By Claudia Chaufan
Santa Cruz Sentinel
04/25/2010
Right after the passage of the Patient Protection and Affordable Care Act, Sentinel reporter Kurtis Alexander listed among its benefits that close to two-thirds of Santa Cruz’s County 45,000 uninsured residents would become insured, and that those under 26 years of age would now be allowed to remain in their parents’ plans.
Is this great news and should we uncork the champagne? Not yet. Here go selected facts for the reader to assess:
First, health insurance is just a means to the real thing: health care. Yet the promised coverage is an umbrella full of holes under pouring rain. Under the hundreds of pages of the bill, one discovers plans that pay as little as 60 percent of “covered services” — and what this means is anybody’s guess. We do know, however, that there will be “four levels” of coverage, of varying prices. Guess what will drive people’s “choice” of level? Probably not their medical needs.
We also know that skimpy coverage can be as bad as no coverage. Harvard researchers have shown that close to 80 percent of medical bankruptcies occur among the insured. Yet deductibles, co-pays, and co-insurance render their policies worthless and health care ultimately unaffordable. As to “lifetime caps,” many among those pushed to bankruptcy go broke way before they reach those caps, which apply only to “covered services” anyway. “Uncovered” ones, even if medically necessary, are on us.
Second, being “allowed” coverage under one’s parents’ plan assuming one’s parents have one is an “advantage” if the alternative is nothing. But of course this alternative is false. Young adults in all industrialized nations except for us have a right to health care. Their medical bills are paid by pools of shared savings to which everybody contributes a predictable proportion of income. Profit from selling policies for medically necessary services is virtually banned. One can buy the “over and above” through private insurance or cash, of course. And they pay a fraction of our price tag.
Third, the promise that insurers will no longer be able to cancel policies is the greatest scam. They are still allowed to cancel them for “fraud,” the number one cause insurers allege today for cancelling policies when people get sick.
Last, the act leaves 23 million uninsured by 2019, according to the Congressional Budget Office. This translates into 23,000 deaths annually.
Did it need to be like this? Not at all. Had “all the options” been on the table, as promised by President Obama, Americans may have achieved what others have enjoyed for decades: the ease to pursue our dreams, including our dream job, without fearing that we or our loved ones won’t be able to see a doctor.
But of course there were strong countervailing forces. As the PBS-Frontline production “Obama’s Deal” showed, the administration struck several backroom deals that left us with a bill virtually written by a major insurer, WellPoint Inc. So it succeeded in passing “reform” by legally binding us to buy shoddy products, some of us with “help” subsidies from our own pockets, thus consolidating the major transfer of wealth from Main Street to Wall Street of the decade second only to the transfer to finance.
Can we do something about it? Yes we can. We can support the right of states to try the best ways to provide health care to the population. This is the goal of SB 810, a single payer bill introduced by state Sen. Mark Leno. This bill would implement a publicly financed, privately delivered, single payer system that would provide comprehensive coverage to all California residents and allow the choices that really matter — of health professionals and needed services — at a price that not only “the budget” but individuals and families can afford.
Californians can show the way.
Dr. Claudia Chaufan is an assistant professor of Health Policy and Sociology at the Institute for Health and Aging, University of California San Francisco, and vice president of the California Chapter of Physicians for a National Health Program, a national organization that advocates for National Social Insurance along a single payer model.