Passage of President Obama's healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent rightwing opposition. Now that we have an insurance bill, can we move on to healthcare reform?
As an organization of registered nurses, we have an obligation to provide an honest assessment, as nurses must do every hour of every day. The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth.
When all the boasts fade, comparing the bill to Social Security and Medicare, probably intended to mollify liberal supporters following repeated concessions to the healthcare industry and conservative Democrats, a sobering reality will probably set in.
What the bill does provide
-Expansion of government-funded Medicaid to cover 16 million additional low income people, though the program remains significantly under funded. This limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance, with the result some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target to budget cutting governors and legislatures.
-Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders, that will open their doors to nearly double their current patient volume.
-Reducing but not eliminating the infamous "donut hole" gap in prescription drug coverage for which Medicare enrollees have to pay the costs fully out of pocket.
-Insurance regulations covering members' dependent children until age 26, and new restrictions on limits on annual and lifetime on lifetime insurance coverage, and exclusion of policies for children with pre-existing conditions.
-Permission for individual states -- though weakened from the version sponsored by Rep. Dennis Kucinich -- to waive some federal regulations to adopt innovative state programs like an expanded Medicare.
All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them.
Where the bill falls short
-The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for other moderate income working people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gouging, care denials, and other abuses.
-Inadequate healthcare cost controls for individuals and families.
1. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, an idea also dropped from the bill.
2. There is no standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer provided plans.
3. An illusory limit on out-of-pocket medical expenses. But even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.
-No meaningful restrictions on claims denials insurers don't want to pay for. Proponents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.
-Significant loopholes in the much touted insurance reforms:
1. Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
2. Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will likely set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
4. Insurers may continue to rescind policies, drop coverage, for "fraud or intentional misrepresentation" -- the main pretext insurance companies now use.
-Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.
-Erosion of women's reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.
-A windfall for pharmaceutical giants. Through a deal with the White House, the administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.
Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.
As former Labor Secretary Robert Reich wrote after the vote "don't believe anyone who says Obama's healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama's health bill is a very conservative piece of legislation, building on a Republican (a private market approach) rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option."
Unlike Social Security and Medicare which expanded a public safety net, this bill requires people -- in the midst of the mass unemployment and the worse economic downturn since the Great Depression -- to pay thousands of dollars out of pocket to big private companies for a product that may or may not provide health coverage in return.
Too many people will remain uninsured, individual and family healthcare costs will continue to rise largely unabated and private insurers will still be able to deny claims with little recourse for patients.
If, as the President and his supporters insist, the bill is just a start, let's hold them to that promise. Let's see the same resolve and mobilization from legislators and constituency groups who pushed through this bill to go farther, and achieve a permanent, lasting solution to our healthcare crisis with universal, guaranteed healthcare by expanding and improving Medicare to cover everyone.
Leaders of the National Nurses United have raised many of these concerns about the legislation for months. But, sadly, as the healthcare bill moved closer to final passage, the space for genuine debate and critique of the bill's very real limitations was largely squeezed out.
Much of the fault lies with the far right, from the streets to the airwaves to some legislators that steadily escalated from deliberate misrepresentations to fear mongering to racial epithets to hints of threatened violence against bill supporters.
For its part, the administration and its major supporters shut out advocates of more far reaching reform, while vilifying critics on the left.
Both trends are troubling for democracy, as is the pervasive corruption of corporate lobbying that so clearly influenced the language of the bill. Insurers, drug companies, and other corporate lobbyists shattered all records for federal influence peddling and were rewarded with a bill that largely protected their interests, along with a Supreme Court ruling that will allow corporations, including the health care industry, to spend unlimited sums in federal elections.
Rightwing opponents fought as hard to block this legislation as they would have against a Medicare for all plan. As more Americans recognize the bill does not resemble the distortions peddled by the right, and become disappointed by their rising medical bills and ongoing fights with insurers for needed care, there will be new opportunity to press the case for real reform. Next time, let's get it done right.
Rose Ann DeMoro is executive director of the 150,000-member National Nurses United
Follow Rose Ann DeMoro on Twitter: www.twitter.com/NationalNurses
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And what is Ron Paul bitc*ing about anyway--he has MEDICARE--
I favor expanding MEDICARE to EVERY American who wants in.
The insurance cartel game is a failure.
http://www
Jane Hamsher was far more on target in her item last week. dubbing this reform
a step on the road to fascism. She wrote, in part:
"Forcing 31 million people to buy a product they don't want
and can't afford to use does not constitute health care reform.
Once again, the poor get used as human shields so corporatio
can be the beneficiar
"Rather than actually helping the poor, this bill is a
dangerous and unpreceden
government by private corporate players who use it to suppress
competitio
of fascism.
"... Members of Congress are dealing their seats away, planning to
retire after the vote is cast in exchange for appointmen
administra
realize that the progressiv
to anything but putting on a show...
"We need to develop new partners in the fight, because there
is tremendous public will to resist and the old ones can't be
trusted. We also need a new language to describe it, because the
old right-left paradigm is firing past the true opponent..
Well stated.
Why don't we have a public option? It polls highly. Just a thought. We all have some idea of how power works. What organized lobby was in there pitching for it? Let's see, there was MoveOn, CredoActio
we'll only vote for them in November
IF they PASS "Medicare For ALL" By November.
Please run some CRITICAL analysis on your front page.
More on Obama's back room deals to exclude Public Option while claiming he's for it.
Today's revelation
with preexistin
Well there goes the excuse for not amending it to include a public option.
**********
The Next Big Fight
Now that health care reform has passed both the House and the Senate, Congress and the Obama administra
**********
And that's all folks!! Health care has been "solved!" (shut up Progressiv
Any senator can propose an amendment to the reconcilia
Besides, even one change in the wording of the reconcilia
The fact is the Democratic Party can make change now, or they don't want it. It's not as if nobody told the "progressi
Now when most Americans according to polls like their insurance the way it is, probably because they have never been real sick, or because of fear tactics by the GOP and media, then it would be political suicide to radically change the system. Even pushing a public option would not fly because the will is not there in Congress. Many of them talk the talk, but when push comes to shove the votes would not be there. The insurance companies have spent millions to guarantee this outcome. So we can move the ball down the road some, or like has happened the past 70 years make a lot of smoke and noise, then end up with the exact same thing, nothing.
Now the insurance companies have plenty of rope to play with. They will have many new customers, sure, but if they still are unable to contain costs, maybe the majority of Americans will finally say enough and a public option can pass. And the Republican
Any senator can propose an amendment to the reconcilia
Besides, even one change in the wording of the reconcilia
Republican
I ask this question only rhetorical
Any senator can propose an amendment to the reconcilia
One change in the wording of the reconcilia
Is it a great bill? Debatable.
Is it a really really really really really really really good bill? Absolutely
I support the public option, but this bill handles a litany of problems, like lifetime limits, pre-existi
Did we get everything we wanted? Not this time.
But we sure as heck got more than the other side and a whole lot more than anybody thought we ever could.
I'm happy with this bill. Let's tie up the loose ends and change the conversati
Policy wise, this bill was step one in establishi
From here utilizing the informatio
The cost reforms which necessaril
In the meanwhile however, there are also measures to protect consumers from being fleeced, the expansion of coverage will lower cost for all consumers relative to the the cost inflation absent this expansion. The HHS secretary will be given authority to approve or reject premium increases, the 85% medical spending mandate will ensure savings are spread to consumers not executive salaries.
and in the meantime we progressiv
You make some pretty unsubstati
The rest of your comment appears to be just a lot of words that lead to no actual point.
I am not sure what you are really trying to say with this paragraph:
"From here utilizing the informatio
I thought you said this was a START! How, then, do we START by changing the conversati
The biggest risk we face are people like rodneyhopp
People - you are looking at another 20 years before any more changes occur in a meaningful way. Rodneyhopp
The healthcare conversati
Before you start attacking me and others like me, let's be pragmatic about this.
Do I wish this bill went farther? ABSOLUTELY
Do I wish many of the provisions kicked in today? ABSOLUTELY
Are we getting our butts kicked in the court of public opinion? ABSOLUTELY
If healthcare is the topic six months from now, will the Republican
The Democrats have about 30 weeks to convince people they still deserve to run the country.
Right now, deserved or not, for better or for worse, independen
We can't keep progressiv
So why do I want to change the conversati
Because the number one item on people's minds is not healthcare
Unless the Democrats can get the healthcare 'funk' off of them and show some meaningful unemployme
Which is why you've not seen me out in the streets with a party popper.
I am disappoint
The concession
Yet, there is a shallow victory in knowing that reform (of sorts) was passed.
It will be up to us as champions for universal healthcare
Fortunatel
We know that Republican Supreme Court appointees will allow corporatio
We have met the enemy and he is us. -- Pogo
I agree with National Nurses United (I am a member) and Dennis Kucinich that healthcare is a human rights issue.
We have more work to do.
Adrienne Zurub, RN, CNOR
Author/Spe
http://adr
Not only do we pay more for insurance in this region, we will now be taxed for doing so.
How is this fair? We can't afford the cost of insurance as it is, so we're supposed to pay a tax, a fine, something else on top of it?
Meanwhile costs go up, along with deductible
We are being FORCED to twist in the wind ...