3.21.2010

to pass their pitiful excuse for health care reform, obama and congress say fuck you to women

It's no surprise, but it's still shameful and unconscionable.
Health Care Reform Victory Comes with Tragic Setback for Women's Rights

Statement of NOW President Terry O'Neill

March 21, 2010

As a longtime proponent of health care reform, I truly wish that the National Organization for Women could join in celebrating the historic passage of the Patient Protection and Affordable Care Act. It pains me to have to stand against what many see as a major achievement. But feminist, progressive principles are in direct conflict with many of the compromises built into and tacked onto this legislation.

The health care reform bill passed by Congress today offers a number of good solutions to our nation's critical health care problems, but it also fails in many important respects. After a full year of controversy and compromise, the result is a highly flawed, diminished piece of legislation that continues reliance on a failing, profit-driven private insurance system and rewards those who have been abusive of their customers. With more than 45,000 unnecessary deaths annually and hundreds of thousands of bankruptcies each year due to medical bills, this bill is only a timid first step toward meaningful reform.

Fact: The bill contains a sweeping anti-abortion provision. Contrary to the talking points circulated by congressional leaders, the bill passed today ultimately achieves the same outcome as the infamous Stupak-Pitts Amendment, namely the likely elimination of all private as well as public insurance coverage for abortion. It imposes a bizarre requirement on insurance plan enrollees who buy coverage through the health insurance exchanges to write two monthly checks (one for an abortion care rider and one for all other health care). Even employers will have to write two separate checks for each of their employees requesting the abortion rider.

This burdensome, elaborate system must be eliminated. It is there because the Catholic bishops and extremist abortion rights opponents know that it will result in greatly restricting access to abortion care, currently one of the most common medical procedures for women.

Fact: President Obama made an eleventh-hour agreement to issue an executive order lending the weight of his office to the anti-abortion measures included in the bill. This move was designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women's access to abortion. This executive order helps to cement the misconception that the Hyde Amendment is settled law rather than what it really is -- an illegitimate tack-on to an annual must-pass appropriations bill. It also sends the outrageous message that it is acceptable to negotiate health care reform on the backs of women.

Fact: The bill permits age-rating, the practice of imposing higher premiums on older people. This practice has a disproportionate impact on women, whose incomes and savings are lower due to a lifetime of systematic wage discrimination.

Fact: The bill also permits gender-rating, the practice of charging women higher premiums simply because they are women. Some are under the mistaken impression that gender-rating has been prohibited, but that is only true in the individual and small-group markets. Larger group plans (more than 100 employees) sold through the exchanges will be permitted to discriminate against women -- having an especially harmful impact in workplaces where women predominate.

We know why those gender- and age-rating provisions are in the bill: because insurers insisted on them, as they will generate billions of dollars in profits for the companies. Such discriminatory rating must be completely eliminated.

Fact: The bill imposes harsh restrictions on the ability of immigrants to access health care, imposing a 5-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibiting undocumented workers even to use their own money to purchase health insurance through an exchange. These provisions are counterproductive in terms of controlling health care costs; they are there because of ugly anti-immigrant sentiment, and must be eliminated.

Fact: The bill covers only 32 million of the 47 million uninsured in this country, does not contain a meaningful public option and provides no pathway to a single payer system like Medicare for all. Democratic negotiators crumpled before powerful business interests and right-wing extremists, and until they get a spine there will be no true competition to help rein in costs.

The bottom line is that everyone -- citizen and non-citizen, undocumented immigrant and visitor -- has a fundamental human right to health care. This right has been denied in the U.S. for far too long, while the rest of the industrialized world moved ahead to assure universal and affordable care for their people.

We call upon President Obama and elected officials in both houses to commit to a process of steady improvement of our health care system that will result in true reform with universal coverage, realistically affordable rates and no discrimination. We still have a lot of work to do before we can genuinely celebrate.

Thanks to Antonia Z for the press release.

71 comments:

Amy said...

Sadly, I have to agree with all this. But given the fact that I live in a country with people who are woefully ignorant at best and sexist, racist and incredibly selfish at their worst, it is still amazing that anything passed at all. Although I am not about to have a whole-hearted celebration, I at least feel like some small step was taken in the right direction. In this country, I have to be grateful for even that. Sadly so.

James said...

You know, if they'd adopted the slogan "Medicare For All" at the start, they might have had a good bill at this point.

James said...

Some Guy With A Website captured the spirit of the current bill very well. (See also his comments.)

James said...

That should be "Robert's Rules of Kindergarden" in that last post, of course...

James said...

I at least feel like some small step was taken in the right direction.

It is the biggest step forward in sixty years of trying -- and its failure would probably have delayed the next attempt at reform by at least ten years, if not twenty.

But the way the Republicans have managed to get away with "Rogers Rules of Kindergarden" tactics that should have seen them laughed off of the Hill is rather less than inspiring.

redsock said...

Meanwhile: US weighs more troops for north Afghanistan

US commanders may send an additional 2,500 troops to fend off the Taliban in northern Afghanistan ... President Barack Obama approved the deployment of 30,000 additional troops in December to turn the war around ...

****

"to turn the war around" -- that is hilarious.

L-girl said...

More from William Blum:

In his "State of the Union" address on January 27, President Obama said: "But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know." Well, ending America's many wars would free up enough money to do anything a rational, humane society would want to do. Eliminating the military budget would pay for free medical care for everyone. Free university education for everyone. Creating a government public works project that could provide millions of decently-paid jobs, like repairing the decrepit infrastructure and healing the environment to the best of our ability. You can add your own favorite projects. All covered, just by ending the damn wars. Imagine that.

James, good cartoon, thanks.

Amy, I'd love to feel that way, too. The fact that it was so incredibly difficult to even make this one half-assed "step" that leaves out so many people and needs, and does nothing to check the power of the insurance companies does not give me hope. But I can understand where you're coming from.

L-girl said...

Re "Some Guy"'s comments:

And frankly, if it's pissing off both right-wing and left-wing nutjobs, it's gotta at least be a little good.

WTF does that mean? What is a "left-wing nut job" when it comes to health care????

James said...

Apparnetly Bart Stupak got called a "baby killer" by an unknown Republican Congressman for deciding to vote for the bill.

Amy said...

I don't have much hope at all either; I think this will be the best we can get, at least for a long, long time (like my lifetime). That's not hope; it's sad acceptance. I am disgusted by my fellow US citizens, by the politicians one and all, and by corporate greed. I just am trying my best to find some light in the darkness. And that itself is very, very hard, even for someone like me who usually sees the glass as half-full.

redsock said...

firedoglake has some facts:

The bill is neither universal health care nor universal health insurance.

This bill is almost identical to the plan written by AHIP, the insurance company trade association, in 2009.

The bill will not bring down premiums significantly, and certainly not the $2,500/year that the President promised.

The bill will impose a financial hardship on middle class Americans who will be forced to buy a product that they can't afford to use.

This bill will mandate that millions of people who are currently uninsured must purchase insurance from private companies, or the IRS will collect up to 2% of their annual income in penalties.

The excise tax will result in employers switching to plans with higher co-pays and fewer covered services.

This bill does not bring down costs and leaves out nearly every key cost control measure.

The bill was written so that most WalMart employees will qualify for subsidies, and taxpayers will pick up a large portion of the cost of their coverage.

The bill ignored proven ways to cut health care costs and still leaves 24 million people uninsured.

Access to the "high risk pool" is limited and the pool is underfunded. It will cover few people, and will run out of money in 2011 or 2012.

The "internal appeals process" is in the hands of the insurance companies themselves, and the "external" one is up to each state.

This bill does not limit insurance company rate hikes. Private insurers continue to be exempt from anti-trust laws, and are free to raise rates without fear of competition in many areas of the country.

Most provisions in this bill, such as an end to the ban on pre-existing conditions for adults, do not take effect until 2014.

The bill does not create a pathway for single payer.

****

Greenwald: "For almost a full year, scores of progressive House members vowed -- publicly and unequivocally -- that they would never support a health care bill without a robust public option. ... But now? All of those progressives House members are doing exactly what they swore they would never do -- vote for a health care bill with no public option -- and virtually every progressive opinion leader is not only now supportive of the bill, but vehemently so. In other words, exactly what Rahm said would happen -- ignore the progressives, we don't need to give them anything because they'll get into line -- is exactly what happened. ...

"we have certain things we'd like you to change in this bill, but we'll go along with this even if you give us nothing"

***

L-girl said...

I heard about the baby-killer thing on FB. Tres bizarre.

Amy, I understand. Of course I agree.

Ira said...

Hi, I've been reading your blog for a couple months. I'm a Torontonian who shares your political leanings (NDP). I would agree that this bill is vastly inferior to what Canada has, or what most of Europe has.

I also agree that the restrictions on abortion are reprehensible. However, I've been given to understand that the executive order on abortion really just reaffirms the Senate language (which requires money for abortions to be held in some kind of separate fund - which sucks but is in some ways just a shell game). From what I've read, and if I'm wrong please correct me, this bill neither liberalizes nor further restricts (other than rhetorically) abortion. I know that it is already far too restricted in the US, and I'm certainly not defending that! Also not saying we shouldn't be angry about it! But I don't think anyone was under the impression that this bill was going to make things better regarding abortion access.

As for the rest of it, yes it is in many ways a corporate giveaway, like most American legislation. However, it also helps 32 million people directly, and provides some consumer (yes it is awful that in the US people are "consumers" of health insurance) protection.

If the US had a reasonable political spectrum, this bill would not be worth celebrating, but given how far right the US has been since the late 1970s, this is progress. Unless I am wrong about the abortion clauses of the bill - which I might be - this was still worth passing, and helps make the US a slightly less unfair country.

Anyways, love your blog, and hope to participate in the future!

-Ira

L-girl said...

Ira, thank you for your thoughtful comments and your kind words about wmtc.

I agree with you about abortion rights. When I saw certain bloggers, especially Canadians, decrying Stupak (with good reason, as you say, and I'm not saying they shouldn't!), I wondered if perhaps they weren't aware of the Hyde Amendment and other restrictions to abortion access already in place.

On the other hand, many people hoped that meaningful health care reform would supercede Hyde, and that there was enough pro-choice support in Congress to make that happen.

To some it's an unavoidable compromise, but compromise looks different when your body is the bargaining chip.

However, it also helps 32 million people directly, and provides some consumer (yes it is awful that in the US people are "consumers" of health insurance) protection.

Well, there's helps and there's "helps". It's a big boon to insurance companies, as you have pointed out - and they are the greatest obstacle to meaningful health care reform. (Or perhaps I should the corrupt campaign financing system is the biggest obstacle.)

But you make a lot of sense, and to be honest, I am not fully up to speed on the bill, and won't be able to educate myself more until I'm done with my papers. I hope others can address your comments further.

Now about those papers...

Ira said...

Thanks for the welcome!

To some it's an unavoidable compromise, but compromise looks different when your body is the bargaining chip.

Definitely a fair point. But, since the debate was unfortunately limited to the Stupak language versus the Senate language, in this case, the less anti-choice (I won't insult anybody's intelligence by saying pro-choice) forces won.

My major in university was American history, and I understand how women were ignored when the 13th, 14th, and 15th Amendments were written, and how women's equality was an afterthought in the Civil Rights Act of 1964 (actually a Southern amendment designed to derail the process). So I'm sure it's infuriating to hear someone say that accepting the Hyde Amendment was necessary to pass this bill. If I thought it could be rolled back by scrapping this bill, I'd probably support that.

Well, there's helps and there's "helps". It's a big boon to insurance companies, as you have pointed out - and they are the greatest obstacle to meaningful health care reform.

Yes, my major concern is that without a public option this actually makes single payer even further out of reach because it makes it less urgent. But if getting rid of the insurance companies isn't going to happen, this is better than nothing. That's the conclusion Dennis Kucinich came to and I sadly agree.

But you make a lot of sense, and to be honest, I am not fully up to speed on the bill, and won't be able to educate myself more until I'm done with my papers. I hope others can address your comments further.

Thanks! The New York Times has a decent summary of the changes from this bill.

http://www.nytimes.com/interactive/2010/03/21/us/health-care-reform.html

The gist of why I think this bill should be -reluctantly - supported by progressives:

-High-income earners — families making more than $250,000 — will pay several thousand dollars more in Medicare payroll taxes starting in 2018. Their unearned income, now exempt from the payroll tax, would also be subject to a 3.8 percent levy.

-Starting in 2014, anyone with an income below 133 percent of the poverty level — or about $29,327 in 2009 for a family of four — will be eligible for a rejuvenated Medicaid program. Medicaid’s often anemic reimbursements will be increased to the same level as Medicare, making more doctors willing to accept it.

-Coverage for those making up to four times the poverty threshold — $88,200 for a family of four in 2009 — will get subsidies on a sliding scale. That means you will pay somewhere between 3 percent and 9.5 percent of your income for insurance, and the government will cover the rest.

-There will also be limits on overhead and profit. Insurers will be required to spend between 80 cents and 85 cents of every premium dollar on health care. They have been paying about 74 cents on average.

--------------------------------

I think the changes to medicaid are hugely positive. People paying insurance premiums on a progressive scale based on income is very nice too...even though it helps the insurance companies bottom line.

The Times summary also says this:

"Health plans on exchanges can offer abortion coverage. But if they do, subscribers who get federal subsidies will have to make separate premium payments for the coverage. States can prohibit abortion coverage."

Can states prohibit insurance from covering abortions now? If not then I have to eat my words and admit this does go further than the Hyde Amendment.

Good luck with your papers!

James said...

While I also prefer a single-payer style system, there are countries which run successful universal health coverage using mandated private insurance systems -- IIRC, both Switzerland and Germany use forms of this.

Any movement forward from this bill will be towards a Swiss-style system rather than the Canadian model. The major missing parts are a public option and more comprehensive coverage.

BTW, a recent study looking at the Massachusetts system discovered that abortions are down significantly since the new plan went in. Apparently it rendered two common reasons for having abortions irrelevant: inability to afford the cost of the birth, and inability to afford health care for the new infant.

But, of course, reducing the need for abortions was never part of the conservatives' plan...

Amy said...

BTW, a recent study looking at the Massachusetts system discovered that abortions are down significantly since the new plan went in. Apparently it rendered two common reasons for having abortions irrelevant: inability to afford the cost of the birth, and inability to afford health care for the new infant.

Wow, that's fascinating. Do you have a link to this study? I live in MA and am intrigued to see the stats on this.

Ira said...

Good point James. They only believe in the "sanctity of life" until 9 months after conception.

I agree that the Swiss and German model works, but it remains to be seen whether enough politicians AND regulators can avoid the ever present mantra in U.S. (and more and more Canada) political dialogue: the cry to deregulate, deregulate, deregulate. This bill and the system it represents can work, but we probably won't know for some time if it will.

James said...

Here is the article I read about the MA study.

As for the Swiss & German model -- those only work because the insurance industry is heavily regulated; that's the big weakness of this approach in the US, as Ira's pointing out. The stuff in the bill is the bare minimum you need (you can't mandate that people buy insurance if you allow insurance companies to refuse to sell to people!), but there should probably be more, and getting more will be difficult.

OTOH, the real reason the Republicans are so scared of health care reform is that they know it will be popular. That's what Kristol's memo back during the Clinton HC episode was about: they didn't want it to pass, not because it was in some way bad, but because it was good, and would reflect well on Democrats. So, if the current bill makes things any better (and there are reasons to think it will -- just not as much better as a good bill would have), improving it may well be easier than passing a better bill in the first place would have been.

Ira said...

I remember reading about the Kristol memo. Newt Gingrich came to the opposite conclusion about this bill, but still demonstrates his callousness.

“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years” by passing civil rights legislation.

Krugman is astounded by the comparison:

"Think about what it means to condemn health reform by comparing it to the Civil Rights Act. Who in modern America would say that L.B.J. did the wrong thing by pushing for racial equality? (Actually, we know who: the people at the Tea Party protest who hurled racial epithets at Democratic members of Congress on the eve of the vote.)"

They don't care about human beings.

L-girl said...

Passage of the Civil Rights Act did shatter the Democratic party. It was a sea change in US electoral politics - the white South instantly changed from Democrat to Republican and almost every African-American changed overnight from Republican to Democrat.

We may love the reasons it was shattered, but shattered it was.

L-girl said...

[Just an aside. Of course I agree with Krugman.]

Amy said...

Thanks, James. I will take a look.

Ira said...

Oh yes, definitely true, although Nixon put the nail in the coffin with the Southern Strategy.

But it does remind me that there is some cause to occasionally give tentative support to Democrats. I see politics as directional, and Democrats sometimes move in the right direction, even if not very far. You've written that you very reluctantly want Ignatieff to be the next prime minister. I assume that this is something similar.

Ira said...

I just realized I implied you though Iggy would move in the right direction! I didn't mean that haha..I meant a Liberal government, hopefully with a minority held up by the NDP.

Nitangae said...

My main thought is that, for the next health-care battle, American progressives can focus on those anti-woman aspects of the health-care bill, now that the principle that everybody has a right to basic healthcare has been established.

In fact, they should start right now! The sooner they start, the sooner that Republicans huff angrily that their socialist actions will endanger sacred Obama care.

In any case, I reflect on how depressed I get with Harper sinking his claws into Canada (how long would we have public healthcare if ever won a majority?), and think how much more depressing it must be to have to fight for the principle int he first place.

L-girl said...

My main thought is that, for the next health-care battle, American progressives can focus on those anti-woman aspects of the health-care bill, now that the principle that everybody has a right to basic healthcare has been established.

Wait... are you being sarcastic? Or are you serious?

Nitangae, I love your comments and I hope I will not offend you when I ask you this. I mean it truly as a question, not as a dig.

Where did you get the idea that any principle of a right to healthcare has been established?

Nothing of the kind has happened.

This is not universal coverage, nor is there room in the bill through which to create universal coverage.

redsock said...

, now that the principle that everybody has a right to basic healthcare has been established

I feel like I've woken up in a bizarro world. No such thing has been established. It wasn't even ever part of the discussion.

This bill is one of the best con jobs ever -- so many people who should know better have been utterly convinced that something that did not happen actually happened.

This is not the first baby step towards proper health care in the US. It is the FINAL STEP in finally shutting the American people the fuck up about this issue. This is it -- a windfall for the insurance companies -- just like when Obama gave more than $700,000,000,000 in taxpayer dollars to the banks with no questions asked and no accountability. And they turned around and paid out mega-bonuses.

Now ... continuing the three wars in the Middle East.

L-girl said...

The gist of why I think this bill should be -reluctantly - supported by progressives:

I guess I don't really understand what you're getting at. "Support" how? We don't vote there, and we don't have to use their fucked up health care system. If that system was in Canada, we would hate it and rail against it daily. So in what way do we "support" or not support it? By selling it to other progressives? I couldn't do that, because it's nothing I would want for myself - how could I want it for others?

I'm not trying to be snide, truly I'm not. I just don't understand why so many otherwise progressive people are working so hard to rationalize something that they know is wrong - not just in degree (as in doesn't cover everything and everyone), but in substance, because it leaves all the structural problems untouched.

Because it's a baby step in the right direction? That's not progressive thinking, it's status quo thinking.

If maintaining the system with a bit of tweaking is good enough, what are we working towards? Might as well just leave the job to the Democrats, since that's what they do?

L-girl said...

This is not the first baby step towards proper health care in the US. It is the FINAL STEP in finally shutting the American people the fuck up about this issue.

This is how I see it. I don't even understand why anyone thinks this is a step towards something. It may be, as Amy said earlier, a small step in the right direction, but as she also said, it's very likely the only step we will see in our lifetimes. So it's a step - but not one of a series of steps that will move the US towards single-payer, universal health care.

alterwords said...

Hi everybody - thanks for inviting me over L-girl! I'm late to the discussion but I've read all the comments and have been reading up, down and around on the health careless bill all day. As a woman I would feel completely thrown under the bus if I was American and I feel threatened by the rhetoric and the action even as a Canadian. Seems to me that the Hyde Amendment got approved just the same way - by convincing women not to fight it cause the Dems would get rid of it later. Oh sure. Obama's executive order isn't meaningless. He's going to have to live with it isn't he? And that means women are going to live with it for a long time to come - who in hell is going to have the political will to do anything about it? But believe it or not, that's not what worries me most. Not being a hopey changey type person, my prediction is that unionized labour is going to be ripely pissed when the "cadillac" health care they have bargained for is taxed. And that the rest of America is going to be ripely pissed when the cost of health care goes up and premiums go up and they have no choice but to buy in. Then the whole "reform" will be seen as a miserable failure and Obama will be blamed for being such a socialist. I think this bill had to pass or Obama would have been finished - I think that's why he pushed so hard and that's why some Dems came on board. But I don't think it had to pass because it's any kind of step forward. I'm rather worried that it is the opposite.

Ira said...

I guess I don't really understand what you're getting at. "Support" how? We don't vote there, and we don't have to use their fucked up health care system. If that system was in Canada, we would hate it and rail against it daily. So in what way do we "support" or not support it? By selling it to other progressives? I couldn't do that, because it's nothing I would want for myself - how could I want it for others?

Until you asked, I wasn't completely sure what I meant by support. Of course as Canadians we don't vote or use their system, so I suppose I do mean "sell to other progressives." This is funny, because in most conversations I take your position against well-meaning Canadians who think this bill is better than it is. I do know better than that.

It really depends on the frame of mind I'm in at the time: Am I comparing this bill to what currently exists, or do I compare it to what could be in a more ideal America with a workable system of government?

When the public option died and Howard Dean said it would be better to kill the bill and start over, I agreed with him, because he appealed to my idealism. But I changed my mind because I fear that the political spectrum is just going to go further and further to the right. I really didn't think it was possible for that to happen, and then the Tea Party started. Kill the bill, nothing happens for 15 years, and when it does it will probably be something along the lines of "A Modest Proposal."

This is not universal coverage, nor is there room in the bill through which to create universal coverage.

With the very important exception of undocumented immigrants, this does start a path towards universal coverage. People who earn up to 133% of the poverty level will have access to a Medicaid which will now have the same reimbursement rate as Medicare, and families up to 400% of the poverty level (for a family of four that is income up to around $88,000) will pay 3-9.5% of their income for insurance. And that insurance will not have the abuses of today.

As James was saying, this is the bare minimum to begin emulating the Swiss health care system. By itself this bill is not universal, but it does create a pathway. Again, it does exclude undocumented immigrants which should be up there with the Hyde Amendment on our list of things to fix.

Because it's a baby step in the right direction? That's not progressive thinking, it's status quo thinking.

Like I said, I see progress as more of a direction than a destination. If I were in charge, I would go as fast and as far as possible, but I'm not willing to stop and wait 15 years for the small possibility of being able to go further and faster then. I'm with you on fighting for something better - but after this bill rather than starting the fight from the beginning.

L-girl said...

So, in short, the bill extends the present system to more people, and mandates that others buy private health insurance. This means that it does not change anything, it merely extends the status quo.

Two questions:

And that insurance will not have the abuses of today.

1. How so? This is counter to what I'm seeing from any progressive source.

and

2. How does this create a path to universal coverage?

Northern Girl said...

"This is not the first baby step towards proper health care in the US. It is the FINAL STEP in finally shutting the American people the fuck up about this issue."

I totally agree.

hhw said...

to answer #2, and assuming these parts aren't gutted later, I see the new (limited) restrictions on insurers' ability to deny and drop coverage willy nilly as one of the ways the whole mess might be dragged kicking and screaming toward the path of universal coverage. Not actually ON that path yet, just a little closer to the general vicinity.

All this makes me particularly happy to be transferring to a university in the Niagara region in the fall, with an eye toward the new-ish Canadian Experience Class route to PR.

James said...

So, in short, the bill extends the present system to more people, and mandates that others buy private health insurance. This means that it does not change anything, it merely extends the status quo.

Not entirely. It forbids insurance companies from using "pre-existing conditions" or other dodges to refuse or drop insurance on people who need it, it provides subsidies to low-income people so they can actually afford to meet the mandate, and it establishes competitive insurance exchanges to drive prices down.

And that insurance will not have the abuses of today.

1. How so? This is counter to what I'm seeing from any progressive source.


New regulations banning at least some of the abuses, such as hunting through policy agreements for typos as excuses to drop coverage.

2. How does this create a path to universal coverage?

By subsidizing insurance for low-income people, it makes it possible for more people to be covered.

Under the current bill -- if it goes as planned -- everyone will be covered except undocumented immigrants, those who opt out of coverage, and those who don't even meet the minimums for subsidies.

A public option would take care of the second and third of those groups, but you can bet that even if a public option passed, it wouldn't cover undocumented immigrants.

With a few modifications, this system could be pretty much identical to the Swiss system, which (IIRC) has coverage as good as Canada's.

The whole thing is much more complicated than it needs to be, and a "Medicare for all" system would be a lot easier to manage and administrate, but this bill does have potential. Whether it lives up to its potential is another thing.

L-girl said...

It forbids insurance companies from using "pre-existing conditions" or other dodges to refuse or drop insurance on people who need it, it provides subsidies to low-income people so they can actually afford to meet the mandate

If this is true and enforced, it's good.

I'm more than a bit skeptical, since the structural issues that allow the insurance companies to control Congress still exist.

L-girl said...

I see the new (limited) restrictions on insurers' ability to deny and drop coverage willy nilly as one of the ways the whole mess might be dragged kicking and screaming toward the path of universal coverage. Not actually ON that path yet, just a little closer to the general vicinity.

That might be true if there was political will to walk that path. There clearly is not.

Again, this whole "on the path" thing assumes that this is a first step in a series of reforms. I think that's magical thinking.

All this makes me particularly happy to be transferring to a university in the Niagara region in the fall, with an eye toward the new-ish Canadian Experience Class route to PR.

Congrats! Get in touch when you do, we're right down the QEW from Niagara.

Ira said...

In addition to what others have mentioned, annual and lifetime caps on claims will be prohibited, primary care will no longer have co-payments, and annual out of pocket expenses will be capped. They will also no longer be able to use more than 15-20% of their revenue for things other than medical care (profit and overhead). And kids will be able to stay on their parents insurance until the age of 26.

And the pathway to universal coverage will be achieved because nobody earning less than four times the poverty level will be unable to afford coverage. People who earn more than that typically have employer provided coverage, and if they don't they have have the money to by coverage for themselves from these insurance exchanges.

In some ways you're right though, it does expand the current system while eliminating a lot of the abuses. As James said, its much more complicated than it needs to be, but if everything works the way it says on paper it provides a lot more fairness.

L-girl said...

Thanks for the additional info. I'm not usually this lazy, depending on readers to fill me in! Blame school.

So the bill, if enforced, does rein in some of the worst abusers of the insurance companies. In other words, the insurance industry conceded some of the most untenable and unpopular practices in order to continue to control the system.

That's typical of any industry under fire. That's how basic labour laws (minimum wage, overtime, the right to organize, etc.) were won, modifying the edges rather than building a new system.

It's an age-old debate, whether to reform or remake. In this case, the analogy is imperfect, since the remade system - universal, single-payer - does exist and can be shown to function well.

The more James and Ira post about what the bill contains in terms of regulating insurance companies, the more convinced I am that this is the sum-total of any health care reform we will ever see in the US, that it will never go any further (not in our lifetimes, anyway) and it will be a minor miracle if it's not rolled back.

This is not the first step in a series of steps. This is it.

L-girl said...

Ira, any reason why you don't make a basic profile available? It doesn't have to contain personal identifying information.

Amy said...

What Ira and James describe is also consistent with my understanding. Of course, we are relying on general summaries of the bill since (I assume) none of us has actually read the entire bill. It's a little scary to think what might be in there or what might not be in there. Even a generally trusting person like myself wonders whether we are actually getting a complete and accurate summary from the various sources.

What puzzles me the most about this whole situation is the degree of fear and dread it has stirred up. A poll shows that the bill is opposed by half of those US citizens polled. WHY? What are they concerned about? Higher taxes? Socialism?

I have friends and acquaintances whom I consider fairly intelligent who are frightened by this law. I just don't get it. I am not talking about the right wing Tea Party types or racists or fundamental Christian fanatics. I am talking about generally moderate to liberal people who seem scared to death of what this bill will bring. Can anyone shed any insight on what the hell is so scary?

James said...

"if everything works the way it says on paper" is, of course, a huge caveat. At least one Republican has announced an upcoming "Repeal Socialist Obamacare" bill, of course.

Here is a good summary of how the bill is put together. Major improvements:

- Eliminates pre-existing condition exclusions
- Ends lifetime limits on benefits
- Bans rescission (cancelling coverage even if you've kept your policy current)
- Excise tax on "Cadillac plans" to control costs (this is major: the US has a serious problem with excessive, unnecessary tests which are driving up health care costs)
- Subsidies for people who can't afford policies at market prices, but who don't qualify for Medicaid
- Fixed the infamous "donut hole" in the Medicare drug plan

Certainly not ideal, and certainly more complicated than other approaches, but it looks like an overall improvement -- if it works the way it says on paper.

Ira said...

It's an age-old debate, whether to reform or remake. In this case, the analogy is imperfect, since the remade system - universal, single-payer - does exist and can be shown to function well.

I too find it frustrating that our excellent system was simply taken off the table before the debate even started.

Ira, any reason why you don't make a basic profile available? It doesn't have to contain personal identifying information.

I signed in using my Google Account. I don't have a blog myself, so the need to make a profile has never come up. What does a profile let you do? :)

L-girl said...

Of course, we are relying on general summaries of the bill since (I assume) none of us has actually read the entire bill. It's a little scary to think what might be in there or what might not be in there.

That's an excellent point. Most - if not all - of what we read is also based on summaries, and those summaries are issued by the people who passed the bill. What other loopholes or concessions to the insurance industries were made won't become clear until much later.

What puzzles me the most about this whole situation is the degree of fear and dread it has stirred up. A poll shows that the bill is opposed by half of those US citizens polled. WHY? What are they concerned about? Higher taxes? Socialism?

I have friends and acquaintances whom I consider fairly intelligent who are frightened by this law. I just don't get it. I am not talking about the right wing Tea Party types or racists or fundamental Christian fanatics. I am talking about generally moderate to liberal people who seem scared to death of what this bill will bring. Can anyone shed any insight on what the hell is so scary?


This is very interesting and very puzzling! They're afraid of this, but presumably they're not afraid of the billions upon billions of deficit spending being shoveled into the military every year?

[I'm getting back to work now, will be reading but usually not replying.]

L-girl said...

Most - if not all - of what we read is also based on summaries, and those summaries are issued by the people who passed the bill.

I mean the published summaries are generally all the writers and editors have - media releases. Very few journalists have read the whole bill.

L-girl said...

I signed in using my Google Account. I don't have a blog myself, so the need to make a profile has never come up. What does a profile let you do? :)

If you have a Google account, you already have a profile. All you have to do is tick the box to make it visible.

It's not what the profile does for you, it's what it does for blog owners and other readers. It makes you a unique and identifiable commenter, as opposed to anyone whose sign-in name is Ira.

Because there has been (and continues to be) trouble with trolls and impersonators on this blog, it would be very nice if you had a visible profile. Nice for me, that is, and you lose nothing.

James said...

this is the sum-total of any health care reform we will ever see in the US

I can see a couple of possible incremental improvements: adjustments to the subsidies to cover more people, and the addition of a public option through the exchanges. I doubt "Medicare For All" could come any time soon with this in place, though.

Until this kicks in fully, it's very vulnerable. But once it kicks in, I think it's pretty safe from repeal: health care programs are usually very popular once people see them functioning -- to the point where Republicans were trying to scare the public by claiming that Obama's "socialized medicine" was threatening Medicare.

What puzzles me the most about this whole situation is the degree of fear and dread it has stirred up.

It's not so puzzling: stirring up fear and dread is what Republicans do best. Think of the attacks they've made on Obama's proposals: Death panels! Threats to Medicare! Bureaucrats between you and your doctor! etc -- a of these are flat-out lies, but the Republicans are really skilled and promoting lies. Even if you don't buy the Republicans' talking points, they poison the atmosphere.

This is where the Democrats really fell down. Every time someone said "Death panels", Democrats should have been pointing and laughing at what a nutbar he is. Bipartisanship was never a possibility on this, not while the Republicans are so tight with the Tea Party crowd.

One of the Republicans who was speaking Sunday or Monday -- I can't remember who it was -- had it right, though: the Republicans have been acting as children, and it's the "last of bipartisanship" in the final vote is not the Democrats' fault, but the Republicans. If they weren't so beholden to the Bircher and Birther crowd, they could have worked out something truly bipartisan -- but they've thrown their lot in with the crazies, and they have to life with that.

And while I sometimes think it's just as well they ended up not contributing to the bill, in the end I suspect that Obama still gave them too much in his effort to be "postpartisan". We might even have had a better bill if the sensible wing of the Republicans had been in control of their party.

L-girl said...

I too find it frustrating that our excellent system was simply taken off the table before the debate even started.

Frustrating perhaps, but unsurprising, considering 100% of what the US MSM says about the Canadian system is lies.

redsock said...

Major improvements:
- Eliminates pre-existing condition exclusions


firedoglake says this will not take effect for adults until 2014 (for children, only 6 months, but parents will likely have to pay more $$$ for that provision).

Plus I have to think the companies will simply come up with some other-worded way to deny as much coverage as possible. As we know, there are scores of people whose only job is to dream up ways to deny coverage.

Amy said...

Very true, James, and very sad---that literate people with access to endless information will buy into the distortions and lies spread by the Republicans. I could not listen to Boehner on Sunday night without feeling my blood pressure explode. What was he talking about? The end of America as we know it?? HOW?

Of course, the Republicans did "contribute" to this law, not by their votes but by the many compromises and conditions that the Democrats conceded to them (and to the right wing of their own party) in an attempt to get bipartisan support. This is not the bill Obama originally wanted, nor is it the bill that many Democrats wanted. It's just the one that was left after a year long erosion in an attempt to get something passed.

It's interesting that there have been comparisons to the Swiss situation because the metaphor that has been running through my mind as the process has been going on is that the bill is like Swiss cheese---lots of holes have been made throughout it to make it seem more palatable to some.

redsock said...

Jon Walker:

The Senate bill further entrenches the private health insurance system ... continues the terrible pattern of privatizing our social safety net ... makes sure the big, life saving medications of the future remain incredibly expensive, so as to enrich the drug industry ... takes a giant step towards eroding women's reproductive rights ... wastes hundreds of millions to fortify the same, broken health care system that is crushing our economy. ...

If anyone can actually explain how this bill, which will funnel hundreds of billions of dollar into private hands, and force millions of Americans to be customers of the same private health insurance companies that helped ruin our health care system, will actually serve as a vehicle for the real reform we will eventually need, I would love to hear it.

***

More Walker:
Dems Reap All The Red-Baiting Pain With None Of The Socialist Gain
&
Six Big Flaws Need Fixing to Make New Law Meaningful Health Care Reform

redsock said...

This is where the Democrats really fell down. Every time someone said "Death panels", Democrats should have been pointing and laughing at what a nutbar he is.

The question is WHY did they not do the obvious? Anyone with a IQ not in single digits would know how to counter that shit. It's easy. And the Democrats actually are not morons.

So: Why do they act the way they do?

James said...

There is an excellent section-by-section breakdown of the bill at OpenCongress.org. The bill itself is also there, but it's written entirely in terms of amending adjustments to insertions in other bills, so it's a tough slog.

The CBO analysis is also up at OpenCongress.org. The CBO is claiming an additional 35 million people would be able to get insurance and 16 million more would be eligible for Medicaid, getting coverage up to 95% of the population. Of course, that still leaves 23 million uncovered.

About 7-8 million of those are undocumented immigrants, who (sad to say) never had a hope of getting coverage under any plan, single-player, public option, or whatever. Most of the rest are either exempt from the mandate or are among those expected to opt out and pay the tax penalty.

The CBO also expects around 4 million people to move from employer-provided insurance to subsidized privately purchased insurance.

James said...

There is an excellent section-by-section breakdown of the bill at OpenCongress.org. The bill itself is also there, but it's written entirely in terms of amending adjustments to insertions in other bills, so it's a tough slog.

The CBO analysis is also up at OpenCongress.org. The CBO is claiming an additional 35 million people would be able to get insurance and 16 million more would be eligible for Medicaid, getting coverage up to 95% of the population. Of course, that still leaves 23 million uncovered.

About 7-8 million of those are undocumented immigrants, who (sad to say) never had a hope of getting coverage under any plan, single-player, public option, or whatever. Most of the rest are either exempt from the mandate or are among those expected to opt out and pay the tax penalty.

The CBO also expects around 4 million people to move from employer-provided insurance to subsidized privately purchased insurance.

Amy said...

I think the Dems DID try to counter this stuff by saying it's not true. But how do you prove a negative? People are so quick to assume the truth of scary lies, and denials sounds just like denials. I also think the Democrats were trying to take the high road and appear more "statesman" like (what a joke, and sorry for the sexist word!). For some bizarre reason, people are more likely to believe in death panels than in the possibility of improved health care coverage.

Sometimes I think the average IQ of the average US citizen is in the single digits. Hate to sound elitist, but sometimes the shoe just fits.

Ira said...

If we're talking about the same thing, the "Share my profile" box was already ticked. If it's something else, forgive my ignorance as I'm new to blogger.

James said...

firedoglake says this will not take effect for adults until 2014 (for children, only 6 months, but parents will likely have to pay more $$$ for that provision).

Yup, many of the provisions don't kick in until 2014, in order to lower the 10-year cost of the bill to appease Republicans. It's an dumb trick -- similar to Bush's putting a 10-year sunset on his tax cuts to make them look cheaper -- and weakens the bill by giving the Republicans four years to repeal it before anything happens.

The question is WHY did they not do the obvious?

The infamous Democrat spinelessness strikes again: they're afraid of being called names, because they think those names will cost them re-election.

To address Jon Walker's question: there are provisions in the bill meant to drive down costs, such as the "Cadillac plan" tax. They're probably much weaker than they should be, though.

James said...

I think the Dems DID try to counter this stuff by saying it's not true. But how do you prove a negative?

Proving a negative is easy if you're dealing with a small, closed system -- like the text of a bill. All you have to do is show that there's nothing in the bill like what's being attributed to it.

But the Republicans are much, much better at disseminating scary stories than the Dems are at refuting them.

redsock said...

Sometimes I think the average IQ of the average US citizen is in the single digits. Hate to sound elitist, but sometimes the shoe just fits.

In a culture which celebrates ignorance, where all opinions on a subject are treated as valid for discussion, where someone with actual expertise on a subject is ridiculed as being elitist*, it's no surprise.

(* There is another word that gets thrown around, but I can't remember it. Don't watch enough Fox News [sic], I guess.)

Amy said...

Proving a negative is easy if you're dealing with a small, closed system -- like the text of a bill. All you have to do is show that there's nothing in the bill like what's being attributed to it.

Not really so easy, given the length of the bill and the complexity of its structure and language. It would be sort of like saying, "Here's a haystack. You can see there is no needle in it."

But I agree that the Dems did a poor job of responding, perhaps in the name of bipartisanship or in the hope that the people would be less willing to buy into the scare mongering.

James said...

There is another word that gets thrown around, but I can't remember it.

You're probably thinking of "intellectual".

Because there's nothing Fox News hates more than intellect.

L-girl said...

Oh yeah. An "intuh-leck-shoo-al"

That anti-intellectual streak in US culture goes back a long ways. My father used to talk about Adlai Stevenson, a hero in our home, being labelled an "egghead" in the press. And you can be sure it goes back far longer than that.

If you're looking for catch phrases used to ridicule intelligence, search the 2004 campaign files. Moron had the handshake, Kerry was brainy and elitist.

redsock said...

The infamous Democrat spinelessness strikes again

No one gets that far in politics by having no spine. And even when 90% of the population agrees with what should be the proper Democratic response, they don't do it. So the re-election excuse doesn't hold water in a lot of cases.

They are owned by major corporations and they do the bidding of those corporations. Granted, it's tougher for the Democrats. They have to act "lefty" some of the time, but they eventually give that up and vote the way their donors want them to.

This bill was a perfect example: a bunch of tough talk and ultimatums, then when crunch time comes, wink wink, suddenly an attack of "spinelessness".

Or when the MTA wanted to raise the public transit fares in NYC. Say it's $1 and they say (amongst themselves) it should be $1.25. So they announce that fares will soon be $1.50. Everyone freaks out so the MTA says, okay, $1.25. Was the MTA spineless? Did it cave to public pressure?

redsock said...

Yeah, that was probably it.

The "all opinions are valid / must consider both sides" shit drives me insane.

***

OT!

L-girl said...

The infamous Democrat spinelessness strikes again: they're afraid of being called names, because they think those names will cost them re-election.

I was also going to comment on this. This is similar to my standard correction with people say the Cheney Administration was incompetent and the Iraq War was a debacle. I maintain that regime was spectacularly successful and accomplished their goals likely beyond their wildest imaginings.

Similarly, I don't think the Dems are spineless or afraid of the voters. Rather, they do the bidding of their corporate bosses and voters be damned.

Before you can run for re-election, you have to get contributions, and you don't get those contributions without the quid pro quo.

This is why I hate that "Evil Party vs Stupid Party" conceit. No one here is stupid, and they are both evil.

James said...

Another collection of documents concerning the HCR bill, these from the House Speaker's website.

redsock said...

Now ... continuing the three wars in the Middle East.

You can set your watch by it.

"Iran is helping train Taliban fighters within its borders, according to U.S. military and intelligence officials."

James said...

Here's some speculation on how the US health care might evolve now that the HCR bill has passed.

Amy said...

James, Klein's scenario is quite optimistic, but I wonder how realistic. I hope that he is right that the exchanges don't just become health insurance for the "near-poor." Time will tell, assuming that neither the Republicans or the Supreme Court can repeal/overturn the law.

James said...

Definitely optimistic, sure, but feasible.

At the moment, it looks like the Republicans aren't going to repeal the whole thing. There are too many popular bits -- the end of "pre-existing conditions" refusals (which start immediately for children) and other insurance company abuses being foremost among them. But they will try to cripple it.

Another interesting indication of how far right the US has moved in the past 20 years: the HCR law as passed is almost identical to the bill the Republicans proposed as an alternative to Clinton's health care reform initiative, yet the current Republicans are calling it socialist -- and a recent Harris poll suggests that 2/3 of Republicans believe that Obama is, indeed, a socialist.