EDITORIAL It's hard to imagine a better time for real, lasting health care reform. A popular president with a reform mandate has made it a top priority. The Democrats control both houses of Congress, with enough votes in the Senate to block a filibuster. Medical costs are soaring, driving individuals and businesses into bankruptcy. Even some big corporate executives, who recognize that the United States can't compete in the global economy when companies have to spend so much on employee health insurance, are starting to come around.
So why is the bill working its way through Congress so incredibly weak?
One reason: the private insurance industry is still calling the shots.
In fact, from the very beginning, private insurers were involved in the policy discussions. Nancy Ann DeParle, President Obama's senior health policy advisor and the White House point person on reform, brought the industry into the room on day one. Sen. Max Baucus of Montana, who heads the Finance Committee that is now considering the bill, received more contributions from the insurance industry than any other Democrat in the Senate.
And as long as the needs of an industry that makes profits by denying medical coverage to sick people matter more than the needs of the American people, there's not going to be a decent reform bill.
The best experts all agree that the only way to hold down costs, insure everyone, and make the nation competitive again is to eliminate private insurance and create a government-run, single-payer system. That's what almost every other industrialized country has and it works. Canada spends far less than the U.S. does on health care and the health outcomes for Canadians are far better by every measurable standard.
Yet single-payer health insurance was never on the table. The best Obama and Congress have to offer is a complex measure that increases some regulations on the industry and offers (for now) the prospect of a public option that is, the ability of any citizen to buy a Medicare-style public insurance plan. The public plan is obviously an attractive option private companies spend as much as 40 percent of every health care dollar on administrative overhead and profit. The figure for Medicare is about 2 percent. But even that option may not survive the final wording of the bill.
And in exchange for accepting a few new rules and (maybe) having to compete against the government, the insurers get a huge bounty: the plan would mandate that every American buys health insurance. Even if many people choose the public option (if it's even available), the insurance industry will get millions of new customers.
And there's no guarantee that those who are currently uninsured will be able to afford the plans they need. Many will probably buy a minimal policy and wind up vastly underinsured which means they'll go broke and fall onto the medical and social safety net if they get seriously ill. As Steven T. Jones and Rebecca Bowe report in this issue, the vast majority of the medical bankruptcies today involve people who have insurance.
The House Progressive Caucus is only willing to support the bill if it includes a strong, viable public option. We'd go even further: if Congress can't offer a single-payer plan, it should at least allow the states to do that. Rep. Dennis Kucinich (DOhio) has an amendment that would authorize single-payer in any state that wants to try it, and that must be part of the final bill. Rep. Nancy Pelosi, who supports the current House package, should make clear that the Kucinich amendment must be part of the final package.
State Sen. Mark Leno has a single-payer bill in Sacramento that has passed twice but been vetoed by Gov. Schwarzenegger.