Because we have extensive experience with three health systems, we could have had a very informed debate. The U.S. has a market-based system (private insurance-controlled health care); a single payer system (Medicare) and a socialist system (the Veterans Administration). We could have asked which worked best, which covered the most people, which was least expensive, and which produced the best health outcomes. This fact-based discussion could have resulted in putting in place an efficient, effective national health system moving the U.S. into the top tier of health programs from its current dismal ranking of 37th in the world.
But, that debate never happened. Right from the outset President Obama and the Democratic leadership decided to consider only a private insurance, market-based solution. A real debate would have found that the market approach was the least effective and most costly part of American health care. In the end we got the pre-ordained decision; market-based health insurance was further enshrined with all its administrative and bureaucratic costs, its unfairness and inability to provide health care to all.
Over the last year, Democratic and Republican partisans in and out of government have made the debate on health a misleading one. False distractions like 'death panels' and 'government take-over' kept the right wing and Republicans fomenting and angry when neither was occurring. On the left, the public option, always miniscule and never really on the table, was the primary focus of non-profits aligned with the Democratic Party. This non-issue distracted progressives from the real issues and divided Americans who wanted real reform.
Reality is still hard to see through the fog of partisan rhetoric. The Republicans continue to claim socialism and a government takeover of health care, when the law is neither. And, the Democrats have been high-fiving each other and claiming they've achieved the equivalent of Social Security, the Civil Rights Acts, and Medicare none of that is true either.
When the rhetorical fog lifts, we will see the system has not changed much. Health care will still be dominated by profit-driven insurance companies. More public money will go to executive salaries and private industry profits. Tens of millions of people will remain uninsured and costs will continue to increase. The challenge for the future is how to get public dollars to go to the nation's public health and not to corporations that serve as middlemen that do not provide health care.
The centerpiece of the "reform," subsidizing the insurance industry, forcing Americans to buy their overpriced product and more deeply embedding insurance market-control of health care, was barely debated. Only after passage of the bill is a debate beginning on whether this is within the constitutional power of government. Of course, the corporate media are saying the mandate is constitutional, not surprisingly since it is in the interests of corporate power. But never before has the federal government required Americans to buy a product. This unprecedented expansion of federal power raises a very real constitutional question that expands the Commerce Clause at a time when the Supreme Court is reining it in. Putting on my lawyer hat, I see this as unconstitutional and in the end it will be decided by a divided court. Click here and here for links to the legal arguments from a progressive and conservative perspective.
We never had a debate about whether it is a good idea to have the federal government force Americans to buy a corporate product. This major, unprecedented approach was lost in the din of death panels and the public option. Where does this precedent lead? Should Americans be forced to buy a retirement plan from JPMorgan or Bank of America to ensure retirement security? The U.S. already gives hundreds of billions annually in corporate welfare through crony capitalism, disguising it with "free market" rhetoric, not even counting the massive bailouts of the last year. This new form of corporate welfare will extend the big business-big government connection in new ways and further the pay-to-play politics of Washington, D.C., with more corporate money polluting politics.
The new law forces Americans to buy a corporate product that is overpriced and flawed. Americans could be required to pay up to 9.5 percent of their income on insurance that only covers an average of 70 percent of their medical expenses. In addition, insurance is allowed to deny care with no court review of that decision. As a result, someone with insurance, paying an expensive premium, could find themselves in bankruptcy as a result of this law. The major cause of bankruptcy before this bill was a health care crisis and a majority of those people had insurance. That will remain true under the new law.
What did we get? There were some attempts to fix insurance abuse, but every fix had a poison pill added by the insurance industry. A good example is insurance no longer being able to deny care for pre-existing illness. The poison pill, which may actually make things worse for more people, is the industry can charge people who do not meet their wellness guidelines double what they charge others. And, if you are older, they can charge triple. So, while you cannot be denied insurance, will you be able to afford it?
We also got expansion of coverage. The largest source of expansion is Medicaid 16 million more people will be covered. Medicaid is woefully underfunded poverty medicine that pays doctors such poor reimbursement that many refuse Medicaid patients, and it does not cover all health needs. States are already stretched thin trying to pay for Medicaid resulting in more cuts to services and lowered payments to doctors. The federal government provides financial assistance but that ends in 2016. Relying on Medicaid re-enforces a caste system where health care depends on wealth.
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