It's worth recapping. Originally, there were three goals for healthcare:
- Universal coverage, cradle to grave, no pre-existing condition traps, no recisions, no inability to obtain coverage when you need it
- "Bend the curve": reduce the growth of costs of healthcare which have, in the past two decades, greatly outpaced inflation
- Improve the quality of healthcare
Many-- most?-- on the left believed the best way to accomplish these three goals was with the "single payer option", "Canadian style health insurance", "Medicare for all". Use the existing health care provider systems but pay for them with one insurance plan, provided by the government, funded by a mixture of premiums and taxes (including the current payroll tax).
In the single payer system, everyone would be covered, you would be unable to loose that coverage, and premiums would be affordable and not depend on your other health conditions. So the first goal would be covered.
By having this entity negotiate rates for pharmaceuticals and devices and setting standardized rates for procedures and care, as well as removing the profits of the insurance companies, the second goal would be met.
Finally, by setting up panels to determine best practices and encouraging their adoption nationwide, we would be meet the third goal as well.
Impartial ratings have indicated that it would meet its goals at the lowest possible cost to the United States.
As we all know, single payer was never seriously considered, although members of both the House and the Senate attempted to introduce it.
Our next fall-back was "true public option". Most of us defined that as "ability to buy in to Medicare instead of a private insurance company at any age". That was never put on the table either.
Neither of these were seriously considered because of opposition from the right.
Both Houses talked about weakened public options: some other, non-Medicare plan, or co-ops, or a new non-profit insurance company.
Anything except the weakest of public options (if you can call the weakest public option a "public option"; and perhaps even that) have also been dropped. Again, because of opposition from the right.
As of now, most people are betting that nothing will happen along these lines. We could still be surprised in reconciliation, but it looks doubtful.
"Universal health coverage" isn't a likely outcome of either bill. Their attempts at moving towards UHC have been summed up with the word "mandate". All Americans will now be "mandated" to purchase insurance; even if it is not affordable. That mandate has been insisted upon by the insurance industry and so has been championed by their allies on the right.
In a non-public option realm, the best attempt to make health care affordable is to subsidize people of limited incomes. Those subsidies have been cut at the request of-- who else?-- the right wing.
To keep catastrophic care (car wrecks, cancer treatments, transplants) from bankrupting their unfortunate victims, clauses were added to remove maximum payments. Those, too, appear to have been removed from the Senate legislation (at least)-- presumably, at the behest of the right.
Any attempts or discussions of limiting reimbursements or setting up best practice boards to make sure that all Americans receive high-quality health care but that money isn't spent on procedures and treatments and devices that provide little or no benefit and may cause harm have been curtailed or eliminated because of the right-wing, "tea baggers" and their demonization of these policies as "grandma killers".
So to recap:
- The current "health care reform bills" won't provide universal coverage
- Healthcare costs may be unaffordable for some or many Americans and will continue to skyrocket for all
- People who are unlucky enough to get very ill may still find themselves destitute
- Best practices will not be encouraged or enforced, leaving many people obtaining expensive and potentially harmful care of possibly dubious value
Everything that made this bill good, both from a policy and politics perspective has been removed.
As a bonus, the Republicans who spent all summer screaming about how healthcare reform would allow government to come between patients and their doctors have now inserted language in bills before both Houses to limit choice of patients when it comes to reproductive medicine. I'm not here to debate the abortion issue now: just to point out the hypocrisy of opposing healthcare because of government intrusion, only to use the bills themselves as a means to do just that.
So what is there in this bill to appeal to those of us on the left? There are attempts to improve coverage and affordability and provide subsidies; there's talk about studying best practices and trying to do something to bend the curve. That's about it. Not much and not clear of how much value.
For the right? They get a mandate that will increase subscribers of their insurance company allies. They have eliminated the central negotiating body that would have put price pressure on other corporate allies. There is no new competition to the insurance companies that will lower their profit margins. The final governmental subsidies will most likely be smaller than necessary to keep healthcare affordable. And they get the choice wording they wanted in the bill.
So why are they upset? |
