By Eric LaMotte, Contributing Writer
Synapse, The UCSF Student Newspaper
April 8, 2010
Despite the intense efforts of a vocal minority, healthcare reform was enacted this year by congressional Democrats who claimed to place the needs of American citizens over those of corporations. Unfortunately, they chose to enact policies that will continue to allow a costly, complex, fragmented, for-profit insurance system to inflict damage on the rest of our healthcare system. Now, living in a post-reform world, we must decide where to go from here, and I am reminded of the error prompt that every frustrated computer user has had to answer at one point or another: Abort, Retry, Ignore?
Republicans are clamoring to repeal the law after November’s midterm elections. They want us to “Abort” our efforts for reform.
Congressional Democrats, the White House and the press want us to play dumb and pretend that the law is a “sweeping measure of reform” that is going to bring meaningful change to patient’s lives, and that we should wait ten years to see how the reform goes before tackling the subject again. They want us to “Ignore” the deficiencies of the new law, despite the fact that Massachusetts, our model for national reform, is already retracting the expansion of insurance coverage it enacted in 2006 and cutting payments to safety net hospitals in order to sustain a fiscally irresponsible model of reform. Massachusetts has the most expensive healthcare system in the world, and yet we are emulating this system in an effort to address rising costs.
Unfortunately, neither “Aborting” nor “Ignoring” are going to lower the $2.4 trillion dollars that we currently spend on healthcare, or get us significantly more healthcare for that pricetag. Neither option will decrease the 31% of healthcare costs that we spend pushing paper to figure out who’s going to pay for care. Neither option will prevent a middle-class family from going bankrupt when a parent gets very ill, has to temporarily miss work and is still on the line for paying her premiums, deductibles, 30% co-payments and full costs for out-of-network charges and uncovered benefits. This political triumph for Democrats is a policy disaster, shifting problems around rather than fixing them.
Instead, we must click “Retry” and quickly. Before HR3962/4872, the thing our country needed most from Congress was universal healthcare. After reform, it’s still universal healthcare.
Democrats could have improved Medicare and expanded it to cover all Americans, giving them full coverage for a comprehensive array of benefits (including dental, drug and mental health coverage) with no co-payments or deductibles: a 100% actuarial value plan. American residents would be guaranteed coverage from birth to death, without having to sign up year after year or worry about transferring insurance and providers with changes in employment. Patients would have full choice of doctor, without limitation to “networks,” and decisions about medical care would be restored to patients and providers. Private insurance would be allowed for any services not covered in the universal benefits package, such as cosmetic surgery. This is what is called a single payer system, since one organization is paying every part of every bill for every patient. The plan would be paid for by taxes that would replace the current mix of taxes, premiums, copayments, and deductibles, and would cost the same amount we pay now by eliminating $400 billion in bureaucratic waste from the system. In essence, Congress could have enacted a law that obviously and successfully prevents patients from going broke when they get sick.
Instead, Congress enacted a law that prevents patients from going broke in some ways – for example, by being rescinded from their plan – but leaves other ways of going broke wide open. You can bet that insurance companies will quickly adapt. As just one example, they could lower payments to providers, which would also cause providers to drop off the plan, making it harder to find a doctor who is “in-network” and raising the likelihood of out-of-network, uncovered charges.
Many progressives see these adaptations as a reason to trash corporations, and especially executives of private insurance companies. I think this reaction is ineffective and counterproductive, as it can turn off moderates and conservatives. Insurance companies are businesses, and they’re supposed to make the biggest profit they can within the boundaries of the law. We shouldn’t expect them to do anything else. The problem is not that they are evil, but rather that they are amoral, and yet we decide to put them in charge of access to a service with moral value. The fault is with us. If we are going to routinely consider the actions that we should naturally expect insurance companies to take to be abusive, then perhaps we shouldn’t put them in that position in the first place. Democrats, including President Obama, pretended to be outraged when Anthem Blue Cross threatened to raise premiums 39% in California, yet Democrats are unwilling to even allow the idea into the public debate that it might make sense to cut the private insurance industry out of the game altogether. They need to learn the meaning of the Ice T lyric, “don’t hate the player, hate the game.”
Amidst the already loud voices in support of “Abort” and “Ignore,” we need to raise a new and thundering voice for “Retry.” The national single payer bill described above is already written: HR 676. It’s thirty pages long, and written in plain English. It’s deficit neutral. It’s fiscally responsible. It guarantees access to healthcare as a right for all Americans. It has 88 co-sponsors, many of whom are “progressive” democrats who violated public promises to constituents by voting for a bill without a public option and are now in need of appealing to their base. Democrats have shown that they can pass something without the help of a single Republican.
Although San Francisco’s congresswomen are unlikely to work towards a new healthcare bill this year, we can make that their fault, not our own. Currently, neither Rep. Jackie Speier nor Speaker Nancy Pelosi are among the 88 cosponsors of the bill. If I know one thing, it’s that we won’t get single payer until we give our representatives no choice but to vote for it, by making our voices heard loud and clear. Don’t just call them today – keep them on your speed dial.
In California, we will have our own shot at enacting a statewide single payer system with SB 810. The bill passed the State Senate in January by a vote of 22-14. But it’s a long way from being enacted, and California’s idiosyncratic political system makes it unlikely that California will be the first state to enact a single payer plan. You can support real reform by joining efforts with PNHP/CaPA, CaHPSA, AMSA, CNA, or California OneCare.