the high-sounding rhetoric one could swallow, a 2,000 page monster has been birthed.

Though President Barack Obama hailed the bill’s passage by declaring, “This will be the most important piece of social legislation since Social Security passed in the 1930s,” it carries few of the universal qualities or public control of the Social Security legislation. For all the political theater associated with the bill, remarkably little in the bigger picture of healthcare in America has changed - private health insurers still run the system, Washington politicians are still gathering in the campaign contributions and millions will still be left without health insurance.

 Bad Gets Worse in the Senate

The Senate bill is even weaker than the already comprised piece of legislation passed by the House of Representatives. The number of uninsured capable of gaining insurance will be somewhere around 24 million. With private plans as the alternative, estimates are that more than $450 billion in tax-payer money will be transferred to private insurers in order to allow the uninsured to gain coverage. However, that coverage will be something akin to the lowest form of car insurance – you get by before the eyes of the state, but get into an accident and you will find yourself facing massive debt. Estimates are that the low-coverage plans would only cover 60% of costs. Even worse news comes for the more than 20 million people who will likely remain uninsured. They will now also have to forfeit 2% of their annual income because of it. A nightmarish scenario indeed – uninsured and penalized!

Smaller parts of the bill also promise negative outcomes. Medicare plans are still being trimmed by $43 billion. Democrats claim it is fat-cutting through the elimination of tax-payer subsidies to private insurers. Seniors fear the long-term impact of the cuts will result in reduced services, especially for quality of life issues such as the ability to participate in exercise programs for free.
Reproductive rights also took a hit. While the Senate bill moves off the harsh language on abortion proposed by the Stupak amendment in the House bill, it still represents a serious reversal of reproductive rights on a national scale. If a female subscriber wishes to use her healthcare plan to pay for an abortion, she will have to pay into a separate fund connected to plan. Given the unexpectedness of most unwanted pregnancies, this measure practically eliminates the ability to use insurance to obtain an abortion. The Stupak amendment was defeated in words, but its content seems certain to return in practice.

 Finger-pointing Misses the Big Picture

Who is to blame for such a fiasco? Much progressive ink has been spilt in examining the days leading up the Christmas Eve coup. Joe Lieberman has been a particular target, and even Bernie Sanders has taken some grief for removing his single-payer amendment and, ultimately, voting yes on the bill. Yet this focus on the theatrics of the approval misses the larger structural dimensions of how this bill will become law. Sure, Lieberman converted his leverage as a fence-sitting Conservative into a further watering of bill and Sanders left the field without much of a fight, preferring a go-along-to-get-along approach in order to fight another day. Neither of these statements says much about how this bill came to be.

The real story of this bill is rooted in two moments. One came from the campaign trails of 2008, where massive sums of campaign contributions from health insurers and pharmaceutical companies tipped the balance of national and local elections throughout the country. Democrats drank deeply from this revenue stream and proved to be loyal servants to both the insurance industry and the pharmaceutical lobby. The contributions were targeted – committees that would be formulating the healthcare reform bill, such as the House Committee on Ways and Means, received an inordinate amount of funds. No wonder then, that when candidate Barack Obama declared a goal of “universal healthcare coverage,” little rebuttal was heard from the normally vocal insurance lobby. The fix was in and it was insured by some $2 million dollars in donations to his campaign.

Just to insure that things went well for the healthcare lobby, an army of lobbyists was mobilized at a critical juncture in May 2009. The lobby spent a reported $2.3 million a day peddling influence. Such a massive expenditure of political and financial resources insured that the perspectives of private insurers were represented at every committee meeting and in the offices of every elected representative. The lobby was also buffered by the efforts of the right-wing Heritage Foundation, which successfully exported their free-market notion that “insurance exchanges” could cure the ills of rising healthcare costs. Soon everyone – from Barack Obama to Harry Reid and even Howard Dean in his statement opposing the bill – was parroting this line. This, despite the fact that nearly sixty years of private control, through free-market policies, over healthcare has created a national emergency in the cost and access to care. So much for learning from history.

 Single-Payer: Union Hall or Lobby Day?

There was some resistance to this process as single-payer proponents did their best to fight the good fight. Massively outgunned in the realm of financial resources, they turned to a campaign of civil disobedience that bore witness to the sheer hypocrisy of the proceedings. Democracy was not in motion in the House committees that formulated the bills, and doctors, healthcare activists and victims of private insurers rallied to express their dissent. For their trouble, these activists received stinging rebukes from some of the very same politicians they had championed as friends. Not only Sanders, but Representative John Conyers, the author of the single-payer bill HR 676, voted in favor of the watered-down reform proposal. Both yielded to expediency and provided a useful lesson in how power politics work in Washington, where you are only as good as your next campaign contribution or legislative horse-trade.

In the end, the movement in support of single-payer was too thin – not able to mobilize large numbers or exercise any influence on a political process saturated with corporate funds. Single-payer activists will have to return to running broad educational campaigns with an eye toward developing a movement with solid roots in working communities throughout the country. They may pick up some new allies from a labor movement that recoiled from unfettered support of the Democrats once the terms of the Senate bill were released. Now wonder then that the bill was swiftly forced through – popular support was rapidly dwindling. In the end, a painful lesson may have been learned - only the ungovernability of the people in motion can win single-payer. To accomplish this, the church congregation, the dinner table and the union hall are more potent weapons than cultivating “friends” in the Senate or House.

 The Healthcare Scrooges

Like Scrooge before his revelation, the health insurance industry and their Democratic and Republican representatives have one-track minds – money, money, and money. Such a singular pursuit blinds one to the reality of the social suffering that the three ghosts introduced old Scrooge to.

A day may come, perhaps even sometime soon, when the millions of sufferers wake up from this nightmare in order to assert the only quality that no socio-economic system can strip them of – their humanity. Then we might not be willing to offer our healthcare Scrooges the chance to reform themselves. It will be right to the political grave for the private insurers and their political lackeys in order to insure that healthcare becomes the birth-right of all the people.

What a wonderful Christmas present that would be.

Billy Wharton