Wednesday, December 14, 2011

Everything is Political. Especially politics.

Thomas Mann, the German social critic and Nobel laureate once memorably said, "There is nothing that is not political. Everything is politics." Like much of what he wrote, he was dead on. Particularly in the politically charged atmosphere of a highly divided nation on the brink of an election that will decide whether or not it continues as a center-right social democratic republic or a hard right confederation of business-dominated special interests.

And nothing illustrates that like the debate over the Patient Protection and Affordable Care Act, known to Fox News viewers as Obamacare, but to the rest of us simply as health care reform. I'm not a huge fan of the PPA-ACA, but not because I believe it to be some sort of dark socialist plot to undermine the American health care system, but because I believe it to be a large-scale giveaway to insurance companies in the largest corporate raid on American pocketbooks ever. And because it does not solve the basic problem of health care for millions of people. Even the most rosy estimates of the PPA-ACA put the number of uninsured at 14,000,000 after the full implementation of the law in 2018. Single-payer, universal health care access would be cheaper, simpler and fairer. But the law is at least a start towards insuring that every American can get access to health care without using hospital emergency rooms as primary care centers.

One of the law's provisions is that each state must implement a state-run "health insurance exchange," a sort of Travelocity of health insurance, public and private. If a state elects not to do that, then the federal government will operate the exchange in that state. Back in March, South Carolina Governor Nikki Haley issued an Executive Order creating a nonpartisan South Carolina Health Planning Committee to decide whether or not the state should establish a health insurance exchange.

Today's Charleston Post and Courier published an article headlined "SC Gov. Haley dictated health panel finding" with the subtitle "Outcome ordered before committee met." The article cited recently released emails among the Governor, her staff and the Director of the the Department of Health and Human Services, Tony Keck. The work of the Committee, it charged, was a sham, and all along the Committee's report was fixed.

Don't believe everything you read in the newspaper. I know, because I was a member of that Committee.

 When Governor Haley asked me to serve as a consumer advocate and representative of the nonprofit sector, I agreed without hesitation. I spend way too much time advocating for quality health care access as a basic human right to say no to an opportunity like that. Besides, I wanted to advocate for a federally-run exchange, because I simply don't trust South Carolina state government to serve the interests of people who are not a)wealthy and b) well-connected. Whatever problems the federal government has in its programs to serve the poor, the sick, or the disabled, (and they are many) it still does it better than we do things when left to our own devices in the Palmetto State.

We worked long and hard through months of meetings, reams of reports, mind-numbing Power Points and expert testimony. Some members of the Committee originally felt that South Carolina should run its own exchange and tell the Feds to take a hike. But after all the work, and more than a few good-natured political jabs around the table, we came together in a final report that said there were so many unknown factors around the implementation of the law that we could not, in good conscience recommend a state-exchange. As one of the Senators on the Committee noted, "we can't even get the computer systems we have up to federal standards, there's just no way we are competent to do something this complicated."

We encouraged some interim steps: staying in serious conversation and negotiations with the federal agencies charged with implementation, encouraging private exchanges, and promoting smaller-scale, community-based health access networks, like the Duke Endowment funded AccessHealth SC and Tri-County Project Care, run by Charleston's incredible visionary surgeon, Dr. Casey Fitts.

And you know what? Not once did I hear from Governor Haley telling me to support a pre-determined outcome. Because if she had, I would have raised hell. And though I may have been the token liberal on the Committee, I believe many of the other Committee members would have as well.

Everything is politics. The Committee's final report contained a lot of politically charged language that made me roll my eyes. But I voted for it because, in 2014, South Carolina will not have a state exchange and barring a Supreme Court overturn or a Congressional roll-back, the federal government will be running the South Carolina Health Insurance Exchange and hundreds of thousands of people who don't have health insurance now will have it.

It's precisely the opposite of what the tea-guzzling-tell-the-feds-to-get-their-goddam-government-hands-off-our-health-care crowd wants. And that's a good thing.

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