The Health Care Voting Game – Bishops and Robber Barons

If you were a member of the House of Representatives voting on the House health care reform bill, then Saturday night the 7th of November was your chance to show appreciation to your sponsors. You could thank the Chamber of Commerce by voting NO because of the “public option.” You could keep your bishop happy by voting YES only after the plans in the “insurance exchange” excluded abortion. You would keep the medical technology barons off your back even though you voted YES since you worked the halls of congress to get the tax on medical devices lowered from 4% to 2%.

Setting aside the thanks to the lobbyists, how do we evaluate this bill? Its main advantage is expanding coverage. It could reduce the number of uninsured by two-thirds. It would accomplish this by increased Medicaid coverage for up to 130% of poverty and by subsidizing the purchase of for-profit insurance. Further advantages include various restrictions on private insurers, including no cap on payment for a single illness and no cap on life-time payments.

However the public option of the House bill would be doubtful as an advantage. Doctors and hospitals could negotiate higher fees and rates than in private plans. This would open the public option to the charge that in comparison with for-profit insurance it is a failed plan.

Foremost among the disadvantages is the expansion of the field for for-profit insurers. This has to be seen as privatization’s preemption of the last unclaimed frontier in health care. Privatizing Medicare is going at a snail space, so for privatizers, it is best to snatch the uninsured away while the government is still willing to pay the subsidies without demanding that the uninsured be put in Medicare. Also important is the exclusion of subsidies for undocumented migrants and of abortion coverage in a way that goes beyond what the Hyde Amendment calls for. Finally, the three year delay in applying the law to the uninsured not only blunts the effect of helping people in need but also opens up the possibility of health-industry-friendly revisions in regulations, a last minute rush of profit taking, and positioning by powerful companies to take maximum advantage of the new structures.

The House bill is better than what we might expect from the Senate bill, if indeed the Senate passes its bill. But the House bill is on balance a poor bill. It will create hyperinflation in health care because of the greater amount of business going to and the lack of pricing regulation of the insurance industry, hospitals, and doctors. Premiums for subsidized and other insurance will continue rising, since insurers and providers mutually benefit from higher premiums. Health reform without national affordability is no reform. Moreover, reform without universality violates solidarity among groups. But there is no universality where abortion and immigrants are excluded. So we need to protest any part of a bill that excludes plans covering abortion from the insurance exchange, where we would find people with subsidized insurance. And we need to work to eliminate any part of a bill that excludes immigrants from coverage by requirements for length of residence or by lack of documented status.

In the three years before a bill would become effective, we would have time to create a genuine national movement for some form of single payer insurance. Derailing a bill like the House bill before it gets to the President for his signature will not create a humanitarian disaster. In fact it will not be any worse than what we would have in those three years while waiting for implementation of the bill.

See the excellent statement by Rose Ann Demoro, president of the California Nurses Association for more.

Milton Fisk

November 10, 2009

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