Americans Want Health Care Reform to Go Forward
Some people are spinning hard about the outcome of the recent mid-term elections. They are trying to say that the changes in Congress were a “mandate” to repeal health care reform. As usual, most of those spinners have little to say about how to resolve health care issues--for them health care is an ideological or political issue, not an issue of importance in everyday lives. It is a tactical issue in the beltway game, a ploy in the never-ending struggle for power and for special interest money.
But out here, when the issue is reduced to kitchen-table reality, people don’t think ideologically or politically. They think about their own health care, their families’ health care, and their own financial circumstances.
Here are some numbers about health coverage and the election.
Even on the ideological level on which they choose to operate, the spinners are wrong. The election result was driven by concern about the economy and jobs, not health care. According to a CNN exit poll, only 19% of voters named health care reform as their top concern--a distant second to the 61% of voters most concerned with the economy.
On the big abstract ideological question about support for the health reform law, the voters split down the middle: 48% say they support repeal and 47% say they want the reform law to stay the same or be expanded. Some mandate.
Polls consistently confirm that, when the public hears truthful facts (as opposed to the other kind of “facts”) about the health reform law, they want the benefits and support health reform. The specifics of health care reform already help people in ways that matter deeply to them. Undoing health care reform would mean:
- People would continue to be denied coverage or charged more for it due to pre-existing conditions.
- People diagnosed with the particular pre-existing condition of being female would continue to be discriminated against in the cost of their coverage. The spinners would continue that outrageous discrimination.
- People would continue to have coverage dropped when they get sick.
- People would continue to have lifetime caps on their insurance coverage.
- Small businesses would continue to have to pay higher rates for health insurance than big corporations.
- There will be no smart investment in prevention as the focus of our healthcare system--clearly the way to get both lower cost and better patient outcomes.
- People would lose the comfort of knowing that, no matter what happens to their job, their health, or their family, there will always be access to affordable, decent coverage.
- Entrepreneurs would continue to experience the drag on their creativity and chances for success caused by the health coverage problems. And health coverage issues would continue to prevent would-be entrepreneurs from even getting started, stuck in their current jobs in order to retain insurance.
The post-election spinners stay far away from these real problems. The new law leaves the private insurance sector in place (a single-payer system would have ended it), but imposes fair boundaries on it. The spinners, scrupulously avoiding anything specific about how to address health coverage issues, instead simply call the new law names: “takeover,” “socialism.” But calling something a name is not the same as talking about it honestly--indeed, it’s a time-honored way to stifle full discussion. The health reform law is in fact a very promising public-private effort to address a problem that plagues American households everywhere. The spinners are wrong about the importance to real people of health care reform. When the focus is on the actual health coverage problems that plague American households, most Americans want their federal and state officials to get on with implementation--and do a good job of it.
I agree with Mr. Bouman about the determination of the Right to ignore the dangers of repealing health care "reform," but I'll also point out the he hasn't mentioned all the realities either.
To take his bullet points one by one:
People with pre-exisiting conditions (of which I am one)can STILL be denied coverage or charged more until the magical day in 2012 when that's supposed to be eliminated. However, as we saw on September 23, when the first wave of reform laws went into effect, the insurance companies got around having to cover children with pre-existing conditions by either just suddenly stopping the sale of children's policies or making them so expensive that parents can't afford them.
Women would still be discriminated against in terms of reproductive care, because Democrats caved in to the anti-abortion demands for restrictive language.
The points about people having coverage dropped when they get sick or having lifetime limits on coverage have been made somewhat moot by the huge increases in premiums, co-pays, deductibles, and coinsurance along with the decreases in the percentage of costs covered. For example, my agency offers Blue Cros Blue Shield, both the HMO and PPO plans. For the PPO, our co-pays doubled or quadrupled, depending on the kind of doctor you saw; even after meeting the $500 deductible and the new $1000 coinsurance, only 90% of our costs would be covered, and drug co-pays were raised as well, an issue of vital importance for an HIV/AIDS agency where many of the staff are HIV-positive. The barriers to care that these hikes have created will result in fewer doctor visits, less monitoring of different conditions, problems accessing drugs, and, ultimately, worse health for me and my co-workers.
Business costs will continue to be extreme for small businesses no matter what. My non-profit agency with 38 employees pays 9% of its annual budget to insurance and each employee pays $100 per month for the PPO, which is now useless.
BCBS claims that it is still "waiting for guidance" as to exactly what preventive care will be covered. In the meantime, we'll have to pony up or do without.
"No matter what happens to their job, their health, or their family, there will always be access to affordable, decent coverage"--REALLY??? The only way that's going to happen is if we finally have a single payer system in this country that provides CARE, not "coverage." As it stands now, I am more worried, more fearful, and more trapped than ever before since I know my "coverage" will prevent me from getting the CARE I need but can't afford. It has always been joke that what is considered "affordable" to a politician, an economist, or an academic would actually BE affordable for the majority of the working class.
As far as entrepreneurs and every other businesses go, the "drag" of health coverage problems, as well as the negotiation over it between unions and management, would be totally eliminated by single payer.
As Mr. Bouman says, "calling something a name is not the same as talking about it honestly--indeed, it’s a time-honored way to stifle full discussion." As far as I'm concerned, calling the current system we have "reformed" is as deceptive as calling single payer "socialized." But then, to me there's nothing wrong with the idea that a society would take care of all of its own.
Thanks for your strong comment. You make a host of good points, Sue, about the flaws or soft spots in the health insurance reform law,but I'd ask you to consider the following:
1. Most of the reforms are not yet in place, which creates a disconnect between what we hear on the news and what we actually feel in our own situations. Full implementation, which phases in over the next three years, will come closer to telling the tale, because the provisions of the law are inter-dependent. Coverage expansions, insurance market reforms, the exchanges, subsidies, individual mandate, etc., must all be in place for each of them to have its full intended effect. As they phase in, they do not immediately have their intended impact, which will come later.
2. The "medical loss ratio" requirement, which requires health insurance companies to spend 80 or 85% of their income on actually covering health care costs, is not yet in effect, but will be soon. That is a provision that will help reduce the amount of money we are charged that goes to high executive compensation and profits, which in turn should reduce premiums and co-pays.
3. In my piece, I say the health reform is "promising" -- I do not say that the promise is fulfilled yet. Much of that depends on the states, which is why I said the people want the states to get on with it and do a good job. A LOT depends on the energy and good faith and skill of state implementation, and alot of that is political. So, for example, the issue you appear to care the very most about, the cost of insurance premiums, is left up the the states. The federal reform law requires a lot more public information and transparency, but it does not actually regulate insurance rates (Congress tried, but the votes were not there). So that issue remains an issue of state law. Illinois can change the law to allow regulation of insurance rates -- or not. That's our job, and the job of those we elect.
4. Finally, since you have insurance (such as it is), its natural that you didn't note one of the most important things about the reform law: it will cover 32 million currently uninsured people. That's not just important to them. Its important to all of us. As noted above, this coverage is an important part of reducing the cost of insurance for those currently insured. It is also part of the promise I referred to in the blog post: if something happens to your insurance or your job (after 2014, when all this is in effect), you will qualify for or be able to purchase decent coverage (the same programs and policies that will cover the 32 million). You may never need it, but that's a significant reduction of worry and potential exposure.
So, you are right that the system is not "reformed", but that's because we are just getting started. Most of the changes are yet to come. Even then, it won't be ideal (as you strongly note), but it will be a far cry better from the current system. And nothing says we can't keep trying to improve it further.
John
Thanks for responding to my response, John. I hope you don't regret it!
"Full implementation, which phases in over the next three years, will come closer to telling the tale, because the provisions of the law are inter-dependent." It’s precisely this “phasing in” that I have doubt about. If, as you say, all provisions are inter-dependent, why did they set it up to trickle in bit by bit? “Coverage expansions” will never happen because “insurance market reforms” will never happen due to both the strength of the insurance lobby and the industry’s talent for finding ways to get around the law. “Exchanges” and “subsidies” are likely to follow the same formula that Illinois’ current “high-risk/pre-exisiting condition” program does – so expensive that anyone who can afford the premiums, not to mention co-pays, deductibles, etc. can probably afford to pay out of pocket. The fact that these provisions were designed by politicians, economists, and insurance industry honchos, NOT lower-middle class consumers, or even medical providers, leads me to believe that, as in the original “reform” bills, the word “affordable” really has nothing to do with what the average person can actually afford.
"The 'medical loss ratio' requirement, which requires health insurance companies to spend 80 or 85% of their income on actually covering health care costs, is not yet in effect, but will be soon." Maybe, but based on what we’ve seen from the insurance industry so far, they’d rather leave a kid with cancer untreated than let anything eat into their bottom line.
"A LOT depends on the energy and good faith and skill of state implementation, and alot of that is political. So, for example, the issue you appear to care the very most about, the cost of insurance premiums, is left up the the states." True that the “promise” is not fulfilled. And very true that the states must take up the fight for health justice, since it’s clear that the federal government won’t. My biggest concern, however, is not the cost of premiums—I care most about access to and the cost of CARE, not “coverage.” Which is why I’ve joined with the Illinois Single Payer Coalition to push ahead in making Illinois a single payer state. All of these up-in-the-air, complicated, phased-in, phased-out aspects can be eliminated by the establishment of a single payer health care system in this country. But I’ll start with my own state first, as they’re doing in Vermont, Minnesota, Oregon and California, among others. The more states that adopt single payer systems, the more proof there will be that it works as capitalism never will.
"...one of the most important things about the reform law: it will cover 32 million currently uninsured people." I’m sorry to disagree, John, but by the time 2014 rolls around there will be close to 70 million un- or underinsured people in the U.S. The CDC just published findings from a survey that proves that right now there are more than 50 million and that number will only grow as the current system makes health care a luxury that only the rich can afford. But you’re right – the issue of everyone having health care IS important to us all. Which is why a single payer system is the only answer. Even though it will cost me less than 5% of my income, I would gladly pay 10% (about half of what I pay now in insurance/medical costs) if I knew that I and everyone I love, and all my HIV-positive colleagues and millions of people I will never know could have access to the care and treatment they need. And with a single payer system, there is no insurance to lose or to have to transfer from job to job and “reducing the cost of insurance for those currently insured” would be moot. Call me crazy, but I don’t want to settle for “a significant reduction of worry and potential exposure.” I want to know that I will never again see a spike in my blood sugar or blood pressure because of the stress of not being able to see my doctor or pay my medical bills.
"And nothing says we can't keep trying to improve it further." Exactly! And I’ll keep fighting the single payer fight until our health care system truly is reformed, nay, even reborn! Thanks for the dialog, though!
Sue