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Sunday, December 30, 2007

Negotiating With Ourselves

I hate to use up a little space on Digby's own blog to essentially say What Digby Said (tm), but, you know, that. And let me try and apply it to what everyone feels is the most important domestic issue of the election, health care.

The debate so far, as it's been set up by the leading Democratic candidates, is extremely narrow. It asks whether you want to mandate coverage through the government, or to bring costs down to the point that people will want to get coverage. And yet what often goes unsaid is what that coverage actually buys you. Why is this not the most fundamental point in the entire debate?

At 13, David Denney's body functions like that of a baby. Severe brain damage halted his motor development at 4 months.

Unable to walk, sit up, speak or even eat by mouth, David is cared for by a licensed vocational nurse who feeds him formula through a stomach tube, watching closely in case he retches.

Blue Cross of California, the family's health plan, paid for the nurse for most of David's life at a cost of about $1,200 a week.Then about two years ago, the company decided that David didn't need a nurse anymore -- contradicting the opinions of two of David's physicians -- and it stopped paying.

"He's fragile, very fragile," said the boy's mother, Amparo Denney of Torrance. "It's not humanly possible to do this without help."

As a matter of course, insurers scrutinize what physicians order -- watching for unnecessary drugs, questionable treatments, experimental and unproven therapies, unwarranted surgery.

The extent of treatment denials by insurers is unknown. But patients are contesting them more than ever [...]

Many people who are denied treatment never contest it because they are unaware that they can or are too caught up in their medical crises to bother. As a result, some denials go unnoticed; some draw headlines.

A much-publicized pair of decisions this month by insurer Cigna HealthCare to deny and then permit a liver transplant for a 17-year-old girl from Northridge drew much criticism after she died hours later.

In a sane world, the fault line would be: eliminating health care that values profit over treatment versus maintaining the same failed system, and the parties would line up on those two tracks. That's certainly the way the Republicans are playing it. They'd rather smear a seven year-old and his family than give them health care. This so-called "post-partisan" compromise for health care reform in California was passed in the state legislature without one Republican vote, it will continue to pass without one Republican vote, and may become law without one Republican vote. They're not interested in compromise. They're absolutists, and as Digby says, they're better in the opposition obstructing everything.

But the Democrats are so browbeaten by taunts of class warfare and extreme partisanship that they give in halfway before the negotiation even begins. And the Republicans obstruct, so they give in some more, and the Republicans obstruct again, and then the bipartisan zombie goons get all upset at the Democrats for not getting anything done.

So we have these Rube Goldberg plans that try to split the difference between universal health care and placating insurance companies. And we hear all this happy talk about giving a place at the table to all competing interests and forging a workable solution.

I'm sorry, the company that favors the balance sheet over human life isn't really interested in that. The trade-off is supposed to be a forced market through mandates in exchange for having to sign up everybody. What about quality of care? I can tell you that in our California plan, which many have said is supposed to be better than the major Dem candidates' plans, there is no defined minimum baseline coverage. The companies have to spend 85% of premiums on health care (Medicare spends 96%), that's it. Good thing we don't live in a country where there have been phony accounting scandals recently!

The Nataline Sarkysians of the world, the David Denneys of the world are still at risk in that scenario. My man Edwards at least understands that negotiation isn't an option, but his plan doesn't say "Look, the hell with it, they're not going to compromise, sign everybody up for Medicare." It tries to sneak that under the door, but the conservative movement really isn't being sneaky, and they're not likely to get duped. They'll lie and call something that doesn't approach socialized medicine "more from the Commies who wanna control every part of your life."

So why are we* so interested in being cordial?

* Note responding to the comments; I say "we" because we are the Democratic Party, not these piles of mush who think we can wish our disagreements away.