Of all the torrent of words that followed House passage of its version of healthcare reform legislation in early November, perhaps the most misleading were those comparing it to enactment of Social Security and Medicare.
Sadly no. Social Security and Medicare were both federal programs guaranteeing respectively pensions and health care for our nation’s seniors, paid for and administered by the federal government with public oversight and public accountability.
While the House bill, and its Senate counterpart, do have several important reform components, along with many weaknesses, neither one comes close to the guarantees and the expansion of health and income security provided by Social Security or Medicare.
By contrast, if the central premise of Social Security and Medicare was a federal guarantee of health and retirement security, the main provision of the bills in Congress is a mandate requiring most Americans without health coverage to buy private insurance.
In other words, the principle beneficiary is not Americans’ health, but the bottom line of the insurance industry which stands to harvest tens of billions of dollars in additional profits ordered by the federal government. Or as Rep. Eric Massa of New York put it on the eve of the House vote, “at the highest level, this bill will enshrine in law the monopolistic powers of the private health insurance industry, period.”
Further, while Social Security and Medicare, two of the most important reforms in American history, were both significant expansions of public protection, the House bill actually reduces public protection for a substantial segment of the population, women, with its unconscionable rollback of reproductive rights in the anti-abortion amendment.
Why then so much cheerleading by many progressive and liberal legislators, columnists, and activists?
1- Passage of the bill was a clear defeat for the Republican opposition and those on the right who have so mischaracterized what boils down to modest reform that looks more like a “robust” version of the Medicare prescription drug benefit or the state children’s health initiative.
2- Proponents of the bill, starting in the White House and running through the Democratic leadership in Congress, with the assistance and support of many in labor and liberal and progressive constituency groups, have so lowered expectations on healthcare reform that with eyes wide shut they can call this a sweeping victory.
To be sure there are commendable provisions in the House bill that bear note. Among the most important are:
- Expansion of Medicaid to millions of low income adults.
- Reduction of the “doughnut hole” in the Medicare drug coverage law making drug costs more affordable for many seniors.
- Increased federal funding for community health programs, such as home visits for nurses and social workers to low income families.
- Additional regulation of the insurance industry, mostly targeted to people who are presently without coverage rather than those with existing health plans. Those include limits on insurers ability to drop sick enrollees or refuse to sell policies to people with prior health problems, extending the age that dependent children can be on their parents’ plan, and repeal of the anti-trust exemption for insurers.
- Extending the same health benefit tax benefits available to married couples to domestic partners.
- A progressive tax to help pay the bill through a surcharge on wealthy earners and required contributions from large employers, in sharp contrast with the Senate proposal to tax health benefits on misnamed “Cadillac” plans, comprehensive coverage available to many union members, for example.
But the acclaim now flowing from some quarters would have been better deserved had these provisions been enacted on their own — not accompanied by the many shortcomings of the legislation. To cite a few:
- Healthcare will remain unaffordable for many Americans. The bill does not do nearly enough to control skyrocketing insurance, pharmaceutical, and hospital costs. Indeed, by various estimates, with no effective limits on the insurance industry’s price gouging, out-of-pocket costs for premiums, deductibles and other fees by some estimates with eat up from 15 to 19 percent of family incomes by several accounts.
- No meaningful reform of the rampant insurance denials of medical treatment the insurers don’t want to pay for.
- Little assistance for individuals and families who presently have employer-sponsored health plans and face frequent erosion of their coverage and health security. No help for the healthcare cost-shifting from employers to employees.
- Minimal expansion of consumer choice. The much debated public plan option will be available only to about 2 percent of people under age 65, mostly those now not covered who buy insurance on their own (it may or may not be expanded in 2015). Further, no additional plan options for those in the many markets dominated by one or two private plans, and no additional choice of doctor or hospital within existing plans.
- The new limits on abortion extended to poor women.
Ultimately, the combination of the mandate to buy insurance, federal subsidies to low income families to purchase private plans, failure to adequately control insurance prices or crack down on the abuse of insurance denials make the House bill — and its Senate counterpart — look a lot like a massive bailout for the private insurance industry.
Don’t be misled by the howling from insurance industry which has been spending some $1.4 million a day to steer the direction of legislation. They would have preferred the status quo, but will be more than happy to count the increased revenues coming their way.
As Rep. Dennis Kucinich said on the House floor, “we cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem.”
While some people will have improved access, the final accounting will be an even firmer private insurance grip on our healthcare system, with the U.S. remaining the only industrialized nation which barters our health for private profit.
Months ago, the Obama administration pre-determined this outcome by ruling out the most comprehensive, most cost effective, most humane reform, single payer, or an expanded and improved Medicare for all. Single payer proponents were shut out of White House forums, blocked from most hearings in the Senate, and single payer amendments stripped from the final House bill. Yet, through grassroots pressure, single-payer advocates forced consideration by the House of an improved Medicare for all until the very end.
But nurses and other single payer proponents who have heroically fought for this reform for years will continue the campaign, next in the Senate, where single payer amendments are expected to be introduced. The scene will also shift to state capitols, where vibrant single payer movements remain active and will escalate.
Proponents of comprehensive reform will never be silent, and never stop working for the real change we most desperately need.