Usually, the politics of health care remain obscured behind clouds of professional jargon, indecipherable acronyms and economic quackery, but, lately, one clear fact has emerged: Americans hate corporate medicine even more than they despise big government. Unfettered free enterprise may work in theory, but too many people have felt the invisible hand of the medical market tighten into the clenched fist of the insurance bureaucrat.
So consumers are again becoming citizens, who demand that government do its job-to protect them and their families from the rapacity of an unregulated industry.
Having rejected the incomprehensible plan for national insurance laid out by the Clintons in 1994, voters have had a bitter taste of the Republican alternative, and they don’t like it. Politicians in both parties and corporate executives are scrambling for some kind of regulatory compromise, as two symbolic leaders head toward a classic confrontation. On the left is Senator Edward Kennedy, the Democrat of Massachusetts who has spent almost three decades fighting to provide decent health care as a right of citizenship and liberal legacy. On the right is J. Patrick Rooney, conservative activist and chairman of Indiana’s giant Golden Rule Insurance Company, whose goal is a thoroughly privatized system that caters to the rich.
Mr. Rooney is not as famous as Mr. Kennedy, of course, but he is a man of considerable eminence in Republican and right-wing circles. As a donor of millions of soft and hard dollars to G.O.P. candidates and causes over the past few election cycles, the Golden Rule boss has exemplified the rule of gold in national politics. He is a confidant of House Speaker Newt Gingrich and other paladins of the Republican revolution, and most recently helped to bankroll the failed California initiative to curtail campaign spending by unions. Straddling the nexus of the health care industry and the Republican Congress, Mr. Rooney could be the poster boy for campaign finance reform; in 1998 alone, he and his company PAC have given almost $90,000 in soft money.
Mr. Rooney is at once ideologue and special interest. Over the past few years, he has doggedly promoted tax benefits for “medical savings accounts,” a Golden Rule specialty that mainly benefits individuals who can set aside $5,000 a year to cover their uninsured medical expenses.
Medical savings accounts represent a device for insurance executives like Mr. Rooney to profitably serve the healthy and wealthy while leaving the ill and indigent behind as wards of charity and government. Such a scheme would suck billions of dollars out of the insurance pool and into private accounts, resulting in fiscal imbalance and ultimate collapse for any insurer with too many sick and elderly clients. It contradicts the very idea of insurance, which is to spread risks over a varied population. This is not mere theory: Mr. Gingrich’s infamous remark about letting Medicare “wither on the vine” was a direct reference to his and Mr. Rooney’s plan to entice wealthy seniors out of the program with medical savings accounts.
Apparently, Mr. Rooney considers his business to be divinely inspired. As his company’s name attempts to suggest, he is a devout Christian. Occasionally, he cites New Testament teachings in dealing with obstinate government officials. Once, in a letter to Missouri insurance regulators, he wrote: “Jesus was put to death, not for his miracles, but for his criticism of those in power. If Jesus was forthright and critical of those who abused their positions of authority, we should be willing to follow that example.”
According to Scripture, however, Jesus didn’t let “pre-existing conditions” get in the way of healing the sick, as Mr. Rooney’s company has become notorious for doing. Before his Republican friends took control of Capitol Hill in 1994, Golden Rule was the subject of a Congressional investigation that uncovered many instances in which the company cited technicalities to deny coverage to consumers in dire need of care. In one amazing case, Golden Rule refused to reimburse a stroke victim in 1993 because he had suffered a bout of flu before signing up and failed to report it. After state regulators told Golden Rule to honor the claim, the company actually went to court rather than pay up.
Mr. Rooney’s chief nemesis is Mr. Kennedy, who has long opposed Golden Rule’s attempts to attach tax breaks for medical savings accounts to reform legislation. Responding to the abuses of unregulated insurance companies and H.M.O.’s, the Senator is seeking a “Patient’s Bill of Rights” that would mandate minimum levels of coverage and consumer rights, including the right to sue. In his view, “reform that forces companies like Golden Rule to compete fairly by providing good services at a reasonable price would put them out of business.” And good riddance.
The current struggle over health care reform offers a fair test of how deeply money has corrupted American politics. Given the desire of consumers-and voters-to punish medical predators, even all the gold poured into Congress by Mr. Rooney and his colleagues may not be enough to protect their rule.