Health Care Reform -- The Battle Has Just Begun

03/18/2010 05:12 am ET | Updated May 25, 2011

The battle for health care reform is going into the home stretch but by no means can a conclusion be drawn that we will see it and thus can rest our wary heads. As evidence of this, a huge rally is scheduled for November 17 in Chicago at meetings of the American Health Insurance Plans headed by Karen Ignani. If anything, the battle lines have formed that pit those in corporate America against the millions at the grassroots level. Who will win out -- those who wish to ensure healthcare for all Americans, as if a right, or a community service like riding the municipal bus to work or bringing heat to warm our homes, or those in the insurance industry whose bottom lines a recent Goldman Sachs report states will be adversely impacted by real reform and that the best option from the insurance industry perspective is to have no public option at all? Note, too, that the insurance lobbyists have spent upwards of $120 million to lobby Congress against reform. And in recent days, big insurance companies are emailing all of their thousands of employees to become their advocates to Members of Congress. Or, how about the threats of big pharma to pull out of the deal it made with the White House where it has committed $80 billion to shore up the donut hole in prescription drugs under Medicare so long as the government does not use its muscle to force drug prices to be negotiated. Funny that the drug manufacturers don't tell seniors that they (pharmaceutical houses) stand to make over $130 billion on an ongoing basis by committing a mere $80 billion. Looks like a good return on investment, huh? But does pharma think we can be fooled by thinking we are swayed by name brands here? Hardly.

To be sure, without incredible support and advocacy from grassroots support and organizational effort there, the progress to date for healthcare reform in the United States would have been a pipe dream. Not since 1965 when Medicare was enacted, and not since 1935 when Social Security became the law of the land, has a social program like reforming the health care system come as close as it has to enable all Americans to afford and access health care. But to become complacent because one chamber of our Congress has passed a bill is like looking at a fox in sheep's clothing guarding the chicken coop.

No doubt we will see considerable new regulations imposed on insurers like precluding pre-existing conditions from barring coverage; or seeing limits on what we pay for out of pocket expenses; or knowing that an insurance company will not be able to rescind an insurance policy once care and treatment is provided. But before you give out a hoot and holler here, know that such "goodies" increase exposures to the insurance industry that will cost them more money than they now spend, and take away from their bottom lines. That is okay with them so long as they have no real competitive check to their ability to raise premiums when they want in order to recapture some of this lost income. To state this slightly differently, we cannot let the industry preemptively gouge consumers while we wait for a public plan. This is where the public option comes in, and not one defined by a "trigger," or an opt-out, or opt-in, plan being tossed around in the Senate these days. Thus, while we may see insurance reforms coming our way once and for all, we will not yet see insurance industry reform until we have true competition to what private insurers have to offer us in the marketplace. All Americans must know that the (American) way to create competition in the private market is to have a public offering as a choice among choices. This is another way of saying to offer a Medicare like system for those not considered eligible for the present Medicare program.

Another fact that goes unnoticed is that a strong and effective public option for all spreads the risk for insuring entities. The more the risk is spread, the less the cost of the product will be for all. Insurance companies don't tell us this. A colleague from Illinois, Andy Kurz, a retired executive from a Blue Cross/Blue Shield company, has graphically shown that of the nation's 305 million in population, some 100 million Americans could become eligible to participate in it. This, then, is the goal for Members of Congress to consider when next debating the merits of a public option. Hand in hand with this is to ensure that the exemption from the antitrust laws that the insurance industry has enjoyed since 1945 is taken away.

One final thought. If we are fortunate enough to see President Obama sign a bill into law within the next couple of months, rest assured that those whose bottom lines will diminish because of it will not stop at finding ways to gain additional revenues by gouging us. That is why we need to ensure that key provisions become effective immediately upon a bill becoming law. As an example of what I am saying, look at what big banks did with the bailout money that came their way -- pocketing it in the form of big bonuses instead of ensuring community banks received their fair share so as to allow their small business customers to borrow from them and grow their businesses. Or, look at what the credit card companies have been doing in charging fees and costs (even for overdraft protection that fortunately is being corrected now through legislation) -- all to obtain additional revenues before the new law capping interest rate charges takes effect this coming February. And if you doubt what I am saying about insurers, look to the mails this Fall and see how much your premiums have gone up from a year ago!

So, to those who want real health care reform, you must not rest of your laurels. We cannot afford to become couch potatoes on this subject. The battle has just begun, but the "war" can surely be won by heeding the words of the famous New York Yankee catcher, Yogi Berra: "It ain't over 'till it's over."