Three Card Monte

I was in New York City for the first time many years ago and I got to see a street

performance of Three Card Monte. It is a fascinating piece of theater which requires the

performer to maintain snappy and frenetic repartee encouraging people to play while he

moves the cards with lightening speed and performs slight of hand tricks to cheat anyone

who does play. People know they are going to be cheated, but play anyway.

Events over the last week or so brought that image back to me again. Committees

of both the House and Senate are starting to write bills on how to reform the broken

health care system in this nation. The Democrats in the House promise to have a bill by

the end of July. No one knows what the Senate will do. The Health Committee was told

by the Congressional Budget Office that their idea could cost $1.3 trillion over ten years

and this allegedly has moderate Democrats running for the hills. Some of those same

Democrats and moderates (someone will have to define a moderate for me one of these

days) are balking at the President's call for a public health care option to compete against

the private insurance companies. (Paul Krugman wrote that without a public option

there will be no reform.)

For their part, the Republicans unveiled their proposal to reform health care;

which consisted of a tax break for a medical savings account and allows small employers

to pool together to purchase health care. Talk about thinking inside the box. The

Republicans don't even acknowledge the tens of millions of Americans for whom a tax

break is meaningless based on their incomes; and they would essentially leave the system

exactly as it is now. The system as it is now requires Americans to pay more for health

care than anyone else in the industrialized world and get half the benefits. The system as

it is now doesn't cover about 48 million Americans, and the system as it is now will

bankrupt the nation as we scramble to find a doctor who will treat us. There is a huge

lack of primary care doctors, pediatricians, and family practice; because they are the

lowest paid and yet deliver the majority of care.

The snappy repartee has started. We are told in rapid succession that: we can't

afford health care reform, we will lose our choice of doctors, the private health care

industry might go out of business, no one will want to be a doctor anymore, the government

will be telling you how to care for your family, this is socialism, things are fine as they are.

With the snappy talk, of course, the cards are moving rapidly in front of you. The health

care industry is promising to reduce costs and deliver better care, cover more people,

and make it easier to see your doctor; while the pharmaceutical industry, just last week,

promised to reduce the cost of prescription drugs to seniors in Medicare by $80 billion.

(How long have the drug companies been telling us that they couldn't reduce prices because

of all the research and development costs for each drug?) Hospitals are promising to be

more efficient and make fewer mistakes; and even the AMA is chattering about how they

really want to support something, just not anything proposed so far.

What's a poor member of Congress to do? They want their contributions from

health insurance companies and big Pharma, and they don't want to alienate hospital

associates or doctors by doing anything they don't like. However, the latest polls show

that over 70% of Americans favor a public option in health care. Over 70% of Americans

want to see private insurers have some competition; and want the option that if the

health care industry doesn't keep it's word, they will have another option to pick from.

These poor members of Congress are being asked to choose between the people that

show up at their fundraisers, and the "people" they supposedly represent. How unfair

and unrealistic to expect them to choose.

With the snappy chatter getting louder and louder, and with the cards moving

faster and faster, what is a simple taxpayer to do? How do you guarantee to find the

red queen when the cards finally stop? You keep your eyes on the prize and ignore all

the distractions. Don't listen to all the talk about cost. While the Congressional Budget

Office can estimate how much it could cost to implement health care reform, it has no

idea how much it could save. The cost savings from people having a regular doctor

instead of using emergency rooms would be enormous. The cost savings of preventing

illness rather than treating someone after they are sick would be in the billions. The

ability to address obesity, diabetes, heart disease, and other increasingly common ailments,

early and comprehensively, would reduce health costs dramatically and improve the quality

of life for millions of Americans (By the way, how much is the quality of life worth these

days?) Don't pay attention to those who want to scare you by claiming you won't get your

own doctor anymore, or who raise the boogeyman of big government impersonally forcing

you to take care you don't want. (Americans in Medicare, Americans who use the VA

medical system, and members of Congress all get government health care of some kind

with high levels of satisfaction.)

The red queen is right in front of you. If whatever is proposed does not have a

public option to compete with the private health insurance companies, you have been

cheated. If the "moderate" Democrats try to support something other than a public option,

you have been bilked. If the President signs a bill that doesn't increase competition and

cover everyone, you have been flim-flammed. You must keep your eye on the prize.

There is still plenty of work to be done. Contact your member of Congress and

stiffen his or her spine. Contact Nancy Pelosi and Harry Reid and tell them they lose your

political support if they don't produce a public option. Let the White House know that as

much as you love Obama (his favorability numbers are still high); you will not support

him on any bill he signs which doesn't have a public option plan.

Those who want to derail this movement will try any tactic to scare you or

cause your disquiet. They will try to get you to look away from the card table and slip

the red queen by you. They know if they can stop this reform this year, they can stop it

for the foreseeable future. The question is will they succeed in talking a good game and

distracting you, or will you concentrate with a steely-eyed gaze and end up being one of

the rare winners in a Three Card Monte game? What do you think? I welcome your

comments and rebuttals. Please send them to lionoftheleft@gmail.com