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Healthcare Reform
Ladies, I need advice. Here’s the dilemma. What would you do if you wanted to affect positive change but you knew the change would not be well received if it was presented by a woman to an entrenched ole’ boys network? My head is telling me to get a man to make my case publicly and to stay behind the scenes for the sake of my cause. After all, isn’t the cause more important than being right?
But I don’t think it’s that simple. By remaining behind the scenes, do I risk winning the battle and losing the war? My heart is telling me to own the process and the “boys” will have to just deal with it. If I take this course of action, my proposal might fail, but at least a woman will have stepped forward and spoken up for what she believes. And frankly, I think we need to see a lot more of that going on. But then again, if I do speak out and lose the battle, does the establishment get to use me as yet another proof point for why women don’t belong in the game?
When Speaker of the House Nancy Pelosi was strategizing to move the health care bill through the House of Representatives last fall, she negotiated with Rep. Bart Stupak and the U.S. Conference of Catholic Bishops and struck a deal. Stupak would add an amendment to the bill severely restricting a woman’s access to reproductive services and in return his cronies would pass the bill. Following the passage of the amendment, women had to choose between accepting a bill that sacrificed their rights and supporting reform that would help so many Americans.
Obviously, my own dilemma is much smaller than healthcare reform and reproductive rights. But still it’s a compromise and the personal is political. What should I choose: stand up and fight or shut up and win?
WWND? What would YOU do?
Bruce Dixon over at BAR absolutely nails it. His post analyzes the absurdist theatre we’re now witnessing with Democrats and Republicans, which he compares to “televised professional wrestling.” Please go read the whole thing.
What I want to excerpt here, though, is Bruce’s cogent summary of just what the HCR bill does:
On the whole, the Obama health care legislation is just plain bad. It’s fake reform. Most of the people getting medical coverage for the first time under its provisions will get it through an expansion of Medicaid. The Medicaid expansion and inclusion of children in their parents’ policies till the age of 24 are perhaps the only unambiguously positive aspects of the bill, and both these could have been passed through the House and Senate at any time since the end of 2006.
Supposedly, insurers can’t refuse to insure anybody, or jack prices on the basis of pre-existing conditions, and can’t revoke policies when people get sick enough to actually use them. But so many loopholes and end runs have been written into the legislation that these and other widely ballyhooed provisions to safeguard the interests of patients are in fact meaningless. The ban on pre-existing conditions for example is negated by allowing insurers to offer “wellness” discounts. The older, the fatter, the less physically fit and the already sick need not apply for these discounts, and the fit will lose them when they gain a few pounds.
Insurance policies will continue to cherry pick their customers in the marketing, and like the credit card industry, insurers will now be able to evade already weak state regulators by selling policies across state lines. This will undoubtedly lead to concentrations of insurance companies in the least regulated states, and a race to the bottom. Health coverage that many working Americans now get will be steeply taxed, and to evade this tax employers will simply offer policies worth less, provoking yet another downward stampede.
Big pharmaceutical companies are assured exclusive rights for even longer periods than before to new classes of drugs, and insurance companies are prohibited from paying for the re-importation of drugs originally manufactured here from Canada, or combining to negotiate drug prices downward.
The ban on selling low-cost health insurance to the nation’s twelve or fifteen million undocumented means the border will now extend to every doctor’s office and emergency room in the land. And insurance policies offered through “the exchange” are prohibited from covering abortions or a list of reproductive health services.
Private insurance companies will use their all-too-real death panels to continue to decide which procedures they will cover, and which ones they won’t, and how much they will pay for them. Health insurance premiums will be capped at just under ten percent of a family’s income, but this will not include already high co-payments, or deductibles. In Massachusetts, where a version of the president’s plan has been law since 2006, sick people are forgoing treatment because they cannot afford the high co-payments and deductibles, and the flood of bankruptcies from unpayable medical bills is continuing.
The legislation is not a step toward single payer, as it removes none of the legal obstacles facing states which choose that path on their own. It’s almost a good thing that most of the bill’s provisions don’t take effect till 2014.
And of course the too big to fail private health insurers get a stream of compulsory customers, some of them paid for in part with government money.
Now I’m just waiting for John Cole to call Bruce a firebagger.
This handy chart is from the folks at Firedoglake. Note that it doesn’t address any of the woman-related issues we’ve discussed; this is just an analysis of the general provisions of the bill.
Myth |
Truth |
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1. This is a universal health care bill. |
The bill is neither universal health care nor universal health insurance. Per the CBO:
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2. Insurance companies hate this bill. |
This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009. The original Senate Finance Committee bill was authored by a former Wellpoint VP. Since Congress released the first of its health care bills on October 30, 2009, health care stocks have risen 28.35%. |
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3. The bill will significantly bring down insurance premiums for most Americans. |
The bill will not bring down premiums significantly, and certainly not the $2,500/year that the President promised. Annual premiums in 2016, status quo / with bill:
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4. The bill will make health care affordable for middle class Americans. |
The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can’t afford to use. A family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible. |
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5. This plan is similar to the Massachusetts plan, which makes health care affordable. |
Many Massachusetts residents forgo health care because they can’t afford it. A 2009 study by the state of Massachusetts found that:
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6. This bill provide health care to 31 million people who are currently uninsured. |
This bill will mandate that millions of people who are currently uninsured must purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties. Some will be assisted with government subsidies. |
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7. You can keep the insurance you have if you like it. |
The excise tax will result in employers switching to plans with higher co-pays and fewer covered services. Older, less healthy employees with employer-based health care will be forced to pay much more in out-of-pocket expenses than they do now. |
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8. The “excise tax” will encourage employers to reduce the scope of health care benefits, and they will pass the savings on to employees in the form of higher wages. |
There is insufficient evidence that employers pass savings from reduced benefits on to employees. |
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9. This bill employs nearly every cost control idea available to bring down costs. |
This bill does not bring down costs and leaves out nearly every key cost control measure, including:
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10. The bill will require big companies like WalMart to provide insurance for their employees. |
The bill was written so that most WalMart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage. |
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11. The bill “bends the cost curve” on health care. |
The bill ignored proven ways to cut health care costs and still leaves 24 million people uninsured, all while slightly raising total annual costs by $234 million in 2019. “Bends the cost curve” is a misleading and trivial claim, as the US would still spend far more for care than other advanced countries. In 2009, health care costs were 17.3% of GDP.
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12. The bill will provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition. |
Access to the “high risk pool” is limited and the pool is underfunded. It will cover few people, and will run out of money in 2011 or 2012 Only those who have been uninsured for more than six months will qualify for the high risk pool. Only 0.7% of those without insurance now will get coverage, and the CMS report estimates it will run out of funding by 2011 or 2012. |
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13. The bill prohibits dropping people in individual plans from coverage when they get sick. |
The bill does not empower a regulatory body to keep people from being dropped when they’re sick. There are already many states that have laws on the books prohibiting people from being dropped when they’re sick, but without an enforcement mechanism, there is little to hold the insurance companies in check. |
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14. The bill ensures consumers have access to an effective internal and external appeals process to challenge new insurance plan decisions. |
The “internal appeals process” is in the hands of the insurance companies themselves, and the “external” one is up to each state. Ensuring that consumers have access to “internal appeals” simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an “external appeals process,” as there is neither funding nor a regulatory mechanism for enforcement at the federal level. |
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15. This bill will stop insurance companies from hiking rates 30%-40% per year. |
This bill does not limit insurance company rate hikes. Private insurers continue to be exempt from anti-trust laws, and are free to raise rates without fear of competition in many areas of the country. |
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16. When the bill passes, people will begin receiving benefits under this bill immediately. |
Most provisions in this bill, such as an end to the ban on pre-existing conditions for adults, do not take effect until 2014. Six months from the date of passage, children could not be excluded from coverage due to pre-existing conditions, though insurance companies could charge more to cover them. Children would also be allowed to stay on their parents’ plans until age 26. There will be an elimination of lifetime coverage limits, a high risk pool for those who have been uninsured for more than 6 months, and community health centers will start receiving money. |
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17. The bill creates a pathway for single payer. |
Bernie Sanders’ provision in the Senate bill does not start until 2017, and does not cover the Department of Labor, so no, it doesn’t create a pathway for single payer. Obama told Dennis Kucinich that the Ohio Representative’s amendment is similar to Bernie Sanders’ provision in the Senate bill, and creates a pathway to single payer. Since the waiver does not start until 2017, and does not cover the Department of Labor, it is nearly impossible to see how it gets around the ERISA laws that stand in the way of any practical state single payer system. |
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18. The bill will end medical bankruptcy and provide all Americans with peace of mind. |
Most people with medical bankruptcies already have insurance, and out-of-pocket expenses will continue to be a burden on the middle class.
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*Cost of premiums goes up somewhat due to subsidies and mandates of better coverage. CBO assumes that cost of individual policies goes down 7-10%, and that people will buy more generous policies.
Documentation:
We spent all day yesterday glued to our Blackberry and to C-SPAN. The House finally voted in favor of healthcare reform sometime around 11 p.m. Sunday – but not before some very ugly moments elapsed and some serious negotiation –using women’s health as the bargaining chip – took place.
On Saturday, protestors in Washington yelled hateful racial and homophobic slurs at several Congressmen, and in cyberspace plenty of hateful posts could be viewed in Twitter streams. Then late Sunday night, someone on the House floor yelled “baby killer” at Rep. Bart Stupak.
Stupak had been threatening to derail healthcare reform unless the final bill included his amendment containing some very restrictive abortion language. But the bill before the House contained the Nelson amendment, which also restricted access to abortion coverage. Even though pro-choice advocates said the Nelson amendment was a major blow to women’s reproductive rights, Stupak wouldn’t yield. After whisperings about closed door negotiations between Stupak and Pelosi, and Pelosi and pro-choice Democrats, a deal was struck. President Obama agreed to sign an Executive Order effectively supporting the Hyde amendment, which is already in place and prohibits the use of federal funds for abortions, and Stupak agreed to support the bill.
Meanwhile, closer to home, it looked as if we might be getting our first application for the job we just posted. Late Friday a group of supporters posted on Blue Mass Group and Facebook that Harmony Wu, a Needham, Mass. resident and Democratic activist, was considering a run for the 9th Congressional District if Rep. Steven Lynch voted against the healthcare bill. He was indeed a “no” vote.
Here is a statement from Ms. Wu issued this morning. “Late last night, members of Congress cast an historic vote to pass comprehensive health care reform. I know I share my excitement of its passage with millions of Americans across the country. My gratitude goes to all who worked tirelessly to earn this important victory; when we work together, and each do our part, we can make great things happen. As excited as I am about this historic step toward health care for all, I am extremely disappointed that my Congressperson voted against the health care reform bill, demonstrating that he is out of touch with our families’ most important concerns. With this betrayal of key Democratic principles and priorities, we in the 9th district must strongly question whether Mr. Lynch can effectively represent us and stand up for our values. In the coming days, I will be in discussion with my family, members of my community, activists, and voters from across the district as I consider challenging Mr. Lynch for the Democratic nomination for Congress from our 9th district.”
We don’t know enough about Harmony Wu yet to determine if she meets all of the qualifications outlined in our job description. But she is definitely one to watch.
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