Forget about rolling back the ’60s. The story in Washington this week is rolling back the ’30s. The right-wing’s 65-year-old war against the New Deal — old enough to collect Social Security itself — has finally begun to pay off.

Medicare, of course, wasn’t enacted until 1965, but unlike other landmark ’60s legislation — the Civil Rights Act, the War on Poverty, the anti-discrimination act in housing — it had its roots in the ’30s. Franklin Roosevelt thought about including national health insurance in the Social Security Act in 1935, then decided against it. But public funding of health insurance has been an idea in play since then, and under Lyndon Johnson it became a reality for American seniors.

Now, it’s been placed in an utterly gratuitous jeopardy by the Medicare bill moving through the Senate as I write. The Senate has already invoked cloture on what is now a stillborn filibuster, so that the bill’s passage was assured before the Senate went home midweek — an adjournment which may be just about the only recent political event for which the nation can truly give thanks on Thursday.

The bill was always a shotgun wedding between a solution to a real problem (the inability of many seniors to meet the mounting costs of prescription drugs, which Medicare has never covered) and an ideological imperative of the far right (a zealous desire to replace social insurance with a market of for-profit HMOs). The result is a bill that provides only a partial solution to the first problem — a senior will have to pay $3,600 out of the first $5,100 he or she annually pays for prescription drugs before the government starts picking up the tab. As to the second goal, the bill moves heaven and earth and billions of dollars into the HMOs’ coffers to entice those HMOs into the seniors’ market and give them a competitive advantage over Medicare.

The bill, of course, could fully fund the drug benefit were it not for the multitrillion-dollar Bush tax cuts. But these cuts are the holy-of-holies in Bushland, where the first commandment is always to reward the rich with more riches, and the second is that no other national purpose, no matter how urgent — including Bush’s own war — can be undertaken at the expense of the first.

It’s in helping the HMOs, however, that the bill fully becomes a travesty. For all but the right-wing zealots, who have wanted to repeal Medicare because they are opposed to any social insurance, the case for Medicare reform has been that the system will become insolvent over the next several decades as people live longer and the cost of drugs and medical procedures continue to rise. Getting HMOs into the system would supposedly check that rise in prices.

But the bill about to be enacted actively prevents anything that could check the rise in costs while still doing everything it can to help HMOs. For one thing, the bill guarantees that no HMO will be paid less per patient than what Medicare pays for a patient in traditional fee-for-service medical care. Even worse, it expressly forbids Medicare from bargaining with drug companies to bring down the cost of their prescription medicines. The reason that Canadians pay a small fraction of what American seniors pay for drugs is that the government there is the bargaining agent for the public. Here, that task will be entrusted to whichever HMOs enter the senior market, and the HMOs’ record of bringing prices down is in no instance even comparable to the record of governments. Hence, the bill ensures the continuance of mega-profits for drug companies, the continuance of seniors’ struggle to afford prescriptions, and a longtime threat to the solvency of the system.

The bill, then, completely negates the whole cost-saving raison d’être for HMOs. Worse yet, it offers them $12 billion in public funds so that they can provide lower costs than Medicare when they are permitted to go into business in six major cities in 2010. It also offers America’s employers a cool $86 billion so that they can continue to pay for their retirees’ health costs — a contractual obligation that many old-line companies have wholly or partly shucked in recent years. As Thomas Scully, the federal administrator who runs Medicare, told the Washington Post, employers “should be having a giant ticker-tape parade.”

In a sense, the bill moves us closer to travesty-version of a single-payer system. It’s not really single-payer, of course, because seniors will still have to shell out massive amounts of their own money to stay healthy, but the burden on corporations and insurers is certainly lifted. At the end of the day, the government is subsidizing the privatization of a public system that works. Only in America.


Democrats in the House opposed the Medicare bill overwhelmingly — the vote among Democrats was 189 against and just 16 in favor. Only five of those Democrats represent districts outside the South, and just one California Democratic representative (out of 33) voted for it: Cal Dooley, the only Democrat from the San Joaquin Valley.

“I’ve told Democrats that they can vote no on this without fear of jeopardizing their seats,” says Guy Molyneux, a pollster for the Peter Hart firm, which often conducts polls for the AFL-CIO. In one such poll, conducted last week, Americans over 55 were read a description of the bill’s drug benefits, premiums, deductibles and exclusions; 26 percent reacted favorably and 65 percent unfavorably — and that was before the poll even got to the part about subsidies for HMOs. Respondents were particularly unenthused about losing their ability to choose and keep their own doctor, which they now have under Medicare, in return for getting a “choice” of HMOs that offer no such physician options whatsoever.

Despite the opposition of 97 percent of the California Democratic House delegation, despite the fact that the bill will still leave seniors wanting and will imperil Medicare itself, only half of California’s Democratic senators are voting no on this bill: the Barbara Boxer half. Her colleague, Dianne Feinstein, announced Sunday that she would support this monstrosity.

Just one month ago, in an October 22 op-ed piece in the Washington Post, Feinstein wrote with Senator Don Nickles (R-Oklahoma) that “Seniors may be forced into a government-run drug benefit system that is destined to collapse because it is overcommitted and underfunded.” The bill now before her gives seniors a choice of entering government-subsidized HMOs, and it leaves Medicare just as overcommitted and even more underfunded than before. Only now, Feinstein supports the bill.

On the three major congressional votes of the Bush presidency — the ruinous tax cut of 2001, the authorization of war in Iraq and the current assault on Medicare — Feinstein has been on the president’s side in two, the tax cut and the Medicare bill. To the best of my recollection, she did not win re-election in 2000 on a platform of helping George W. Bush destroy social responsibility and the public sector in America. As one of the wealthiest senators, she surely did not campaign on a platform of making the rich richer at everyone else’s expense. Yet these things are precisely what she’s done.

DiFi acts as if Californians are just itching for the social agenda of George W. Bush, though all evidence is way to the contrary. There is on occasion an almost glazed look in her eyes; it could just be the effect of appearing on Larry King so often, but — and this is the one plausible explanation for her voting — maybe, in her confusion, she believes she actually represents a Carolina. Let’s buy her a one-way ticket in the luggage bin and send her there.

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