Co-authored with Rose Ann DeMoro, executive director, California Nurses Association/National Nurses Organizing Committee
Now we know why they've stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.
Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.
But, overall, the leading bills and the President's proposal are, like the dog that didn't bark, more notable for what is missing.
Here are 13 problems with the current health care bills (partial list):
1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.
2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.
3. No restrictions on insurance denials of care that insurers don't want to pay for. In case you missed it, the California Nurses Association/National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.
4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.
5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.
6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.
7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.
8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.
9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.
10. No definition of covered benefits.
11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn't want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.
12. Long delay in implementation. Many reforms don't go into effect until 2013.
13. Nothing changes in basic structure of the system; health care remains a privilege, not a right.
We may be slow learners, but the rest of the industrial world has figured it out: Universal, single-payer or national health care systems. That's the reason why all those other countries cover everyone, have better patient outcomes, cause no one to declare bankruptcy or lose their homes because of medical bills, and spend less than half per capita on health care than we do.
We could do it too, by reducing the starting age for Medicare from 65 to 0. There's still time to act.
Call on your Congress member to support the vote coming up on the House floor on the Anthony Weiner amendment to protect, expand and improve Medicare for All. Senators have the same opportunity in a vote on Senate bill 703, being offered as a floor amendment by Senator Bernie Sanders.
Democrats must also ensure that whatever bill passes includes a provision enabling states to set up their own single-payer systems. These votes are the true litmus tests of the Democrats' commitment to guaranteeing health care for all, and finally solving our health care crisis.
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