There is more and more pressure--from small businesses, from Big Pharm and Big Insurance, from perenially anti-government, pro-business Republicans--to decimate any movement towards real reform of health care. The goal from the business lobbyists and friends is apparently an expanded version of the private system we have now, with government subsidies to support the continuing ability of private insurance to make lots of money spending lots of time trying not to pay for items that patients thought were covered.
For a smattering of the information about leegislative proposals and thoughtful commentary on the critical issues at this juncture, read some of the following:
Robert Reich, The White House needs to fight for healthcare, Salon.com, June 9, 2009
Reich asks whether the Obama administration will provide the strong leadership needed to prevent Congress from yielding to the various powerful lobbies. Big Pharm and Big Insurance don't want a real public option, and are pressuring for a watered down version (the trigger, or treating the government as though it were a private insurer): it is critical that we have a real public option that essentially expands current government health care programs to anyone who opts in. Similarly, businesses are lobbying for a broad exemption for "small" businesses that wouldn't have to pay or play--if there is a broad exemption, forget universal coverage. And it's not clear that even the Dems have the guts to make the wealthy forego some of the tax expenditures goodies they've been getting for decades to help pay for this bill--we should either eliminate the capital gains preference or limit the deductions for those with incomes over $250,000 a year. Get a backbone, Dems, else the people will vote you out of office for caving to the Big Banks, Big Oil and Big Health. (TheRepublicans would have caved without even trying to put up a fight. So Dems should get brave, do something real, and then tell the people about it til they understand the great victory they've gotten.)
E.J. Dionne Jr., Harry and Louise Have changed, Washington Post, June 8, 2009.
EJ Dionne explores the reasons that health system players are giving the appearance of public-minded readiness to work with health system reformers. Everybody knows that the fgovvernment has to intervene, else there will be increasing numbers of uninsured, resulting in increasing premiums and a vicious cycle that repeats til only the wealthy have any coverage. As Dionne puts it, "Leaders of the health industry know that unless more government money flows into the system, they will suffer along with everyone else" and "the experience of every other wealthy democracy in the world shows that health systems require large-scale government support."
But of course, we need to ask what do we get for that government money. If it works like the bank bailouts, where bankers and hedge funds and managers got lots of taxpayer money while taxpayers mostly got left with the (empty) bag, then it won't be a good deal. We ultimately need a single-payer, single-provider system so that people here will have as good a health care system as most of the other developed nations already have. Instead, we have a system where insurers make profits by ferreting out ways to deny coverage, and doctors and hospitals are richly compensated but many don't get health care. The insurance system, and perhaps the tax-exempt hospital system, require major reforms. Question is whether Congress has the stomach to enact appropriate reforms over the give-me-mine lobbying.
House Democratic Caucus "Key features of the Tri-committee Health Reform Draft Proposal in the House of Representatives" June 8, 2009 (BNA or Download Tri-Comm Health Reform Outline in House. 09-06-08).
This House plan has too much of the "blue dog" Democrats so that it looks like the Republican's ideal, since it doesn't create a genuine public option but essentially perpetuates the same private system with everybody mandated to pay into it. See, e.g., The House Tri-Committee Bill--the playing field just moved back to the middle, Health Care Policy and marketplace Review (Bob Laxzewski). A public (in name only) plan will be just one in the marketplace (an insurance "exchange") with private insurers. Private insurers will, in effect, be bailed out by government support for the health system through a "pay or play" employer mandate, but government will be powerless to set up a truly national public health system at much lower cost. Wouldn't private insurers, in spite of the benefits of government mandates and the government's taking on of more low-income populations in Medicare and Medicaid (reducing therefore, the real risks that would otherwise add to private insurer costs) continue to maximize their profits through claim denial, while government wouldn't--and so would have higher costs? This is not the option we should choose. Don't let the lobbyists lead you down this dead-end road, Congress.
Sentate HELP panel, Affordable Health Choices Act and summary (both on BNA).
Meanwhile, the Senate Health, Education, Labor and Pensions committee released its legislative proposal on June 9 that would require pay or play, insurance for all comers without pre-existing condition denials, limited private insurer profits, and a tax credit for small employers (25 or fewer employees) equal to 50% of the average contribution of small employers for coverage. See, e.g., Yoest, Sen Kennedy's Health Bill Unveiled, Sees GOP Criticism, Dow Jones Newswires, June 9, 2009; Bolton, Dodd, Kennedy to introduce healthcare reform bill, The Hill, June, 2009; Werner, Kennedy plans to pursue "American health Choices Act", Times Tribune, com, June 6, 2009 (discussing the draft of the draft released by Kennedy's office a few days earlier). Kennedy had planned a public "affordable access" plan that would offer a public plan option, but the bill, as released, merely has a placeholder requiring states to include a public insurance option in the gateway program but doesn't describe it, leaving it to be worked out "on a bipartisan basis." Baucus of Senate Finance--almost a right-winger on the question of a public plan-- still wields enormous influence, however, so we can't count on such a public plan. Note that the Republicans think the Finance Committee is paying more attention to them. Yoest, above.
Senate Finance Committee Chair Baucus and Budget Committee Chair Conrad, Patient-Centered Outcomes Research Act of 2009 (S. 1213) (on BNA).
The bill would establish an independent research institute to evaluate heath care treatments, financed by a head tax of $2 per person covered. See, e.g., PIPC supports New Senate Comparative Effectiveness Research (CER) Bill, MarketWatch,June 9, 2009 (press release from Partnership to Improve Patient Care, a group formed in November 2008 headed by former congressman and Democratic strategist Tony Coehlo).
We know that private insurance hasn't worked. Costs are mounting incredibly fast and tens of millions of Americans are uninsured and essentially at the mercy of hospital emergency rooms. Insurers make money by denying expected coverage, and weeding out the people that are most likely to need health care services. Veterans medicine (government-provided) works better.
We need an option for a real public plan that reimburses doctors and hospitals at a similar rate to Medicare. Congress just has to summon the guts to do it, and pay for it by adopting Obama's proposal to cap itemized deductions for those with incomes above $250,000. It's hard for me to see why those who want to get decent health care reform enacted should bother to listen to the "fiscal irresponsibility" complaints of right-wingers (who wrote a letter bemoaning health care reform proposals that would "increase our national debt and undermine our economy"). See Yoest, above. They simply have no credibility on issues of fiscal responsibility, after causing the country to borrow trillions during the Bush II years to fund tax cuts (mostly for the wealhy and big corporations) and irresponsible war mongering.
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