With the passage of the Democrats' health bill, Congress and President Obama have created a new (and not so new) legislative framework for health care finance in the United States. Now that we've officially entered the post-legislative period, it's worth noting how we got to where we are.
The for-profit insurers and their health industry allies sunk their claws into the legislative process early and hung on to the very end. The new bill largely reflects their handiwork. Stock prices for virtually all the leading private insurers remain high and have been trending upward. Investors are also bullish on the promising prospects for the drug companies and for-profit hospitals in the wake of the bill's passage.
The attacks on the Democrats' bill from the right-wing Republicans and their proto-fascist allies, including many so-called tea-baggers, were fierce, sometimes absurd and frequently despicable. The racist and homophobic assaults on supporters of the bill set a disturbing, new low for contemporary U.S. politics.
Politically, it can be argued that Obama and his administration squeaked through a highly significant victory, made so by the shameful strategies of the Republicans and their allies. It's a fact that a defeat for Obama engineered by these reactionary forces would have poisoned the climate of political discourse seriously. Nevertheless, the bill is full of pitfalls that harbinger ill for the American public as patients.
Blue Dog and anti-abortion Democrats held out for their agenda until the very last minute, wresting still more restrictions from their party's leadership (at the expense of millions of women and ordinary working people) and making the final vote very close. The bill's curtailment of reproductive choice prompted an appropriately stinging response from the National Organization for Women.
For those of us who wanted to see more fundamental and progressive reform - specifically, those of us who called for sharply reducing the role of the profit-driven insurance companies and Big Pharma in our health system - it's fair to say that virtually no gains were made.
The systemic cause of our universally judged "broken" health care system - the role of the private insurance industry - was not substantively addressed. In fact, the role of that industry was actually strengthened with the passage of this bill.
So what did we end up with?
There are a number of qualified virtues in the bill. Among these are certain restrictions on the ability of insurers to deny coverage to persons with pre-existing conditions, the allowance of children up to the age of 26 to be covered under their family's insurance plan, the expansion of Medicaid by approximately 16 million additional people (although it must be noted that the Medicaid remains badly underfunded and therefore provides substandard care), and new appropriations for community health centers and the training of primary care doctors.
It's worth noting that all of these modestly positive measures could have been enacted separately. Instead, they were linked with measures like a burdensome individual mandate on middle-income uninsured people to buy health insurance (a defective product, as many who use their insurance quickly find out), the handing over of about $450 billion in taxpayer money to the insurers in the form of subsidies, an excise tax on workers' health plans exceeding a certain threshold, and new restrictions on women's reproductive rights, to name just a few. At least 23 million people will still be uninsured by 2019.
Given the big role the insurers played in writing the new law, it's safe to assume they've created sufficient loopholes to protect their interests over both the short and long term. One example: only a few days after the bill was passed, insurers denied that they were obligated to issue coverage to children with pre-existing conditions, a key pro-reform talking point of the president. Under pressure, they've apparently retreated from this stance. But it's only a symptom of a larger problem.
The main cause of our dysfunctional health system, the for-profit private insurance industry, remains in the driver's seat, as the statement of Physicians for a National Health Program stresses.
The bill will do little if anything to check the runaway health system costs and their ability to visit bankruptcy and other forms of penury on the American people.
Simply put, the one rational remedy for all of this, single-payer national health insurance, is more urgent than ever. It's critical to our nation's health and well-being. It has been noted, accurately, that our persistent health care mess is threatening our economic status domestically and in global competition.
We have learned bitterly that the unlimited lobbying resources of the health industry giants can prevail in both chambers of Congress. Where, for instance, was the serious challenge from the 90 representatives on record in favor of H.R. 676, the single-payer proposal?
While the raucous and dangerous right-wing assault was unmitigated throughout the campaign, virtually no serious demand came from the progressive wing of the Congress.
Our work is cut out for us. We have the same important challenge faced by the civil rights advocates of the 1950s and '60s, which ended victoriously. The same steady expansion of popular awareness and demand to the level of a movement is the requirement to end the current corporate control of our health system.