Conservatives may complain bitterly about “Obamacare,” but they “are winning more than even they may realize in the current health care equation.” That’s the point made by Drew Altman, president of the Kaiser Family Foundation, in a recent column.

[F]or all of the frustration and even anger within the conservative movement about where health care is headed, the fact of the matter is that they are winning more than even they may realize in the current health care equation. That’s because the nature of health insurance itself is being redefined and moving gradually but seemingly inexorably in the direction conservatives have long advocated: more consumer “skin in the game” through higher patient deductibles.

As a result, old people are being asked if we would be willing to give up some expensive, life-sustaining treatment so that our grandchildren can have health care. This is a bogus question, and a bogus “choice.” The real question, as I say in the article, is whether we should give up the treatment “so some WellPoint executive can take another expensive vacation, so Pfizer can book $3 billion in annual profits instead of $2 billion, or so private hospitals can make another campaign contribution to some gutless politician.”

It’s a long article, and I’m including just the opening here, with a link at the end to continue reading at the Mother Jones web site. Or you can read the whole thing at MotherJones.com by clicking here. And if you’re one of those geezers who still likes reading print and turning pages, the July/August issue is on newsstands now.

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From Mother Jones, July/August 2010

There’s a certain age at which you cease to regard your own death as a distant hypothetical and start to view it as a coming event. For me, it was 67—the age at which my father died. For many Americans, I suspect it’s 70—the age that puts you within striking distance of our average national life expectancy of 78.1 years. Even if you still feel pretty spry, you suddenly find that your roster of doctor’s appointments has expanded, along with your collection of daily medications. You grow accustomed to hearing that yet another person you once knew has dropped off the twig. And you feel more and more like a walking ghost yourself, invisible to the younger people who push past you on the subway escalator. Like it or not, death becomes something you think about, often on a daily basis.

Actually, you don’t think about death, per se, as much as you do about dying—about when and where and especially how you’re going to die. Will you have to deal with a long illness? With pain, immobility, or dementia? Will you be able to get the care you need, and will you have enough money to pay for it? Most of all, will you lose control over what life you have left, as well as over the circumstances of your death?

These are precisely the preoccupations that the right so cynically exploited in the debate over health care reform, with that ominous talk of Washington bean counters deciding who lives and dies. It was all nonsense, of course—the worst kind of political scare tactic. But at the same time, supporters of health care reform seemed to me too quick to dismiss old people’s fears as just so much paranoid foolishness. There are reasons why the death-panel myth found fertile ground—and those reasons go beyond the gullibility of half-senile old farts.

While politicians of all stripes shun the idea of health care rationing as the political third rail that it is, most of them accept a premise that leads, one way or another, to that end. Here’s what I mean: Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the “experts” persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. Conservatives embrace this notion as the perfect expression of the all-powerful market; though they make a great show of recoiling from the term, in practice they are endorsing rationing on the basis of wealth. Liberals, including supporters of President Obama’s health care reform, advocate subsidies, regulation, and other modest measures to give the less fortunate a little more buying power. But as long as health care is viewed as a product to be bought and sold, even the most well-intentioned reformers will someday soon have to come to grips with health care rationing, if not by wealth then by some other criteria.

In a country that already spends more than 16 percent of each GDP dollar on health care (PDF), it’s easy to see why so many people believe there’s simply not enough of it to go around. But keep in mind that the rest of the industrialized world manages to spend between 20 and 90 percent less per capita and still rank higher than the US in overall health care performance. In 2004, a team of researchers including Princeton’s Uwe Reinhardt, one of the nation’s best known experts on health economics, found that while the US spends 134 percent more than the median of the world’s most developed nations, we get less for our money—fewer physician visits and hospital days per capita, for example—than our counterparts in countries like Germany, Canada, and Australia. (We do, however, have more MRI machines and more cesarean sections.)

Where does the money go instead? By some estimates, administration and insurance profits alone eat up at least 30 percent of our total health care bill (and most of that is in the private sector—Medicare’s overhead is around 2 percent). In other words, we don’t have too little to go around—we overpay for what we get, and we don’t allocate our spending where it does us the most good. “In most [medical] resources we have a surplus,” says Dr. David Himmelstein, cofounder of Physicians for a National Health Program. “People get large amounts of care that don’t do them any good and might cause them harm [while] others don’t get the necessary amount.”

Looking at the numbers, it’s pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a “scarce” resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young.

For years, any push to improve the nation’s finances—balance the budget, pay for the bailout, or help stimulate the economy—has been accompanied by rumblings about the greedy geezers who resist entitlement “reforms” (read: cuts) with their unconscionable demands for basic health care and a hedge against destitution. So, too, today: Already, President Obama’s newly convened deficit commission looks to be blaming the nation’s fiscal woes not on tax cuts, wars, or bank bailouts, but on the burden of Social Security and Medicare. (The commission’s co-chair, former Republican senator Alan Simpson, has declared, “This country is gonna go to the bow-wows unless we deal with entitlements.”)

Old people’s anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on “waste,” they’ve allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost.

Click here to the rest at MotherJones.com.

Despite the fear mongers’ claims, Medicare benefits will not be cut to pay for covering the uninsured.  Before health reform, the federal government was projected to spend about $6 trillion on the Medicare program over the next decade.  After enactment of health reform, Medicare is still projected to spend about $5.6 trillion.  That means over the next 10 years about $450 billion less of American’s money will be spent on wasteful tests, haphazard treatment options, wasteful subsidies to private insurance companies and reimbursement policies that drive up costs without improving the quality of care seniors receive.  The rate of growth will be trimmed by about 1.0 percent over the next 10 years, from about 6.8 percent growth rate to 5.8 percent – hardly the destruction of Medicare that opponents have claimed.  

As a result, the lifespan of the Medicare Trust Fund will more than double: its solvency will be extended from 2017 to about 2026.  Medicare will continue to grow to meet the needs of an expanding older population, but it will grow at a slower rate that will more closely match the growth of the rest of the economy.  And because health reform is designed to slow the growth of costs in the entire health care system at the same time, seniors’ out-of-pocket costs will be trimmed without driving providers out of the Medicare program or creating other barriers to care. 

While these improvements are being made, health reform also provides new tools to help crack down on the fraud in the current Medicare program.  For example, by allowing the Department of Health and Human Services and the Internal Revenue Service to share information, it will be easier to stop Medicare payments to scam artists masquerading as legitimate providers.  The health reform legislation also gives the agencies more time to verify that providers are legitimate and that they have provided seniors with the wheelchairs, hospital beds, oxygen tanks and other lifesaving pieces of equipment that they are billing to the Medicare program.  Fraud in the Medicare program hurts us all by increasing costs. 

Many people worry that curtailment of the Medicare Advantage ripoff plans signals the beginning of the end, denying care to millions and–as people always warn whenever there’s government “intervention” in medicine, driving the doctors out of business. Here’s what the Committee has to say about Medicare Advantage:

Making changes in the Medicare Advantage program is another way of restoring the integrity of Medicare by reducing wasteful spending.  Medicare Advantage is the privatized part of Medicare whose growth has been fueled by the massive subsidies enacted in the Medicare Modernization Act of 2003.  Medicare Advantage plans are paid on average 13 percent more per enrollee than it costs to provide comparable care in traditional Medicare.  These subsidies, which cost over $11 billion in 2009 alone, are paid for by taxpayers and by all beneficiaries, whether or not they are enrolled in a private plan.  It is estimated that every couple receiving Medicare, including the 75 percent in traditional Medicare, will pay about $90 in additional Part B premiums this year to subsidize those in the private Medicare Advantage plans.  And although these plans provide some additional benefits, many require much higher cost-sharing from seniors for expensive services such as chemotherapy, extended hospital stays and skilled nursing home care – a shortcoming few seniors realize until they find themselves needing the service. 

Despite what some are claiming, the health reform legislation does not eliminate Medicare Advantage plans or reduce the extra benefits they provide.  The legislation simply phases down the exorbitant subsidies they are currently getting so their payments end up more in line with what it would cost traditional Medicare to cover the same seniors.  It is up to each private insurer to decide how to absorb the reduced payments, and whether to continue providing extra benefits.  The insurers who run Medicare Advantage plans cannot cut guaranteed benefits – they are required to offer all benefits covered by traditional Medicare.  And under the new health reform law, they are now prohibited from charging seniors more than traditional Medicare for expensive services.  They are also, for the first time, required to spend at least 85 percent of their revenue on patient care rather than profits or overhead.  Finally, the legislation rewards Medicare Advantage plans that are providing high-quality care by giving them bonus payments. 

A closer look, however, reveals that a lot of the cuts are to private Medicare Advantage plans, which I’ve long opposed as a mammoth rip-off. The legislation’s supporters swear it won’t compromise benefits, and the Medicare Rights Center (which I trust a lot more than I do AARP) is all for it. 

I’ll be writing more about this in the future–but for now, Factcheck.org, the Annenberg Public Policy Center’s project that aims to straighten out some of the more egregious misconceptions about public policy, lays out the basics:

Whether these are “cuts” or much-needed “savings” depends on the political expedience of the moment, it seems. When Republican Sen. John McCain, then a presidential candidate, proposed similar reductions to pay for his health care plan, it was the Obama camp that attacked the Republican for cutting benefits. Whatever you want to call them, it’s a $500 billion reduction in the growth of future spending over 10 years, not a slashing of the current Medicare budget or benefits. It’s true that those who get their coverage through Medicare Advantage’s private plans (about 22 percent of Medicare enrollees) would see fewer add-on benefits; the bill aims to reduce the heftier payments made by the government to Medicare Advantage plans, compared with regular fee-for-service Medicare. The Democrats’ bill also boosts certain benefits: It makes preventive care free and closes the “doughnut hole,” a current gap in prescription drug coverage for seniors.

Age-rating has received little attention from the media, even from those criticizing the legislation. The exception is women’s groups, who today pointed out that the reform promotes both age-rating and gender rating (not to mention limiting payment for abortion). 

Members of Congress in both parties generally have lined up behind the insurance and pharmaceutical industries from the get go. So it should come as no surprise that the Democrats, who long ago gave up any pretence of opposing corporate power, found a way to accomodate the pharmaceutical companies on the way to its tepid reform. To a large extent, the “debate” over health care was a show debate, an extended round of Washington smoke and mirrors. The administration early on cuts its deal with Big Pharma, and pretty much stuck to it throughout the process.

In fact, the Dems actually made the drugsters look good, celebrating the industry’s generous “concessions” and “discounts” while ensuring that no real threat to Big Pharma’s profits would make their way into the final bill.

The industry’s  main goal from the very beginning has been to fend off any government power to negotiate or seriously regulate drug prices–and this they did. 

Big Pharma’s second big win was to prevent any measure that would have opened the way for American consumers to buy less expensive drugs abroad, especially from Canada.

At the same time, the supposed give-backs by the drug industry are projected to more than pay for themselves. The much-lauded discounts on brand name drugs for seniors in the Medicare prescription drug program, for example, are good for Big Pharma because they discourage oldsters from switching to generics.

And more insured people simply mean more money coming into the coffers, for Big Pharma as well as for the insurance industry.

Confirmation of the industry analysis came early in the day from the stock market, where drug stocks initially remained level; there certainly was no rush to dump shares, which is what would be expected if the bill actually represented any threat to profits. And by 1 p, EST, CNN Money was reporting a rally in health care stocks.

“I was unable to find anything in there that would cause me to have anxiety if I were a shareholder in a pharmaceutical company,” Ira Loss, a senior health-care analyst at the research firm Washington Analysis, told Dow Jones. According  to the ticker story:

Billy Tauzin, who led the industry’s negotiations on health care with lawmakers, said overall drug makers fare well. “While we’re not totally happy,” Tauzin began, “we generally feel like it tracks with our principles.”

Sanofi-Aventis SA (SNY) Chief Executive Christopher Viehbacher said in an interview that the impact of the legislation will be neutral to slightly negative “but better for the industry than if healthcare reform didn’t pass.”

Tauzin, head of the Pharmaceutical Research and Manufacturers of America or PhRMA, and Viehbacher said getting protection for brand-name biologics is among the important provisions for the industry. Drug makers pushed hard to get 12 years of exclusive market protection while the White House and some lawmakers wanted to lower the protection to seven years.

Despite fees and rebates imposed by the legislation, “analysts say drug makers will end up recouping those costs through new customers: The bill would provide insurance coverage to an additional 32 million Americans.” The Dow Jones story continues:

Chalk up another good round for Pharma and Biotech in health care reform,” began a note to clients Friday from Concept Capital, a research firm.Ken Tsuboi, co-manager of the Allianz RCM Wellness Fund, sees the impact of bill, and its $90 billion in concessions over 10 years, as relatively minor in an industry that has annual global sales of about $750 billion, with about $300 billion in the U.S., and margins close to 30%.”I think that it is actually a pretty good deal for Pharma,” Tsuboi said.

The GOP, which purports to be the party of big business, ought to be applauding at least these portions of the health care reform–and perhaps when the cameras go away, some of them will quit bitching and count their blessings.  As for the obnoxious Tea Party gang, if they start threatening the real power in this country, which is vested in corporations, they may well find themselves whipped and isolated.

It’s been clear for some time that Big Pharma has been jacking up drug prices in preparation for any new regulation that might come out of the health care reform. Last November, the New York Times was reporting that drug prices had already increased so much that they raised the nation’s total health care costs by some $10 billion.

New details on the rise in prices for the drugs most commonly used by elders come from a report by the Kaiser Foundation, which finds that “Between 2009 and 2010, monthly prices in the coverage gap increased by 5 percent or more for half of the top ten brand-name drugs.”

The study notes:

A unique feature of the Medicare Part D drug benefit is the coverage gap, or so-called “doughnut hole,” where Part D enrollees are required to pay 100 percent of total drug costs after their spending exceeds the initial coverage limit, before qualifying for catastrophic coverage. The coverage gap in the Part D standard benefit is $3,610 in 2010 and is projected to increase to $5,755 by 2018, under current law. the coverage gap are likely to have multiple chronic conditions and take either several medications or a smaller number of relatively expensive brand-name drugs. An estimated 3.4 million Part D enrollees (14 percent of all enrollees and 26 percent of those using prescription drugs and not eligible for the low-income subsidy) reached the coverage gap in 2007. 

For example, an older woman taking Actonel for osteoporosis, Aricept formemory loss, and the blood thinner Plavix would spend $448 per month in 2010 after she reached the gap (in roughly six months), and would remain in the gap for the rest of the year, assuming no changes in her drug regimen. Between 2009 and 2010, her total monthly out-of-pocket costs in the gap for these three drugs would have increased by 7 percent (from $417 to $448) – at a time when Part D premiums also increased and there was no increase in Social Security payments.

So let’s see: The cost of drugs is rising (with many brand name drugs not covered by Medicare drug plans–or covered with a co-pay of $50, $75, or more). Medicare Part D premiums are going up sharply, as well, since the insurance companies have to make sure they still get their share. And Social Security payments are remaining the same, with no cost of living increase.

It’s great that health care reform may close the doughnut hole–but at this rate, some old people won’t be able to afford their medication, gap or no gap. And let’s not forget that the government subsidizes Part D, so old folks are getting screwed as taxpayers, as well as “beneficiaries.”

HEFTIER SUBSIDIES: Compared to the Senate legislation, the reconciliation bill would provide more generous subsidies to low- and moderate-income Americans to help them buy health coverage.

THE “MASERATI” TAX: The levy on high-cost insurance plans is scaled back and delayed, rendering it more a “Maserati” than a “Cadillac” tax. It would apply only to the portion of plans costing more than $10,200 a year for individuals, up from $8,500, and $27,500 for families, up from $23,000. The tax wouldn’t kick in until 2018, reducing the projected revenue to the government by 80 percent. Over time, however, the tax would hit more and more plans, because the tax’s threshold is set to increase at the rate of inflation while premiums are expected to continue to grow much more quickly than that.

CLOSING THE DOUGHNUT HOLE: Unlike the Senate bill, the reconciliation measure would eventually close the coverage gap, called the “doughnut hole,” for Medicare beneficiaries enrolled in Part D drug plans. (Currently, seniors who hit the gap must bear the full cost of their medications until they spend a certain amount, when coverage kicks back in.)

Under the new bill, seniors who hit the gap this year would get $250 to help cover the costs of their medications. Starting next year, they’d get a 50 percent discount on brand-name drugs, with the cost borne by the drug industry. In subsequent years, the discounts would expand and begin covering generic drugs, with the expense picked up by the government. By 2020, the discounts would reach 75 percent.

SHIFT IN MEDICARE ADVANTAGE PAYOUTS: Government payments to Medicare Advantage, the private-health plan alternative to traditional Medicare, would be cut back more steeply than under the Senate bill: $132 billion over 10 years, compared to $118 billion.

The government currently pays the private plans an average of 14 percent more than traditional Medicare. The new bill, besides reducing payments overall, would shift the funding; some high-cost areas would be paid 5 percent below traditional Medicare, while some lower-cost areas would be paid 15 percent more than traditional Medicare. The Senate’s plan that would have shielded some areas of the country such as South Florida from major cuts was largely eliminated.

A RAISE FOR DOCTORS: Primary care doctors would get a Medicaid payment boost in the reconciliation bill. Beginning in 2013 and 2014, the doctors’ payment rates would be on par with Medicare rates, which typically are about 20 percent higher than Medicaid. The goal is to ensure that there will be a sufficient number of doctors willing to care for the millions of additional people who would become eligible for Medicaid under the health care overhaul.

PUSHING UP THE MEDICARE TAX: The Senate bill adds a 0.9 percentage point to the Medicare payroll tax on earned income above $200,000 for individuals, or $250,000 for couples. Under the reconciliation bill, starting in 2013, people in those income brackets also would face a 3.8 percent tax on investment income, such as interest, capital gains and dividends.

PENALTY FOR NOT HAVING INSURANCE: Under the new bill, most Americans without insurance would face an annual penalty, starting in 2014 at $95 – the same as in the Senate bill. But in following years, the penalties in the reconciliation bill are slightly different. Those without insurance in 2016, for example, would pay the greater of two alternatives: a flat fee of $695, down from the Senate’s $750, or 2.5 percent of their income, up from 2 percent in the Senate bill.

EXPANDING MEDICAID: The reconciliation package differs from the Senate-passed bill in several ways. It would delete a provision dubbed the “Cornhusker kickback” that would have exempted Nebraska from paying any cost of a Medicaid expansion included in the bill. But it would provide full federal funding to all states for newly eligible Medicaid recipients for three years. And it would give additional funding to states like Vermont and Maine that have already moved to cover adults without children, which isn’t required under the Medicaid program.

MEDICARE SPENDING BOARD: The Senate bill would create an independent, 15-member board to recommend ways to control Medicare spending. The board remains in the reconciliation package, but would be expected to produce just about half of its original projected savings of $23 billion in the Senate bill. That’s because the new proposal would make greater cuts in Medicare Advantage plans

I know it’s a drag to keep going on and on about something everyone knows all too well–but still, it’s worth noting that as Congress equivocates over health care the numbers of uninsured middle class people keep on growing. The numbers are doubtless increased due to the recession–which the press announces daily is at an end.

This new report from the Robert Wood Johnson Foundation throws more light on the situation:

The report shows that the number of middle-income earners who obtained health insurance from their employers dropped by 3 million people from 2000 to 2008. Just 66 percent of people in families earning roughly $45,000 to $85,000 are now insured through their employer—a drop of seven percentage points from 2000 to 2008.

Employer-sponsored insurance (ESI) has long been the mainstay of health coverage for middle-class families, who typically do not qualify for government insurance programs. Among middle-income Americans, only about half of the decline in employer-sponsored coverage from 2000 to 2008 was offset by government insurance programs. For people who earned less money, declines in ESI were even steeper, but those numbers were mostly offset by increases in coverage through government insurance programs like Medicaid.

The result is that America’s middle-class became uninsured at a pace faster than those with less or more income. In total, 13 million middle-income earners were uninsured in 2008—about 2 million more than in 2000.

“America’s uninsured crisis means that hard-working people with average incomes are being squeezed,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “The fallout from rising health insurance costs hits everyone. Employers must choose between either passing on costs to workers who cannot afford the increase and therefore drop coverage, or paying more for their employees’ coverage at the cost of creating and preserving jobs.”

The most recent estimates from the U.S. Census Bureau indicate that 46.3 million people are uninsured, but these figures were compiled before the downturn in the current economy. Experts assume millions more have become uninsured since the 2008 data, due to job loss and rising costs of health insurance since that time.

The report —Barely Hanging On: Middle-Class and Uninsured—chronicles state-by-state health coverage trends. In the first decade of this century, nearly every state has seen increased numbers of uninsured residents, greater costs for individual and family policies for health insurance and significant erosion in private coverage. The report was prepared by the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota. Researchers averaged data from the U.S. Census Bureau from 1999/2000 and 2007/2008 and data from the U.S. Department of Health and Human Services. The report shows:

• More middle-class Americans are uninsured.
  Nationwide, the total number of uninsured, middle-class people increased by more than 2 million since 2000, to12.9 million in 2008.
• The average employee’s costs for health insurance rose, while income fell.
  Nationwide, the average cost an employee paid for a family insurance policy rose 81 percent from 2000 to 2008. During the same period, median household income fell 2.5 percent (adjusted for inflation).
• Fewer people were offered, eligible for, or accepted insurance coverage through their jobs.
  As costs of health insurance premiums rose, some employers stopped offering coverage benefits to employees, or changed the criteria for employees’ eligibility. While most employers still paid the lion’s share of their employees’ insurance premiums, rising costs have been passed on to workers—with some choosing to drop insurance. Nationwide, the percentage of people who worked for firms that did not offer insurance increased to 12 percent in 2008. The number of workers who were ineligible for ESI—even though their employer offered it—was 22 percent in 2008. That means more than one in five people who work in firms that offer health insurance weren’t eligible for the benefit. And the percentage of employees nationwide who did not accept ESI increased three percentage points since 2000; 21 percent of employees offered ESI in 2008 did not accept.

“The facts show that everyone is suffering right now, regardless of income,” said Lavizzo-Mourey. “For middle-class families, changes in the cost of insurance far outweigh changes in income. That means a bigger piece of the household budget must go to insurance, or families have to go without coverage, delay needed care and face bankruptcy if anyone in the family gets seriously ill. Business owners can’t afford to shoulder more of the burden of health care costs. And states can’t afford the influx of laid-off workers into public programs. It’s a crisis in need of solutions.”

President Obama charged that insurance companies have made a calculation that they can deny coverage for preexisting conditions, drop coverage when people need it most, and make big profits “as long as they can get away with it.”

It was widely known from the start of the so-called health care debate that a baseline goal would be to stop insurance companies from denying people coverage because of pre-existing conditions, or knocking people off the rolls when they got sick. (The public option, as everyone should by now have realized, was never much more than a bargaining chip.) And that’s just what’s likely to happen.

It was also well understood that any health care reform must genuflect before the alter of the  free market. That has been a given since Reagan took office in 1981 and the Heritage Foundation came up with its health care reform plan–which quite resembles the one now being promoted by Obama and many other Democrats.  

The Heritage plan, as I and others have written before, is based on the Federal Employee Health Benefits program (FEHB). It supports a vending machine type “exchange” to sell private insurance across the country to one and all, thereby achieving a supposed twofer–affordable universal health care and preservation of the free market. The problem, of course, is that there is no free market when it comes to health insurance, and the FEHB is becoming more expensive by the day. So the exchanges will do nothing but bring mediocre and criminally overpriced insurance to slightly larger pool of people.

And if we are to believe the latest tracking poll from the Kaiser Family Foundation, this is pretty much what Americans seem to want–a timid, lukewarm reform that addresses some of the worst abuses of the health care system without rendering any fundamental change.  Here are some details from the poll: 

The public [is] still split on health care reform legislation, with 43 percent in favor and 43 percent opposed. However, the poll also finds that majorities of Americans of all political leanings support several provisions in the health reform proposals in Congress and most attribute delays in passing the legislation to political gamesmanship rather than policy disagreements….

[The] poll finds that at least six of every ten Republicans, Democrats and independents back at least some of the key provisions in the reform bills that have passed the House and Senate. They include measures that would: reform the way health insurance works, such as preventing insurers from excluding people because of pre-existing conditions; offer tax credits to small businesses to help their workers get coverage; create a new health insurance marketplace; help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines; and expand high-risk insurance pools for individuals who cannot get coverage elsewhere.

It is slightly more encouraging to learn that ”Providing subsidies to lower and middle income people also receives strong support from Democrats and independents and near majority support from Republicans.” The problem is that unless we take a meaningful bite out of the profits of the drug and insurance companies–which no one seems willing to do–there won’t be money left to subsidize anything other than junk insurance for those who can’t afford a decent policy. 

The liberal-minded will surely object to me saying this, but I’m inclined to think the Kaiser poll is pretty accurate–because when it comes down to real social and political change, the United States is basically a conservative nation. Anything more than the most incremental change has happened only when we had both a mass grassroots movement and strong political leadership–think of the Civil Rights Movement or the New Deal. 

Neither one of these things has surfaced when it comes to the current health care reform. So the best we can look forward to are a few tinkerings with the existing system, which are better than nothing–but not much better.