[edited to add links and correct typos, after first publication]
I'm not a fervid fan of the health care reform bill in its current shape but like most every progressive I know, I realize that it is time we did something to improve health care in this country and started on a road to adequate reform. The current bill won't get us all the way by any means--it is a patchwork piece of goods, with some measures to try to slow increasing costs, but not enough and missing the most important ones (like a genuine public option). But the US health care system is not in good health and is failing to serve ordinary Americans. The bill's reforms are much better than nothing, I think, and ought to be passed. After that, progressives need to continue the pressure for more health reform that takes "rentier" profits out of health care and puts this country on the same sustainable standard of universal basic health care that every other developed country in the world enjoys.
So it is good to see that there is progress. See McAuliff & Bazinet, Yes, he can? President Obama stays in DC to push health reform bill through final historic vote, Daily Post, Mar. 18, 2010. Passage is looking more likely, as the CBO has estimated that the current proposal would cost $940 billion over 10 years, but would shave $130 billion off the deficit in that time, with a longer term deficit cut of about $1 trillion over 20 years. It is now hoped that the vote can take place Sunday afternoon. Id. See also Ezra Klein, CBO: Health care reform bill cuts deficit by $1.3 trillion over 20 years, covers 95%, Washington Post, Mar. 18, 2010 (adding that the new bill should cover 95% of Americans). Senate Majority Leader Harry Reid has also released a statement today in favor of the health care reform version revealed today in the House, noting that we all "want access to quality, affordable health care, and the bill that the House introduced today moves us another important step closer to that reality." See Reid Voices Support for House Health Care Reform Bill, Political News, Mar. 18, 2010. As Reid also noted, given the support of most Americans for health care reform, the GOP opposition looks like a fight "for insurance company profits and rising health care costs--[i.e.,] more of the same." Id.
A few good things about this bill:
1) it gets us started on the right road --realizing we have an obligation as a country to ensure that nobody goes without decent health care just because they are poor, lost their jobs, or became ill with a disease that leads to catastrophically high medical bills, or are nearing death and need palliative care that is too expensive without assistance
2) it acknowledges the need for higher taxes to pay for benefits that we all know we should provide--including the proposal to have a 3.8% medicare tax on investment income for taxpayers at the $200,000 ($250,000 for joint filers) and up income level. I've explored the rationale for supporting tax increases on investment income from several perspectives, especially the value of eliminating the arbitrary and unfair capital gains preferential rate (my preferred solution to solving our deficit problem, along with substantial cuts to the military-industrial complex that seems to favor costly (in dollars, resources, environment, and human lives) perpetual wars, and the importance of raising funds fairly to provide for the social safety nets of Social Security and Medicare that have been so important in supporting the elderoly and poor in this country. The 3.8% tax on investment income to support Medicare is a good start in the right direction. It would be the first time we have applied the Medicare tax to investment income, since currently workers and their employers split a 2.9% tax that is only levied on compensation for services. See Health Bill Said to Add 3.8% Tax on Unearned Income, Bloomberg.com, Mar. 18, 2010.
3) It mandates that insurers accept people, rather than being able to choose to cover those who are likelier to be healthier so that they can make profits without providing health care coverage.
As readers know, I would have liked to see us reduce the role of for-profit insurance firms so that they cannot apply their investors' interests in higher and higher profits to the provision of health care in this country. Almost everyone who has needed anything unusual in health care has experienced the problems of our health care system based on rent profit-seeking by health insurance companies and private hospitals and too-high incomes for medical specialists while rural areas and family practices are drained of doctors. Those with serious medical problems are often thrown into bankruptcy because they can't pay for absolutely necessary health care--in fact, in 2007, 62% of all filed bankruptcies were linked to medical expenses according to a study in American Journal of Medicine. That figure we a huge increase compared to 2001. See Lovenheim, New Study: Bankruptcy Tied to Medical Bills, Wash. Post (June 4, 2009) (including link to study). Of course, since the study, the Bush changes to bankruptcy laws have made it more difficult to file while the stagnant wages of ordinary Americans and increasing premiums of for-profit health insurance companies have meant that even more Americans are uninsured. And those who've suffered job loss in the Great Recession at the same time that they have some major medical problem face enormous difficulty ever getting their lives on a stable financial keel again.
Most of us who haven't had catstrophic problems have nonetheless seen higher and higher premiums with less and less coverage, coupled with lots of inefficient bureaucracy as health insurance companies require loads of paperwork and then end up using every device possible to deny coverage and raise their profits. Here's just one of my own insurance horror stories. Quite a few years ago, I hurt my ankle badly at the beginning of a several months-visit to another city, so I had to go to the emergency room. I needed crutches for about 3 weeks. I submitted my insurance information for all the bills for the emergency visit (hospital ER was separate from the "medical devices", etc. so there were multiple bills). Just a week later, I received a bill from the hospital for the full amount, claiming that the insurance claim had been refused. I called my insurer, wrote my insurer, and everything seemed to fall into a dark void of "no response land." Weeks later, the hospital still hadn't been paid and I got another bill from the hospital, threatening to turn it over to a collector because I hadn't paid and the insurer had claimed it wasn't covered. (I had by this time looked at my policy to see. It was clearly covered.) Eventually, I paid the bill directly and many months later, finally got the insurer to reimburse me the appropriate amount. But the story during that interim was not a pretty one. The hospital had (accidentially one hopes) turned the bill over to a collector AFTER I had already paid the bill. I got a dunning letter. I sent the collector a copy of the paid receipt and sent the hospital a copy of the dunning letter along with a copy of the receipt for the bill I had paid. I got more dunning calls and more dunning letters. I sent a rather testy letter to the collector and hospital, again with copies of the receipt. The dunning calls and inaccurate collection notices finally ceased. All this because the insurer had done its best to try to deny coverage for something that was clearly covered under my policy (and because some hospitals are apparently so eager to collect that they hire collection services who don't really care if they end up collecting double or if they are dunning people inappropriately--remember the case of the Provena Hospital in Champaign-Urbana, Illinois that used collectors to go after the poor people aided in the emergency room).
Tax increases--especially on the super rich in the top 5% of the income distribution who were the only real gainers during the Bush period of stagnation and decline for ordinary workers' wages--make sense as a way to bring our economy back into better balance. We have allowed concentration of ownership of financial assets and concentration of corporations to increase markedly, while letting ordinary American workers bear the brunt of the burden to provide the benefit of spurts in concentrations of wealth for the wealthy. It's time to reverse that, and carefully targeted tax increases can do that. A release last July by Citizens for Tax Justice provides some interesting comparisons of tax increases that make sense for the country, showing that a graduated surcharge on high-income taxpayers, a medicare tax on unearned income, and a phaseout of the itemized deduction can make sense as elements in the effort to make what we spend fit within the revenues we raise. See Three Proposals to Pay for Health Care Reform without Hurting Struggling Familes in New York (July 15, 2009).
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