Better to Start Over Than to Pass These Bills

By Athena Godet-Calogeras, Peter Mott and Andrew Coates
The Buffalo News, Dec. 17, 2009

You might think that all of us who have worked so long and so hard for comprehensive and affordable health care would be jumping with joy at the recent passage of a House bill and the opening of the Senate debate on health insurance reform. Not so.

In fact, many of us, including some in Congress who are ardent proponents of universal health care — like Rep. Eric Massa, D-Corning— are convinced that the route to comprehensive and affordable health care has taken a dramatically wrong turn.

The main features of the legislation have often seemed obscure, despite unprecedented amounts of attention. For instance, neither a “government takeover” nor a “public option” really have anything much to do with the final bills.

Instead the centerpiece of the House bill will not start until 2013 (2014 in the Senate bill) and at that time health insurance will become mandatory for virtually every person, every family. Being uninsured could become a crime, punishable by an annual fine of up to 2.5 percent of adjusted income under the House bill. The fine in the Senate bill is lower, $95 per person starting in 2014, rising to $750 by 2019.

To make insurance affordable, tax money will be used to subsidize private insurance premiums for those who earn up to 400 percent of the federal poverty level. Even with these subsidies, presently uninsured families with income between 200 percent and 400 percent of poverty will be required to spend 8 percent to 12 percent of their income to purchase insurance. Meanwhile the insurance companies stand to gain tens of millions of new customers and at least $447 billion in taxpayer subsidies.

The bills in Congress offer no meaningful cost controls. Mild promises to “bend the cost curve” fall short when even middle-income people will still end up being saddled with huge, unsustainable health care costs.

Neither will the bills make health coverage universal. By 2019 the House bill still leaves at least 17 million uninsured in the United States. The Senate bill would do less.

Nor will the bills do anything substantial about the high cost of drugs. That is why the pharmaceutical industry has spent hundreds of millions of dollars to help pass the legislation.

We agree with Massa. These “solutions” in Congress will not fix the problems we face. We do not need “insurance reform.” We need health care, comprehensive and affordable for everyone. And we need it now, not over the next four to 10 years.

Congress should reboot the process and start with a proposal for workable reform: a single-payer, national health program, an expanded and improved Medicare for all.

Athena Godet-Calogeras is chairwoman of the Health Care Access Coalition (Allegany/ Olean). Peter Mott, M. D., is associate professor (retired) of community medicine at the University of Rochester. Andrew Coates, M. D., is assistant professor of medicine and psychiatry at Albany Medical College.