It's been a while, and I thought it was high time to explain What To Think (tm) about the impending health care reform.
First things first. The bill as written is a mess. It's a product of a legislative process that both lacks leadership and has a large faction devoted to promoting ignorance and fear. Here's what's troubling about the bill:
1. No minimum level of coverage. The mandate's analogy to auto insurance is compelling to many people, but there's a huge difference: GEICO and State Farm can compete on price because they cannot compete on coverage. The basic coverage required by state law can be improved, but it's a floor that's also an adequate level of coverage. If a consumer takes only the minimum coverage, they'll be OK in the event of a claim. This omission is largely absent from the current debate -- and it's the #1 thing that makes the bill unlikely to improve anyone's health care coverage.
2. No Pre-existing Condition Exclusion. The health insurance lobby got rid of the "no pre-existing condition" language and have re-instated it as a basis for excluding coverage. Again, this received no coverage, but it's a problem.
3. The "subsidies" are a joke. They do not take into account anything like affordability. It assumes that $90,000 has the same value in Los Angeles as it does in Terre Haute, when it obviously does not. A family in NYC that makes $100,000 and pays $3200 a month in housing expense will be required to pay $15,000 a year or else face a fine of about half that (meaning they pay half and get nothing, coverage-wise). This is ridiculous.
4. It preserves the status quo for half a decade. The bill's provisions won't take effect until 2014. That's more than enough time for the moneyed interests to undo the beneficial effects of the bill.
5. Cost-Containment Is Absent. There's a lot of pilot programs to test various kinds of cost-reduction strategies, but there's no guarantee that even successful programs will ever be rolled out more broadly. Cutting the cost of health care in the US isn't a mystery that has flummoxed the nation's brightest minds for years. It's a goal that it antithetical to the interests of those with access to power.
6. It further codifies the Right's misogyny. Telling poor and middle class women that abortions are not for them is simply wrong. I can't imagine greater hypocrisy than saying abortions are OK only for those that can afford them. This is supposed to be principled? Complaining that you don't want your (federal) tax dollars going to support abortions is like me complaining that I don't want to have my (federal) tax dollars spent on killing innocent Yemeni women and children.
7. Public Option? Yeah. Um, just yeah. This was never going to be the panacea we all hoped it would be. At best, it was something that could grow into something useful, but that wouldn't happen for sometime. And in the meantime, we can come back to this, though I doubt we will. The sad truth is that in the class was in the US, the outcome is clear: the rich have won, and they will never accept quality healthcare for all. Being mean to our poor and weak is the hallmark of our society, and that's not going to change any time soon.
I could go on, but that covers it. There are some reasons to support the bill.
1. It goes far beyond what any Presidential aspirant proposed as recently as 2004. Compared to previous health care reform measures, this is significant. Remember it wasn't much more than a year ago that the President (Bush) vetoed a modest expansion in S-CHIP coverage for children. This bill undoes that veto and then some.
2. It signals to the health finance industry a cultural shift toward reform and meaningful cost control. This is the value of thought leadership. For tens or even hundreds of thousands of people who work in healthcare and its related financial industry, this bill will be an inspiration to consider new approaches, to take on things that were previously thought to be sacred cows, etc.
3. It makes Republicans mad. This is the best reason of all. And apart from the sport of seeing the likes of Jim DeMint and "Doc" Coburn fuming mad, this bill is only possible because of the GOP apporach. Their boycott of the process has meant that there are no "middle ground" bills to attract the weak minded Maine Senators and their ilk. For Dems, it's the Senate bill or nothing -- a choice that's bringing us the Nelsons and the Landrieaus.
Add it all up and I'd vote for it. A half loaf is on offer -- take it! I doubt there will be many benefits from it, but even a few benefits are worth it, and who knows, maybe when the electorate gets a load of their money being shovelled to United Healthcare, they might actually want real coverage. It's not likely, but it could happen! Ponies!