Arkansas Blog

Senator Lincoln's Health Care Hypocrisy

By Peter Dreier

Sen. Blanche Lincoln, although an ardent foe of a "public option" health insurance plan, has nevertheless been a fervent advocate of socialized medicine.  How can Lincoln-watchers make sense of this ideological contradiction?

The Arkansas Democrat recently voted to allow the Senate to debate the measure, but warned: "I've already alerted the leader,"  said Lincoln, "and I'm promising my colleagues, that I'm prepared to vote against moving to the next stage of consideration as long as a government-run public option is included."

For years, however, Lincoln has been big booster of one of the world's largest government-run health care programs - the Veterans Health Administration, often called the VA. Whereas Obama's proposed "public option" plan, and even Medicare, is simply a government insurance scheme that pays private providers. the VA actually owns hospitals and clinics. Last year, the VA, which has a $40 billion budget, treated 5.1 million veterans at its 153 hospitals and 900 outpatient clinics throughout the country.  The VA's 200,000 employees, including 14,500 doctors and 60,000 nurses, are government employees. You don't get much more "socialized" than that!

In Arkansas, the VA operates three major medical centers (in Little Rock, North Little Rock, and Fayetteville), 13 community-based outpatient clinics (in Jonesboro, Helena, Paragould, El Dorado, Ft. Smith, Hot Springs, Harrison, Mena, Mountain Home, Pine Bluff, Texarkana, Fayetteville, and Little Rock) and two vet centers (in Fayetteville and Little Rock).

Lincoln has voiced strong support for the VA. Earlier this month, for example, she issued a statement, posted on her website, declaring that she is "Fighting to improve heath care for service members and veterans by providing the VA with the biggest funding increase in its history, which has allowed the VA to better meet its current and future challenges by making needed investments in quality health care, expanding access and improving delivery of care, and enhancing numerous benefits provided to the estimated 257,000 Arkansas veterans and their families."

Lincoln proudly took credit for getting the VA to expand its clinics in rural areas, including a new clinic in Ozark that will open in July. She pushed the VA to expand its mental health services to deal with the growing number of veterans dealing with traumatic brain injury and post-traumatic stress disorder. In August, she hosted a forum at the VA hospital in Little Rock with the VA Secretary General Eric K. Shinseki to discuss new VA rural health care initiatives with Arkansas veterans and VA staff. The visit included a telemedicine demonstration that allows rural veterans to talk to a VA physician if they are unable to drive to a VA clinic or VA hospital. She has also cosponsored legislation to increase to increase the mileage reimbursement rate for veterans traveling to VA facilities.

Lincoln's strong support for the VA isn't surprising. The VA provides first-class health care. Two decades ago, it had a lousy reputation. But in the 1990s, the VA underwent a dramatic improvement that improved the quality of care and made it a model of medical efficiency. Experts say that VA has an excellent track record for restraining health-care costs. A recent Congressional Budget Office report concluded that the VA had a found a "substantial degree of cost control."

In 2003 the New England Journal of Medicine published a study comparing the VA and fee-for-service Medicare. On all 11 measures, the quality of care in VA facilities was "significantly better." Last year, according to the American Customer Satisfaction Index, patients a VA facilities gave the program an 85 satisfaction rating compared with 77 for private hospitals. Phillip Longman's 2007 book about the VHA is entitled The Best Are Anywhere. He concludes that VA facilities provide "the highest quality care in the country."

So why is Lincoln, the big VA advocate, giving her fellow Democrats heartburn by attacking Obama's "public option" plan?

Last July, Lincoln penned a column in the Arkansas Democrat-Gazette supporting a public option: "Individuals should be able to choose from a range of quality health insurance plans," Lincoln wrote. "Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan."

But the upsurge of right-wing rage over the summer, displayed a town meetings and on conservative talk shows, caused Lincoln to have a change-of-heart. She faces a difficult re-election battle next year. Several Republicans are gearing up campaigns to challenge Lincoln's bid for a third term. Polls have shown declining support for Lincoln.  She quickly backpeddled.

"I would not support a solely government-funded public option," Lincoln said at an event in Little Rock on September 1. "We can't afford that."

Lincoln's vote to allow debate on the public option again stirred the right-wing zealots. Last week, over 100 tea party protesters showed up for a candlelight vigil in front of her Little Rock office.

"The majority of Arkansans have told Senator Lincoln that they want health insurance, but they have very different ideas about how to achieve it," said Lincoln spokeswoman Leah Vest DiPietro. "There is general concern from constituents about spending and increasing the size of government."

But the nonpartisan Congressional Budget Office says the Democrats' bill raises enough money to reduce the deficit. Most experts agree that a government-backed insurance plan would force private insurers to lower their costs in order compete. Such competition,  experts suggest, would keep the private insurance companies honest.

Of course, the health insurance companies prefer that status quo. In almost every state, one or two companies dominate the health insurance market, according to a study by the American Medical Association. In Arkansas, Blue Cross/Blue Shield has 75% of the market, followed by United Health Group with 6%.

Under those conditions,  insurance corporations can drive up premiums, restrict coverage, and take advantage of consumers. Nationwide,  for example, health insurance premiums have been rising much faster than family incomes. A little more competition might be just what Arkansans need. The insurance companies don't want any competition from a government plan that would provide American consumers with a choice.

To maintain their oligopoly and big profits, the insurance lobby has been a generous contributor to Congress.  Over her career, the medical-industrial complex (including the health insurers, drug companies, hospitals and nursing homes, and medical professionals) has contributed $1.7 million to Lincoln,  $241,599 just from health insurance lobby.

Under the House version of health care reform, only couples earning over $1 million (and single people earning over $500,000) will pay a surcharge to fund subsidies for low-income and middle-class familiesm who could decide whether to purchase private insurance or use the public option.  If Congress adopts this funding scheme, it would impact only 1,560 households in Arkansas  -- the wealthiest one percent in the state. About 473,000 Arkansas residents lacked health insurance last year, according to the Kaiser Family Foundation. Almost all of them would be eligible for federal assistance under the Senate bill.

Arkansas voters have a right to ask Senator Lincoln:  Which side are you on?

Peter Dreier is E.P. Clapp Distinguished Professor of Politics and director of the Urban & Environmental Policy program at Occidental College.