Passage of President Obama’s health care reform in late March made for great political theater. Here was House Speaker Nancy Pelosi, skillfully maneuvering the bill through Congress after many had given it up for lost. Here was House minority leader and Republican point man John Boehner, reduced to ranting about ‘Armageddon’ and predicting the end of civilization as we know it if the bill passed. Here were Republican legislators egging on the mob of teabaggers who massed outside the Capitol, hurling racist and homophobic slurs at Representatives John Lewis and Barney Frank as they went inside.
I'll admit the scene worked on my emotions. The Republicans' tactics were ugly and cynical and I was happy to see them fail.
Now that the dust has settled, however, a hard look at the legislation that prompted all the fuss suggests that, far from ‘fixing our broken health care system,’ it merely reproduces some of its worst features.
The bill does nothing to lessen the grip of the private insurance industry on our health care system. It won’t bring exploding health care costs under control. It does little to change the shameful disparities in access to treatment in a society that treats medical care as a commodity to be bought and sold, rather than as something all of us need and deserve.
What it will do is require everybody to buy health insurance, with federal subsidies for those who can’t afford the premiums on their own. The price tag of these subsidies is $447 billion over the next ten years. That’s money that could have gone to pay directly for medical treatment but which will, instead, wind up in the pockets of the insurance industry - one more corporate bailout at taxpayers’ expense.
To help pay for it, public hospitals that treat the uninsured will have their federal funding slashed by $36 billion. Eight years down the road, union health plans and other job-based health insurance will be slapped with a 40% ‘excise tax.’ Protests from organized labor succeeded in getting this tax modified somewhat, but not eliminated from the bill.
The bill does expand eligibility for Medicaid, the federal health care program for the poor. And it is supposed to make it harder for insurance companies to deny legitimate claims or refuse to cover ‘high-risk’ patients. Insurance industry lobbyists, who actually helped draft the bill, swallowed these reforms in part because they’ll get 30 million new customers out of the deal, and in part because over the years the industry has proved adept at evading every government attempt at regulation.
Physicians for a National Health Program, which has led the fight for a single payer system comparable to what other developed countries have, likens the bill to morphine for a cancer patient. It lessens the pain for a while, but it doesn’t stop the cancer from spreading. Health care in the U.S. costs twice as much as in most other countries, mainly because the administrative costs of maintaining a private insurance system soak up nearly one in every three dollars we spend on it. And a big chunk of that money goes to buy politicians. The health care industry spent a record $266.8 million last year making sure nothing got into the bill that would seriously threaten its profits.
I’ve heard some interesting arguments over whether we’re better or worse off with this law on the books, but it’s really beside the point. The battle for universal, equal access to care still lies ahead, and it won’t be won until those of us who are victimized by the health care system have more political clout than those who profit from it.
The law’s shortcomings will provide ample organizing opportunities in the fight for true reform. Here are a few:
- Medicaid. It’s financed with matching state and federal funds, and while the federal government may have the money to pay for expanded eligibility, most states don’t. Oregon, where I live, already has a very liberal program of health care for the poor, but the state is so strapped for cash that it actually has to hold a lottery to determine which eligible people get benefits. And because an underfunded Medicaid program compensates doctors so poorly, many doctors are already reluctant to take Medicaid patients. The new law promises to make it easier for poor people to get care; we should be prepared to hold politicians’ feet to the flames if it doesn’t happen.
- Rate hikes. Since everyone will now be required to buy insurance or pay a fine, insurers are likely to take advantage of their captive market by jacking premiums up even more. There should be organized, angry protests every time it happens.
- Underinsurance. Before the law passed, a woman with ‘pre-existing’ breast cancer was apt to be refused coverage. Now she can’t be denied coverage - but she may find that her new policy won’t pay for the extra round of chemotherapy or surgery she needs. Nothing in the law spells out what benefits must be offered for insurance plans to qualify for the government-run ‘health insurance exchanges’ that will be set up in 2014. The requirement that everybody buy insurance will mean a proliferation of cut-rate policies that are of no use when you most need them. When policies like that go on the market, we should read the fine print and expose them for what they are.
- Inadequate regulation. Supporters of the new law boast that it outlaws ‘rescissions,’ the practice of cancelling a policy as soon as a policyholder files a claim. But rescissions were already illegal! State regulators simply didn’t enforce the law. We need to keep a close eye on them and demand that they do their job.
- Employer mandates. “If you like the coverage you have, you can keep it,” says Obama. But it’s really your boss’s decision, not yours. The penalties for employers who cancel their coverage are too small to discourage them from cancelling or cutting back on increasingly costly employee benefits. Unions can expect continued brutal fights over health insurance at contract time. Whenever it happens, they shouldn’t hesitate to point out that health benefits shouldn’t even be on the bargaining table - the government should be picking up the tab for everybody, regardless of where they work or how much they make. Only by advocating for health care for all can unions win public sympathy when their own coverage is under attack.
- Penalizing the uninsured. A lot of people who can’t afford to buy coverage, even with federal subsidies, will get stuck with stiff fines for remaining uninsured. They need to become organized and visible and demand relief.
- Discrimination. Denying coverage to immigrants is a particularly ugly and pointless feature of the new law. Preventing sick people from going to the doctor doesn’t ‘secure our borders’ or discourage people from coming here, as anti-immigrant propagandists claim. It just means more needless and untreated illness and more pressure on overburdened hospital emergency rooms. Full access to health care is a key component in the battle for immigrant rights.
- Federal deficits. As costs keep rising, subsidizing insurance premiums will inevitably add to an already huge federal deficit. There will be intense pressure to cut necessary social programs, including Medicare, to pay for it. In defending those programs, we should be prepared to raise the issue of single payer - pointing out that a universal government-funded health care system would save the taxpayers billions and make those cuts unnecessary.
It’s common for politicians like President Obama to say they support single payer ‘on principle’ but don’t consider it ‘realistic.’ The truth is that it’s the only realistic solution. Nothing else will solve our health care crisis. We have to keep the heat on until we get it.
Peter Shapiro co-chairs the Health Care Committee of Portland Jobs with Justice.