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In an earlier post evaluating the House Health Care Reform Bill, I raised the question of the morality of voting for the bill, and argued that voting for it was an immoral act. Now that the Senate bill has been passed and includes many of the same features of the House bill including a “band-aid” period before the bill takes full effect in 2014, and the likelihood that a final Conference compromise will incorporate features of both bills, it’s time to raise the question of morality again. In connection with the House bill I said:

”So, what should we think of this bill, evaluating it from the perspective of what it provides in the band-aid period. Does it improve things in that period or not? Is it better than nothing at all? Is it an immoral and an intolerable bill, in some ways like Alan Grayson’s Republican plan saying to thousands of people each year, “If you get sick then die quickly.”

”The truth is that the bill does improve things immediately in 2010. It prohibits rescission. It provides a way, through the high risk pool, for people with preconditions to get insurance, even if it is at a high price. It also does some good things for Medicare recipients, and a number of good things that are part of the “goody bag.” Yet even though this bill is an improvement compared to the status quo, I think that both putting it forward and voting for it are immoral acts, if the bill, in any way, creates a dynamic that prevents us from, or weakens our efforts to, take up the health insurance reform problem in the next session, and thereafter, for as long as it takes to get a bill that will end fatalities, bankruptcies, and home foreclosures, due to lack of insurance.”

And to add a point Kip Sullivan made in a comment on one of my earlier posts on the House bill, one very important way in which both House and Senate bills hurt future efforts for health care reform is that they fail to provide legal protection against insurance company law suits, based on ERISA legislation, for States enacting single-payer reforms. Going on with my earlier statement:

”The overriding problem with the bill is that it prioritizes deficit neutrality over the deaths of many thousands of Americans per year. Yes, I said earlier that the bill will reduce the 45,000 annual deaths by some substantial amount, but in the “band-aid” period before the exchange takes effect in 2013, we’re still looking at 31,000 or so deaths per year from lack of insurance. And, even after that at current death rates due to lack of insurance we’re still looking at 11,000 annual deaths. These likely forecasts suggest that the current bill is a great moral failure of the Democratic Party and progressives who support it.”

Of course, the Senate bill provides an effective date of the exchange, the mandates, and the subsidies of 2014, which means that the fatalities to be expected before the effective date will rise to roughly 140,000, from the previous expectation of 108,000, under the House bill. In addition, the latest estimates on the Senate bill forecast 23,000,000 still uninsured by 2018, meaning that my previous estimate of 11,000 fatalities per year after the band-aid period due to lack of insurance for the House bill will rise to 23,000 per year in the Senate bill, which translates to another 127,000 expected fatalities, a grand total of 267,000 expected fatalities by the end of 2019.

Those urging passage of a bill that would be a compromise between the House and Senate bills, say that people have to evaluate such a compromise from the perspective of how it compares to no bill at all. And they argue that this bill is certainly an improvement over none at all, and they claim great credit for getting any legislation at all through Congress. However, that is a false framing, since the fair comparison of this bill is with other possibilities that are within the legal authority for Congress to pass, and that Congress could, if it wished, take up and pass right now. Alternative bills can be passed by Congress now using reconciliation or the nuclear option. It is not true that the only choice is between no bill at all and this one. So, why can’t a bill be passed that ends nearly all the anticipated fatalities due to lack of coverage, along with all the bankruptcies and foreclosures by the end of 2010? While there are many reasons that explain this including many political factors, and just plain, good old-fashioned corruption, the core political rationalization:

”. . . is that the bill’s number one priority is not solving America’s health insurance problem. It is, instead, to pass a bill that legislators can say is deficit neutral. That is “deficit hawkism,” the ideology that prioritizes bringing tax revenues and Government expenditures into balance ahead of other far more essential national needs and priorities. In the case of health insurance and health care problems, adhering to that ideology is not only mistaken, or stingy, or an instance of false economy, but given that it accepts the inevitability of hundreds of thousands of American deaths over the next decade, it is immoral. And its application in this legislation, which has led to the requirement that the final bill cost $900 Billion over 10 years and be deficit neutral, according to CBO estimates, is also immoral.”

The extent of immorality accompanying the choice to vote for one of these two bills, or any compromise that retains its essential provisions is even more apparent, when we recognize that we have not applied that standard to the Bank and Wall Street bailouts, or to the Wars in Afghanistan, and Iraq. We do prioritize some things above “deficit hawkism,” just not the lives of more than 140,000 Americans over the next 4.5 years, and about 127,000 more over the next 5.5 years after that first period.

There are other reasons why choosing to vote for the bill is immoral, depending on its final provisions. The Senate bill allows unregulated price gouging by an industry with an anti-trust exemption whose companies would be allowed to legally fix prices.

Both bills, in slightly differing degrees, impose constraints on the reproductive choices of women.

After 2014, the Senate bill forces people to buy insurance they can’t afford from private insurers, as does the House bill after 2013. The subsidies don’t do anything about high out-of-pocket costs, which will be great enough to drive middle class people into bankruptcies and foreclosure, especially since lifetime caps are still permitted. Marcy Wheeler’s most recent analysis (see also related links) shows that many middle class people will end up paying an enormous amount for routine check-ups they would be entitled to have if they bought insurance, but that their budgets would not allow them to get care if those check-ups revealed any serious illnesses.

The bill facilitates the march of the American political system away from Democracy and toward Plutocracy. By failing to curb rising premium costs in the period up to 2014, the bill adds further to the income insurance companies can use to block further health care reform. So, it hurts the sustainability of political efforts at further health care reform, and their ability to gain strength over time. This highlights another progressive core principle violated by the bill. Every bill must be evaluated in terms of its political effect on democracy, and whether or not it facilitates the evolution of American democracy toward Plutocracy. Bills, like this one, whose effects will be to weaken rather than strengthen the sustainability of democracy, ought to be opposed in principle by progressives.

In addition, passing a bill retaining a “band-aid” period of perhaps 3 to 4.5 years, brings with it the near certainty, if we try to revisit health insurance reform, of having to face a propaganda campaign from those opposing further change, emphasizing the idea that we just got through legislating that, and that we therefore, ought to wait until the “band-aid” period is over, and the legislation with its public option plan, has had a chance to work, without considering more reform.

Looking at things from the perspective of these various reasons, and the possibility of other and better alternatives, and not from the perspective of whether they are better than no bill at all; the two pending bills, are both immoral and intolerable. Any compromise between them coming out of the conference committee needs to be defeated on moral grounds, and another bill needs to be quickly put in its place.

Since voting for these bills or any compromise between them is immoral, everyone who has had a significant part in their passage needs to be called to account. I, of course, don’t have the power to that, but I do have the moral right and duty to do it. I’ll adopt Emile Zola’s style in calling people to account for corruption in the Dreyfuss case in order to dramatize my call, and I’ll limit my calls to account to the Executive Branch and the Congress, since, in the end, people in these branches are the ones most immediately responsible for the bills we see before us.

I accuse: President Barack Obama, of manipulating the Congress in seeking passage of an immoral bill labeled “heath care reform,” but better labeled the Health Insurance Company Bailout Act of 2010.

I accuse: White House Chief of Staff Rahm Emanuel for acting as President Obama’s chief instrument of Congressional influence in seeking passage of the immoral Health Insurance Company Bailout Act of 2010.

I accuse: Speaker of the House Nancy Pelosi of leading the House of Representatives into successfully passing the House version of the immoral Health Insurance Company Bailout Act.

I accuse: Senate Majority Leader Harry Reid of leading the Senate in successfully passing the Senate version of the immoral Health Insurance Company Bailout Act, including his continuing support for and use of regular Senate Order in passing the legislation, to the exclusion of using either reconciliation, or the “nuclear option” removing the filibuster, when the use of either of these would probably have produced a bill that is not immoral.

I accuse: House Minority Leader John Boehner of contributing to the passage of the House version of the immoral Health Insurance Company Bailout Act by creating a solid front of “no” votes on “health care reform,” and in doing so supporting the interests of the health insurance industry against the interests of the American people including the middle and working class voters who provide the vast majority of Republican Party votes.

I accuse: Senate Minority Leader Mitch McConnell of contributing to passage of the House version of the immoral Health Insurance Company Bailout Act by creating a solid front of “no” votes on “health care reform,” and a solid front of Republicans threatening to use the filibuster to prevent any health care reform bill from reaching the floor of the Senate, and receiving an up or down vote requiring only a simple majority for passage, and in doing so supporting the interests of the health insurance industry against the interests of the American people, including the middle and working class voters who provide the vast majority of Republican Party votes.

I accuse: every member of the Republican Party in the House and the Senate of complicity in supporting their leaders in developing and voting for the immoral Health Insurance Company Bailout Act of 2010. And I accuse, in particular, Olympia Snowe, Susan Collins, Mike Enzi, and Chuck Grassley of having particularly great influence in weakening the Senate bill.

I accuse: every member of the Democratic Party in the House and the Senate of complicity in supporting their leaders in developing and voting for the immoral Health Insurance Company Bailout Act of 2010. I further single out for accusation, Representative Bart Stupak and Senators Max Baucus, Kent Conrad, Mary Landrieu, Blanche Lincoln, Ben Nelson, and Joe Lieberman. The first for successfully sponsoring an Amendment constraining women’s reproductive rights under the bill. The second, for his especially invidious role in taking enhanced Medicare for All “off the table” at the beginning of deliberations, and for his key role in crafting the health insurance company bailout that is the central characteristic of this bill. And the rest for their roles in gradually weakening and watering down the reform, while exhibiting to the nation at large the corrupt reality of how anticipation of the filibuster, and efforts to avoid it all costs, result in the weakening of reform legislation.

I accuse: every member of the Congressional Progressive Caucus except Dennis Kucinich and Eric Massa of complicity in supporting their leaders in developing and voting for the immoral Health Insurance Company Bailout Act of 2010. I single out for further accusation Lynn Woolsey and Raul Grijalva for their concurrence in this immoral act. And I further single out for accusation Marcy Kaptur for her vote in support of the Stupak Amendment constraining the reproductive free choice of women under this bill. I further single out noted members of the caucus including: Jon Conyers, Anthony Weiner, Keith Ellison, Alan Grayson, Donna Edwards, Barbara Lee, John Lewis, Eric Massa, Jerry Nadler, Jan Schakowsky, Louise Slaughter, Pete Stark, Maxine Waters, and Robert Wexler. While it may seem unfair to select these members of the Caucus for special mention, since they were probably among the strongest supporters of what would have been a moral bill; they were also the ones who have represented themselves as the strongest supporters of progressive principles, some over many years. They were the last line of defense for a moral bill in the House, yet they too bowed to the pragmatism of the moment and to the Administration and leadership narratives, and refused to stand on the principles that they themselves have claimed were at the core of their political identities. Shame on them for not standing with Dennis Kucinich and Eric Massa, and opposing the House Bill. And shame on them again now if they refuse to vote against a compromise bill that includes band-aid periods, mandates, and insurance company bailouts.

I accuse: every Senator who identifies themselves as a liberal or progressive, for not standing up for their principles and forcing Harry Reid to seek to pass this bill by using reconciliation or “the nuclear option.” Deserving of special mention here are: Bernie Sanders, Sherrod Brown, Russ Feingold, Pat Leahy, Al Franken, Sheldon Whitehouse, Tom Harkin, Ron Wyden, Patty Murray, Dick Durbin, Barbra Boxer, Byron Dorgan, Barbara Mikulski, Ben Cardin, Jay Rockefeller, John Kerry, Maria Cantwell, and Paul Kirk. All that any small group of these Senators needed to do is to tell Harry Reid and the President that they would not vote for any bill with a mandate that did not also come with a Medicare option for everyone, and Reid would have had no choice but to turn to reconciliation and new negotiations to find a bill that could gain 51 votes or perhaps only 50 + 1. However, these progressives could not be counted on to stand on principle against the immoral Health Insurance Company Bailout Act of 2010.

When contemplating American politics today, it’s hard not to think of Yeats’s line from the Second Coming:

”The best lack all conviction, while the worst are full of passionate intensity.”

In the health care reform legislative process, the progressives held true to the slogan that “the perfect is the enemy of the good,” and they forgot the maxim that “if you stand for nothing, you’ll end up with nothing.” So, here we are with worse than nothing, with two immoral bills, that do more harm than good, and with every prospect that an equally bad compromise between them will be presented to both Houses for final ratification.

That immoral compromise needs to be defeated. Health Care Reform must be sent back to the Leadership for further work. If Congress is not immediately ready for true health care reform ending the fatalities, bankruptcies and foreclosures within a years’ implementation time, then, at least, a bill must be passed that ends rescissions, denials of coverage or price discrimination based on preconditions, and that limits insurance premium increases to the annual rate of inflation, effective immediately.

That sort of bill would reduce the fatalities, bankruptcies and foreclosures. It would not provide a solution to health care reform. But, voting for it doesn’t violate morality, because it would alleviate current conditions, while leaving open the possibility of legislating further incremental, or even more significant improvements, almost immediately without having to wait for a band-aid period to pass, and without having to be concerned about a politically strengthened insurance industry opposing further reform. That sort of bill doesn’t get us where we want to go. But it is a step down the path toward universal health care, not a detour toward lemon socialism in health insurance.

(Also posted at the Alllifeisproblemsolving blog and where there may be more comments)

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Joseph M. Firestone, Ph.D. is Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director and co-Instructor of KMCI’s CKIM Certificate program, as well as Director of KMCI’s synchronous, real-time Distance Learning Program. He is also CKO of Executive Information Systems, Inc. a Knowledge and Information Management Consultancy.

Joe is author or co-author of more than 150 articles, white papers, and reports, as well as the following book-length publications: Knowledge Management and Risk Management; A Business Fable, UK: Ark Group, 2008, Risk Intelligence Metrics: An Adaptive Metrics Center Industry Report, Wilmington, DE: KMCI Online Press, 2006, “Has Knowledge management been Done,” Special Issue of The Learning Organization: An International Journal, 12, no. 2, April, 2005, Enterprise Information Portals and Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003; Key Issues in The New Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003, and Excerpt # 1 from The Open Enterprise, Wilmington, DE: KMCI Online Press, 2003.

Joe is also developer of the web sites,,, and the blog “All Life is Problem Solving” at, and He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University.