Democrats Pass Obama-care: Now What? by Dr. Rick Bayer
In March, President Obama signed historical healthcare legislation. But, this law is only a good first step. Our new law—while good politics—represents failed policy. Expect both good and bad news for stakeholders as the law evolves slowly over years.
The clue to bad news for patients was that the bill was drafted by lobbyists from Big Insurance and Big Pharma. Universal healthcare coverage for all Americans became a non-starter while the public option vanished. Even 9 years after the law was signed, 23 million Americans will remain uninsured while 100 million will remain underinsured because of high co-pays and deductibles. For details, see www.pnhp.org.
This new law metaphorically provides morphine to treat cancer. Instead of removing the cause of America’s problem—our profit-driven, private health insurance industry—Congress coddles the industry. These parasitic corporations cannot compete for efficiency against non-profit Medicare. Naturally, it angers taxpayers that Congress plays us for fools by making us buy defective insurance products. Your doctor should after all provide healthcare—not Aetna. And the new law will drain $36 billion from Medicare payments to safety-net hospitals, which threatens care for tens of millions of Americans who will remain uninsured.
Employer-based coverage means workers remain job-locked within a limited network of providers. As insurers rapidly raise premiums, workers will face steep taxes on healthcare benefits. There is no public option to make insurers compete so there is no cost-control. The weak consumer protections in the new law, such as ending denials for pre-existing conditions, contain loopholes. Older people can still be charged more than younger people. And large companies with predominantly female workers can still be charged higher gender-based rates until 2017.
Sadly (and perhaps predictably) the biggest sacrifice will probably be borne by young, poor women. Women’s reproductive rights eroded as politicking yielded a burdensome segregation of insurance premiums for abortion services separate from insurance premiums for all other medical services. Katha Pollitt wrote in The Nation, “As healthcare reform becomes law, you can thank pro-choicers. In the end, forced to decide between sacrificing abortion coverage and voting down coverage of everything else for 30 million people, abortion-rights supporters took the hit.”
What’s the good news? In my opinion, there is growing public awareness that this law needs fixing, partly because of the false expectation it will lower costs. The law copies the Massachusetts experiment, which fails to control costs, meaning we will soon have that failure magnified. For example, Congress already delayed planned Medicare cuts so doctors will see seniors. And, with no cap on premiums charged by health insurers or competition from a public option, Americans will continue to pay the highest premiums in the world. The new law continues to support a failed “market place” system instead of establishing a new universal healthcare system.
Congress may eventually paint us into a corner so it must choose between single-payer health insurance or permanent recession. As Harvard economist Dr. William Hsiao says, “You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.” At best, the new law presents an incremental—albeit brutal—path to achieve a universal healthcare system that most industrialized nations take for granted.
Good changes for 2010 include additional funding for community health centers. Starting this year, insurers can no longer impose lifetime limits on coverage and won’t be able to drop you after you get sick. Coverage for dependent children may last until age 26. Seniors get one free prevention visit if they can find a doctor accepting Medicare and they get a $250 prescription rebate. Unfortunately, we still can’t use mail-order Canadian pharmacies so free-market competition talk is bogus. Small businesses get tax credits for providing workers insurance.
Many more benefits could have been achieved more efficiently by using a successful evidence-based model—Medicare. Instead, Congress pampered healthcare corporations while saddling Americans with expensive mandates and new taxes on health plans through shady deals with Big Insurance and Big Pharma. This new law perpetuates our dysfunctional and unsustainable health insurance market place that depresses both our nation’s health and economy.
Because patients have no lobbyists, we got a raw deal. The USA has no healthcare system—only a market place for insurers to extort the sick. Americans are dying so insurers can make a killing. The stock prices of Aetna and other for-profit insurers rose substantially after the healthcare bill was signed. Patients need to get angry and protest when voting this fall. We should vote out every politician who obstructed Obama-care. We need politicians who are public servants rather than corporate shills for Big Insurance and Big Pharma.
Only a single-payer plan like Medicare for all can assure truly universal, comprehensive, and affordable care to every American. By replacing private insurers with a streamlined system of public financing, America could save $400 billion annually in wasteful administrative costs. That’s enough to cover all the uninsured and to upgrade everyone else’s coverage without increasing overall US health spending by one penny. Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting, and capital planning.
Polls show nearly two-thirds of the public and nearly 60 percent of U.S. physicians support national health insurance. The final ingredient is political will. Americans need to bring the heat to Congress until they fix this law. Major provisions of Obama-care do not go into effect until 2014. Although progressives will be counseled to see how reform plays out, we cannot rest. We must continue our work for the only equitable, financially responsible, and humane remedy that provides universal healthcare: single-payer national health insurance.
Richard “Rick” Bayer, MD, FACP is board-certified in internal medicine, a Fellow in the American College of Physicians (FACP), practiced, and lives in Oregon. He is a member of Physicians for a National Health Program www.pnhp.org