Celebrate HCR, but remember, it's not what we really want
Health care reform is finally in the works. What now? I say it's OK to celebrate partial victories, even while acknowledging what has yet to be accomplished. So lets celebrate this one! ... AND ... it's also OK to acknowledge that this bill does not represent most of what we really want.
The National Coalition on Health Care fought hard for a more extensive health care program than has been passed, yet joins with most progressives in celebrating what was accomplished in the Congress so far. Like Social Security and Medicare, the first steps toward serious reform are always limited, but are then later expanded in good ways. Here are some highlights from the National Coalition on Health Care's statement on how, upon enactment, the health reform bills passed yesterday by the House will move the United States toward accomplishing five major health reform goals:
• Health Care Coverage for All -- the legislation adds coverage for 32 million more Americans, ending insurance abuses like pre-existing condition exclusions and restrictions and also allows young adults to retain coverage under their parents' policies;
• Cost Management -- the bill has an array of cost containment strategies including, fraud prevention and detection measures, new health insurance exchanges where quality plans including new multi-state insurance plans will compete for consumers' dollars and produce greater market transparency, requirements that hospitals post the actual price of services and shift away from today's inefficient fee-for-service system;
• Improvement of Health Care Quality and Safety -- the bill provides new incentives for lower hospital readmission rates, stronger penalties for high rates of hospital-acquired infection and develops quality and performance measures for providers and hospitals, supports unbiased research into which treatments work best through a new Center for Patient-Centered Outcomes Research, creates a Wellness Trust to assess and invest in both clinical and community-based prevention, eliminates co-pays and deductibles for preventive care, provides that physicians' quality performance measures be published on the Internet, and establishes strong pilot programs to reward effective care coordination and empowers the Secretary of Health and Human Services to expand effective pilots;
• Equitable Financing -- combined provisions of the bill will begin to deliver some relief from skyrocketing health care costs with over a trillion dollars in federal deficit savings projected over the next two decades, and for businesses, reduce annual per-employee health care costs by an estimated $3,000, and for those in the individual market, reduce average premiums by 14% to 20%;
• Simplified Administration -- supported by provisions to eliminate unneeded administrative costs, simplify and standardize inefficient and duplicative insurance forms, and to create additional incentives for the adoption of health information technology.
While we celebrate these limited gains, however, let us not forget that this is also the biggest giveaway to the private insurance companies in decades, forcing 30 million people to buy health insurance whether or not they want it, without putting any significant price controls in place, so the insurance companies get a huge new group of health insurance purchasers and can (and will) raise their prices just as they have done in outrageous ways in the past decade. This will inevitably lead to consumers being outraged and angry, but that outrage might well be expressed as "government meddling" in the marketplace as much as at insurance companies, and lead to the repeal of this measure, or at least to the transfer of control of Congress to the Republicans.
The major way to control costs remains obvious: to take health care out of the private sector and make it a public benefit, like Social Security and Medicare, thereby eliminating the super-profits that this legislation virtually ensures to profiteers -- profits that account for a significant part of the rising costs.
That's why we at the Network of Spiritual Progressives and Tikkun will continue to be calling for a "Medicare for All" version of health care. And if it is called socialized medicine, well, that's what the Right already is calling the current plan, so where's the sting?
Socialized medicine works fine in most advanced industrial societies, and the quality of care is far superior to what many Americans are able to afford under our current system. But such a change must be argued for not solely in terms of "cost containment" but also and primarily as an ethical imperative, based on our NSP New Bottom Line and our commitment that it is genuine caring for each other that must be the guiding principle in shaping social practices in our society and around the world. The greatest critique we have of how the Democrats achieved this victory was that they failed to articulate that principle of caring as the center of their legislative campaign, and hence failed to win over the majority to support the reform, a failure that may yet lead to significant losses at the polls in November.
This failure was NOT inevitable -- it was based on a technocratic vision of how to do politics: horse-trading and compromising (even to the extent of making it harder for poverty-stricken women to get access to abortions), rather than by a public campaign to convince people that the legislation embodied a principle of caring for everyone. But how could they convince people of that when the program actually does not provide health care for at least 15 million to 20 million people who lack it today, and when it involved cuts in Medicare in order to meet the new "principle" that the health care reform should not increase the deficit -- a requirement never articulated when the Obama administration seeks huge military expenditures for a war in Afghanistan?
Without that principle of "caring for each other" and without shaping the program to embody that principle, the Democrats decided to put "winning something concrete" over the idea that changing consciousness should be central. That, we believe, is a mistake that may return to haunt them. It may haunt them in upcoming elections, and it may haunt them if at some future time either the Supreme Court or a more conservative Congress overturns what they have won.
A more conservative Congress is continually in danger of getting elected because the Dems are more interested in winning a particular legislative battle than in developing a new understanding of what really is important and what should guide all political thinking (namely, caring for each other and for the planet).
All that said, however, we still think it's a moment to celebrate even the partial victory, to join with the National Coalition on Health Care and endorse their statement, and to congratulate those who stood firm in the face of overwhelming cynicism about the possibility of accomplishing anything in this Congress!
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