Now That Obama's Signed It, Let's Reform the Reform

The Nation editorial
urging Congress to support President Obama's health-care reform
legislation recognized that the measure was flawed. But it argued that
there were practical and political reasons for supporting it.

The core point was that passing the bill needed to be seen as part of a process, not as a finished product.

As such, the editorial closed with the lines:

For all these reasons, we support passage of the bill,
even as we urge the progressive community to begin the struggle
immediately to correct its many flaws and improve its protections. Some
of this can be done quickly, via the reconciliation process. Some of it
can and should be done with new legislation, such as robust public
option bills by Senator Sherrod Brown and Representative Alan Grayson
and proposals to expand Medicare and eliminate the health insurance
industry's anti-trust exemption.

If this crucial second step is taken quickly and boldly, progressives
will have an agenda and an argument for maintaining the pressure
through this year's election cycle and in the years to come--when the
crucial details of the reform will be implemented. Are we prepared to
carry on a knock-down, drag-out fight with the insurance and
pharmaceutical industries? The opposition is formidable, but there is a
base for mobilization in both houses of Congress. Ultimately, our
message must be that genuine reform begins, and only begins, with
passage of the current legislation. It ends with achievement of the
goal that should be our new battle cry: Medicare for All.

On Sunday, that the House passed the legislation.

On Tuesday, it was signed by the president Tuesday at a celebratory White House ceremony,
where Obama declared that: "We have now just enshrined the core
principle that everybody should have some basic security when it comes
to their health."

Now it is time to begin building a "Medicare for All" framework around that core principle

And, as we suggested in the editorial, there are immediate steps that can be taken.

First, however, let's be clear: This reform, while meaningful, is
insufficient and must itself be reformed -- or, at the very least,
dramatically expanded and improved.

Here's what the leaders of Physicians for a National Health Care Program say about it:

As much as we would like to join the celebration of the
House's passage of the health bill last night, in good conscience we
cannot. We take no comfort in seeing aspirin dispensed for the
treatment of cancer.

Instead of eliminating the root of the problem - the profit-driven,
private health insurance industry - this costly new legislation will
enrich and further entrench these firms. The bill would require
millions of Americans to buy private insurers' defective products, and
turn over to them vast amounts of public money.

The hype surrounding the new health bill is belied by the facts:

* About 23 million people will remain uninsured nine years out. That
figure translates into an estimated 23,000 unnecessary deaths annually
and an incalculable toll of suffering.

* Millions of middle-income people will be pressured to buy
commercial health insurance policies costing up to 9.5 percent of their
income but covering an average of only 70 percent of their medical
expenses, potentially leaving them vulnerable to financial ruin if they
become seriously ill. Many will find such policies too expensive to
afford or, if they do buy them, too expensive to use because of the
high co-pays and deductibles.

* Insurance firms will be handed at least $447 billion in taxpayer
money to subsidize the purchase of their shoddy products. This money
will enhance their financial and political power, and with it their
ability to block future reform.

* The bill will drain about $40 billion from Medicare payments to
safety-net hospitals, threatening the care of the tens of millions who
will remain uninsured.

* People with employer-based coverage will be locked into their
plan's limited network of providers, face ever-rising costs and erosion
of their health benefits. Many, even most, will eventually face steep
taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as the experience
with the Massachusetts plan (after which this bill is patterned) amply
demonstrates.

* The much-vaunted insurance regulations - e.g. ending denials on
the basis of pre-existing conditions - are riddled with loopholes,
thanks to the central role that insurers played in crafting the
legislation. Older people can be charged up to three times more than
their younger counterparts, and large companies with a predominantly
female workforce can be charged higher gender-based rates at least
until 2017.

* Women's reproductive rights will be further eroded, thanks to the
burdensome segregation of insurance funds for abortion and for all
other medical services.

It didn't have to be like this. Whatever salutary measures are
contained in this bill, e.g. additional funding for community health
centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid - a woefully underfunded
program that provides substandard care for the poor - could have been
done separately, along with an increase in federal appropriations to
upgrade its quality.

But instead the Congress and the Obama administration have saddled
Americans with an expensive package of onerous individual mandates, new
taxes on workers' health plans, countless sweetheart deals with the
insurers and Big Pharma, and a perpetuation of the fragmented,
dysfunctional, and unsustainable system that is taking such a heavy
toll on our health and economy today.

This bill's passage reflects political considerations, not sound
health policy. As physicians, we cannot accept this inversion of
priorities. We seek evidence-based remedies that will truly help our
patients, not placebos.

A genuine remedy is in plain sight. Sooner rather than later, our
nation will have to adopt a single-payer national health insurance
program, an improved Medicare for all. Only a single-payer plan can
assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of
public financing, our nation could save $400 billion annually in
unnecessary, wasteful administrative costs. That's enough to cover all
the uninsured and to upgrade everyone else's coverage without having to
increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost
control like bulk purchasing, negotiated fees, global hospital
budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an
approach, and a recent survey shows 59 percent of U.S. physicians
support government action to establish national health insurance. All
that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until
2014. Although we will be counseled to "wait and see" how this reform
plays out, we cannot wait, nor can our patients. The stakes are too
high.

We pledge to continue our work for the only equitable, financially
responsible and humane remedy for our health care mess: single-payer
national health insurance, an expanded and improved Medicare for All.

Here's what National Organization for Women president Terry O'Neill, a particularly savvy commentator on this particular fight, has to say:

As a longtime proponent of health care reform, I truly
wish that the National Organization for Women could join in celebrating
the historic passage of the Patient Protection and Affordable Care Act.
It pains me to have to stand against what many see as a major
achievement. But feminist, progressive principles are in direct
conflict with many of the compromises built into and tacked onto this
legislation.

The health care reform bill passed by Congress today offers a
number of good solutions to our nation's critical health care problems,
but it also fails in many important respects. After a full year of
controversy and compromise, the result is a highly flawed, diminished
piece of legislation that continues reliance on a failing,
profit-driven private insurance system and rewards those who have been
abusive of their customers. With more than 45,000 unnecessary deaths
annually and hundreds of thousands of bankruptcies each year due to
medical bills, this bill is only a timid first step toward meaningful
reform.

Fact: The bill contains a sweeping anti-abortion provision. Contrary
to the talking points circulated by congressional leaders, the bill
passed today ultimately achieves the same outcome as the infamous
Stupak-Pitts Amendment, namely the likely elimination of all private as
well as public insurance coverage for abortion. It imposes a bizarre
requirement on insurance plan enrollees who buy coverage through the
health insurance exchanges to write two monthly checks (one for an
abortion care rider and one for all other health care). Even employers
will have to write two separate checks for each of their employees
requesting the abortion rider.

This burdensome, elaborate system must be eliminated. It is there
because the Catholic bishops and extremist abortion rights opponents
know that it will result in greatly restricting access to abortion
care, currently one of the most common medical procedures for women.

Fact: President Obama made an eleventh-hour agreement to issue an
executive order lending the weight of his office to the anti-abortion
measures included in the bill. This move was designed to appease a
handful of anti-choice Democrats who have held up health care reform in
an effort to restrict women's access to abortion. This executive order
helps to cement the misconception that the Hyde Amendment is settled
law rather than what it really is -- an illegitimate tack-on to an
annual must-pass appropriations bill. It also sends the outrageous
message that it is acceptable to negotiate health care reform on the
backs of women.

Fact: The bill permits age-rating, the practice of imposing higher
premiums on older people. This practice has a disproportionate impact
on women, whose incomes and savings are lower due to a lifetime of
systematic wage discrimination.

Fact: The bill also permits gender-rating, the practice of charging
women higher premiums simply because they are women. Some are under the
mistaken impression that gender-rating has been prohibited, but that is
only true in the individual and small-group markets. Larger group plans
(more than 100 employees) sold through the exchanges will be permitted
to discriminate against women -- having an especially harmful impact in
workplaces where women predominate.

We know why those gender- and age-rating provisions are in the bill:
because insurers insisted on them, as they will generate billions of
dollars in profits for the companies. Such discriminatory rating must
be completely eliminated.

Fact: The bill imposes harsh restrictions on the ability of
immigrants to access health care, imposing a 5-year waiting period on
permanent, legal residents before they are eligible for assistance such
as Medicaid, and prohibiting undocumented workers even to use their own
money to purchase health insurance through an exchange. These
provisions are counterproductive in terms of controlling health care
costs; they are there because of ugly anti-immigrant sentiment, and
must be eliminated.

Fact: The bill covers only 32 million of the 47 million uninsured in
this country, does not contain a meaningful public option and provides
no pathway to a single payer system like Medicare for all. Democratic
negotiators crumpled before powerful business interests and right-wing
extremists, and until they get a spine there will be no true
competition to help rein in costs.

The bottom line is that everyone -- citizen and non-citizen,
undocumented immigrant and visitor -- has a fundamental human right to
health care. This right has been denied in the U.S. for far too long,
while the rest of the industrialized world moved ahead to assure
universal and affordable care for their people.

We call upon President Obama and elected officials in both houses to
commit to a process of steady improvement of our health care system
that will result in true reform with universal coverage, realistically
affordable rates and no discrimination. We still have a lot of work to
do before we can genuinely celebrate.

Recognizing all of these criticisms as worthy of response, what's the
first step in the direction of the real reform that is needed?

A smart start to consider is Florida Congressman Alan Grayson's proposal to allow Americans who lack insurance to buy into Medicare.

As Grayson says, his plan "will provide real competition to the
private health insurance companies. Those companies make money by
denying people the care they need. My 'Medicare You Can Buy Into Act'
will go even further toward saving money and saving lives."

Grayson explains his proposal this way:

This simple four-page bill lets any American buy into
Medicare at cost. You want it, you pay for it, you're in. It adds
nothing to the deficit; you pay what it costs.

Let's face it. Health insurance companies charge as much money as
possible, and they provide as little care as possible. The difference
is called profit. You can't blame them for it; that's what a
corporation does. Birds got to fly, fish got to swim, health insurers
got to rip you off. And if you get really expensive, they've got to
pull the plug on you. So for those of us who would like to stay alive,
we need a public option.

In many areas of the country, one or two insurers have over 80% of the
market. They can charge anything they want. And when you get sick, they
can flip the bird at you. So we need a public option.

And they face no real competition because it costs billions of dollars
just to set up a national health care network. In fact, the only one
that's nationwide is . . . Medicare. And we limit that to one-eight of
the population. It's like saying that only seniors can drive on federal
highways. We really need a public option.

And to the right-wing loons who call it socialism, we say, "if you want
to be a slave to the insurance companies, that's fine. If you want 30%
of your premiums to go to 'administrative costs' and billion-dollar
bonuses for insurance CEOs who figure out new and creative ways to deny
you the care you need to stay healthy and alive, that's fine. But don't
you try to dictate to me that I can't have a public option!"

As of Monday, Grayson's bill has 80 cosponsors -- up 30 from last week.

The petition backing it has close to 50,000 signatures, with new backers signing on at a rate of one every ten seconds.

That's a good start -- in Congress and at the grassroots.

Grayson's legislation is not the end of the process. It's a next step
in the right direction -- the direction of "Medicare for All".