You have been sold down the river. So have we all.

We need to differentiate between healthcare reform and tinkering with health insurance. Yes, there is a difference. The entire burlesque these past few months has revolved around the tinkering.

A handful of congressmen offered HR 676, Medicare-For-All. That represents reform. All of the rest of our political entertainment has been farce and sleight of hand.

I will get to the parts that all of you younger folk are concerned about but first let me speak to one that is of more consequence to us geezers. That would be a part of the “secret deal” between al-PhRMA, the White House and Max Baucus – the do-nut hole.

I had the chance to do some more reading of the Senate version of healthcare. It really is quite interesting despite being written in a language no human has ever mastered.

For anyone unfamiliar with the do-nut hole, let me explain. Medicare Part D was a present from the Bush administration to the drug pushers and insurance companies. Not only was it unfunded, it costs the government more than any of the “reform” plans that came out of either house of Congress.

A senior has a choice of insurance plans covering most, not all, prescription drugs. In my case the choice was among 50-odd plans. You are required to pay premiums, deductibles and co-pays until you reach the hole. Once in the hole you pay 100%. Though you are still required to pay premiums, the insurer pays out nothing. It begins at $2,830 for 2010. As with everything connected to healthcare, there are substantial annual increases.

You can reach this amount fairly quickly because it includes all of the above items that you pay plus whatever the insurance company pays. However, getting out is just a bit different. The exit point is $4,550 but there is a catch. You arrive at that figure on your own. Payments made by the insurer are not included.

Now you must remember, this plan was not designed to benefit seniors. The government is forbidden to negotiate drug prices for Medicare. The VA is not so constrained and averages a discount of about 58%. This means that, having insurance, the drug dealers have more customers and they get the full retail price. That price is whatever they want it to be.

No, they didn’t forget the insurance companies. They are guaranteed against loss and receive subsidies from the taxpayer.

Now that you understand Part D, let’s see what the “secret deal” contains. It promises the drug dealers that Medicare will continue to be forbidden to negotiate. The drug dealers promise to help out with $80 billion, spread out over 10 years. Most of that will supposedly be going to reduce seniors’ costs in the do-nut hole.

To get that help, a 50% savings only while the senior is in the hole, you must buy brand names, no generics. Again, that is 50% of whatever the drug dealers want to charge.

Interestingly, al-PhRMA commissioned a study of what all of this will cost them. That study shows that, despite forking over $80 billion over a 10-year period, they will realize an increase of $137 billion in just the next 4 years. That, of course, is in addition to the windfall that Part D itself gave them.

They may have been too embarrassed to extend the study out any further, as a close reading of the plan shows that the do-nut hole will not be closed immediately. It will gradually be closed over a period of 13 years. Oh, lordy. They’re doing all of this for poor little me?

By the way, the Congressional Budget Office (CBO) tells us that there will be substantial increases in the premiums seniors will pay for their do-nut hole discount.

And, now we have just one more bit of information that might be of interest. While the drug dealers are generously offering a discount of $8 billion a year, they are raising prices. This year they have already raised the overall prices the greatest amount since 1992. That would work out to more than $10 billion already this year.

If that doesn’t sound bad enough, let’s look a little more closely. Since those $6,000 per dose drugs, and others up on the high end, are not being raised much, if at all, the bulk of the increases are on the most commonly used drugs. That makes the effect on most people even more pronounced.

The various plans that were developed had price tags from something over $800 billion to $1.1 trillion. That is tax money. That doesn’t count increased premiums, deductibles and co-pays. The government will pay the costs for those who can’t pay. They will subsidize small companies providing healthcare. They will also continue to subsidize the insurance companies. This is in addition to the subsidies represented by the present tax exemptions for health insurance benefits.

I have already covered many of the general problems of the various plans. While the elimination of bans for preexisting conditions is in the plans, there are ways for the insurance companies to circumvent that stricture.

Ms. Pelosi proclaimed the inclusion of the public option and spoke of the plan covering 35 million people. The impression was intentionally left that the public option would cover those 35 millions. Actually, that increase in coverage comes from requiring small businesses and some individuals to purchase coverage. The public option is estimated to be available to up to 6.5 million.

The public option will, therefore, not play the claimed role of competing with private plans so as to keep their prices down. The only potential positive that might come from the public option would be as a foot in the door. It might, only might, be a way of expanding its coverage at some point in the indeterminate future. Don’t hold your breath.

By mandating that more people buy insurance and not holding the companies’ price increases down, the industry will reap tremendously increased revenue and profits. Those will be born by the average Joe, by increases in premiums, deductibles and co-pays, as well as subsidies from the government, i.e., taxpayers.

Obama and the Congress took single-payer off of the table before the “negotiations” began. They gave the various parts of the medical industry places at the table while ignoring the public and the majority of physicians. Then they cowered and kow-towed before al-PhRMA, AHIP, the AHA and the AMA, which represents less than 20% of physicians and stands against the wishes of the majority of them.

I have difficulty comprehending how that can be described as change or leadership or reform. I am convinced that the better way is for the President to take charge, to declare the entire process and resulting mess a failure and to demand a new start based on Medicare-For-All. That would not just require leadership; it would actually be leadership.

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The President has a headache. His healthcare reform is in trouble. He can’t even get a bipartisan agreement that Dr. Seuss ate green eggs and ham.

Two noted health reporters, the Washington Post‘s Ezra Klein and Jonathan Cohn of The New Republic, this week had major articles marking the difficulties the President’s reform was running into in Congress. While Speaker Pelosi continues to insist that the House will produce some vague public option that is to Obama’s liking, the Senate is still taking their marching orders from the healthcare industry.

It seems that the President is refusing to take medical advice. David Scheiner, MD was for 22 years his primary care physician, until he moved into the White House. Dr. Scheiner is a strong advocate for a single-payer system. Mr. Obama would be well-advised to listen to this man. He recently stated, “It’s nonsense that the private insurance companies need to be protected. Why? Because they’ve done such a good job?”

Let me answer the good doctor’s question. Let me do it emphatically. The only valid reason for not supporting a singe-payer system is that it does not generate bribes.

Reid Cherlin, the President’s assistant press secretary for health issues, wrote in an e-mail, “The President has been clear that while a single-payer system may work in some countries, it makes the most sense for us to build on what works in the system we have and to fix what’s broken.” What about the present system is worth saving? To quote Obama’s own physician, “Because they’ve done such a good job?”

I would suggest that the entire system is broken. If you have a complete junker of a car, a Yugo, if you will, that would cost more to repair than buying a brand new Lexus, what is your choice? This question presupposes that comfortable, economic, reliable transportation is your primary consideration. Your answer may be different if you have some strange Yugo fetish.

You may demur. You may say that there are things about our system that are worth saving. You would be missing the point.

The question is not how good the latest MRI machine is. The question is what should replace the present insurance morass. The question is how to structure a system we can afford. The question is how to incentivise preventive healthcare. The question is why do we need to waste nearly $750 billion each and every year on paperwork and on profits for people who don’t heal anyone; for people who ration what we can get; for people who stand between us and our physician?

The denizens of the Congress work for us (supposedly) yet enjoy a far superior healthcare plan than most of the people they work for. Let’s put it this way. Either we should be able to get what they have, or they should get what we have. If they produce a “reform” plan that is not as good as theirs, we need to force them to participate in whatever plan they devise for us or we need to rid ourselves of these parasites.

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Where does the Congress stand on healthcare reform? Who knows?

Nancy Pelosi is the leader of the House of Representatives. She has a commanding edge of Democrats over Regressives. One would think that would give her more leeway than Senator Reid. She should be able to at least make a stab at formulating a rational reform plan. See, you thought you understood politics.

Salvador Dali may have understood what his art represented. Or, maybe not. Either way it isn’t always clear to every observer. I find we are in the same situation with regard to what Congress means. It is also fairly certain that Senor Dali had a firmer grasp of what he intended than does Congress.

Below are excerpts from Speaker Pelosi’s recent press conference. I removed those parts not related to healthcare. My comments have been interspersed at appropriate points to highlight errors, confusion and inanities in Nancy’s answers.

I should note that Chris Weigant sent me the transcript and suggested that I compose a post based on it. Chris is one of the few bloggers left on Huffington Post. He is also one of those special friends from the Internet that I someday hope to meet.

PELOSI: Health care reform will be part of how we address reducing the deficit. This and the point that real reform can make our industries more competitive are two points that need to be given far more emphasis.
Health care reform is entitlement reform, as the President so clearly states.

With that, I would be pleased to take any questions.

QUESTION: On health care, Madam Speaker?

PELOSI: Yes, ma’am.

QUESTION: There are bipartisan discussions in the Senate about an idea, looking at creating a privately run cooperative instead of a public option. I am just wondering what you think of the concept. And given the concerns among some of your moderate members about a public option, is this something you might be open to?
Co-op proposals are a sham put forward by the insurance corporations and their toadies. They are intended to be too small to be a problem for private plans. They cannot be made actuarially viable. It is an attempt to substitute uncompetitive plans for public options.

PELOSI: Not instead of a public option, no. In our Caucus, I think Members have been — I know that Members have been very clear about what their concerns might be about a public option. And I agree it should be actuarially sound, it should be administratively self sufficient. It should be a real competitor with the private sector and not have an unfair advantage. When you say the words “public option,” if that is the term of art we will be using, you have to say right next to it “level playing field.” But in our House, there is strong support for a public option, and great respect for the concerns that have been raised within our Caucus. And we will address them.
More shams. The complete inanities of a supposed “level playing field” and the overwhelming problems with all of the public options being floated in Congress are addressed in my last post, It Ain’t No Game.

QUESTION: Madam Speaker, on health care, given what you just described is going to be very complicated for people to understand, and given the experience that the Clinton health plan had, and then that we had with Medicare part D, with public worries and anxieties and confusion, what strategy are you going to follow to explain this massive bill to people? Because health care is people’s most — one of their most basic worries in life.
This is just one more reason to go to a single-payer system. Make it simple. Medicare should be expanded into Medicare-For-All. It has been around for more than 40 years. People generally find the concept understandable.

PELOSI: It sure is. It is a personal worry in terms of their health and well being. It is also an economic issue for them as well. And I always say everybody in the country is an expert on his or her health care and how to be able to afford it.
A comment such as this is patently untrue and is mere pandering.

We have our overarching message of affordability, accessibility, and quality that the President has put forth. In that framework, we will have the initiatives to help us meet those goals and are deeply rooted in those values.
This sounds good but you would be well-advised to take it with as much faith as politicians commonly deserve.
Right now, the bill is being considered, and I can only speak to the House. The three committees are working in unison, practically, with a unified staff. They will have something on the table in a week or two. Hopefully, most of it will already be scored, because at some point we have to know how much each element of it costs to see what we can afford and then how we pay for it. Because it will be paid for. And that challenge for us is to relate what we are doing here to the lives of the American people and how this makes a difference to them.
A single-payer system has such great cost advantages that it essentially pays for itself, even as it provides coverage for all of those presently uninsured and under-insured. It means that funding sources must be juggled. Some of what is now termed premiums would be called taxes. The total amount of premiums and taxes could remain the same or, given several possible refinements, actually be less than what our system presently costs.

But we are very excited about it, whether it is about prevention and wellness, which is the important part of it, investments in scientific research, that we can have personalized, customized care for all Americans, with investments in technology so that we have a common record for all people to be on it, whether it is investments in community health centers to reach out to achieve this, as many people being involved as possible, because that is hard, and community health centers will enable us to do that. Whether it is having the resources to have sufficient health care providers at every step of the way.

We will be able to explain the bill to the American people once it is — a mark comes forward, and then Congress will work its will, people will make suggestions (Except that suggestions of a single-payer system will continue to be ignored), and we will have a product that will meet the President’s values, meet the needs of the American people, be paid for, and make America healthier.

QUESTION: Madam Speaker, on health care and the public plan or government plan, whatever you want to call it, is it your belief that this is central, you know, an essential element of health care reform? Can you have effective health care reform without a public or government plan?

PELOSI: Well, let me say at the health summit the President was asked this question by Senator Grassley. You may have heard him. He said, “Don’t you think that having a public health plan is unfair in terms of competition with the private plans?” The President said, “I think a public option is a way to keep the private sector honest.” But, and we want to achieve what I just said, accessibility, quality, and affordability so that all Americans have access to quality health care. He then said if you have another way to do that, put it on the table. And that is where we are.
The majority of the President’s supporters, and many who continue to call themselves Republicans, are not being allowed to put single-payer on the table. So, that is where we really are, or aren’t.

Everything should be on the table. (Should be, but isn’t.) From our perspective here, though, there is strong support for a public option right from the start.
There is a problem in that public option is often thought to mean single-payer. They are not the same. The confusion is intentional.
And there is also full support for having it be a real competitor, not something that has an overwhelming advantage. Of course it is not for profit and it doesn’t advertise. So it doesn’t have some of the overhead that the private sector has.
Remember, to be a real competitor would require a public option to be priced artificially high in order not to significantly undercut private plans. This is to require those with a public plan to subsidize the private plans and the profits of the leeches that have put us in the position of desperately needing reform.

Already just the thought of having a public option has sort of eliminated words from the health insurance glossary of precondition, portability. Everybody seems to be subscribing to the idea that we shouldn’t have a precondition in order to get eliminating you for health insurance.
Eliminating denials due to preconditions is essential but will cause present private plans to become even more expensive.

So this is what we have come to do. Our three chairmen have asked that Chairman Dingell be the author of this bill. Every year since he has been here he has been the author of universal health care. Before that his father was. When he was a young Member of Congress in the ‘60s, he gaveled Medicare. He gaveled down (?) the Medicare bill. Very few Republican votes, by the way, on Medicare. Very few Republican votes.

So we have heard the same concerns before. But it is a pretty — as I say, this is the life work for many Members of Congress, and it certainly is the responsibility for all of us. This will happen. We told the President we would have a bill by the end of July, that it would be paid for, and that is the course of action we are on. And I commend our three chairmen, Chairman Rangel, Chairman Waxman, and Chairman George Miller , for working together, eliminating any turf challenges that occurred in the mid- or early ‘90s, 1993 or 1994, and to facilitate this improvement in the lives of the American people.

Thank you all very much.

One may think that much of what she says sounds good. Those are known as platitudes. They are also the reason for the confusion. Those platitudes must come face-to-face with the realities of the proposals to which the Congress and the President are limiting themselves, and us. They want reform without harming the health insurance and drug corporations. One or the other. Choose. We can’t have both.

For those naive enough to think that the corporations that caused this mess need to be guaranteed continued existence and unconscionable profits, email me with a list of all of those countries with a national health system who are conducting a national debate about swapping their system for one like ours.

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