Is the House bill better than nothing (continued)


More comments from worthy commentators – Jonathan Cohn, a highly respected single payer advocate and writer, in The New Republic writes about why we should support the bill and urge its passage in the Senate, and Dennis Kucinich discusses why he voted against the House Bill.  For commentary from HCHP’s own Dr Aaron Carroll, check out his blog

The House Bill Is “Worse Than Nothing”? Really?

  • Jonathan Cohn November 9, 2009 | 1:47 pm
    Marcia Angell, M.D., is one of the nation’s most well-respected experts on health care issues. And with good reason. A board-certified pathologist who also trained in internal medicine, she’s a former editor of the New England Journal of Medicine and senior lecturer at Harvard Medical School. Her writing credits include The Truth About Drug Companies and an award-winning article at TNR on the same subject. (She co-wrote that with Arnold Relman, a distinguished physician, writer, and intellectual in his own right.)

Angell is a well-known advocate for single-payer health care: If it were up to her, she’d simply expand Medicare to cover everybody. This is not, of course, the kind of health care reform we’re going to get this year. Instead, we will–if we are lucky–get something that looks like the bill that passed the House of Representatives on Saturday night.

Angell is not impressed, as she explains today at the Huffington Post:

Is the House bill better than nothing? I don’t think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

I’m a longtime single-payer supporter myself. If Angell could get her way, I’d be thrilled. But Angell can’t get her way.

Blame the composition of the U.S. Senate, where North Dakota has the same representation as California. Blame the power of special interests like the drug industry, which virtually own large swaths of Congress. Blame public opinion, which remains stubbornly skeptical of big government even as it cherishes programs like Medicare. Or blame somebody else. The numbers in Congress simply don’t provide enough support for anything remotely approaching single-payer. Just look at how hard it is to pass a scaled-back public insurance option.

To Angell–and to others on the left, as my colleague John Judis notes today–this is reason for ditching the whole effort. But what, really, would that accomplish? The immediate impact would be to undermine Obama and his allies in Congress, creating the (accurate) impression they are incapable of passing major legislation. The Democratic Party would lose seats at the midterms and then, quite possibly, suffer even bigger setbacks two years hence. That’s not exactly a recipe for progressive revival.

Perhaps Angell and those who agree with her that this would be a constructive failure–that eventually growing frustration with our health care system will help us elect even more progressives and pass more ambitious reforms. Well, maybe. But that’s an awfully big chance to take. Progressives said the same thing when the Clinton health care plan failed and, before that, when efforts to pass universal coverage under President Richard Nixon collapsed. If anything, the conversation about health care reform has drifted the opposite direction over that span of time. You could plausibly claim that the reforms on the table today are more or less what moderate Republicans were proposing under Clinton, just as the Clinton reforms were not that far removed from what Nixon himself wanted in the early 70s.

And what would happen in the meantime? According to the Congressional Budget Office, the House bill would mean about 36 milion people get health insurance, reducing the number of uninsured by around two-thirds. People who had pre-existing medication conditions would, finally, have the ability to get insurance just like the employees of large companies do. The insurance would not always be as generous as it should be, but the government would prohibit lifetime caps, place some limits on out-of-pocket spending, and establish a basic benefits package that makes sure all policies cover a broad range of services.

The studies–which, I know, Angell has seen–suggests tens of thousands of people* die or go bankrupt every year because they can’t afford to pay their medical bills. Countless more suffer. The House bill wouldn’t stop such hardship altogether. But it would reduce it significantly–arguably, by as much as any single piece of domestic legislation since the Great Society. Surely that qualifies as something more than “a few improvements around the edges.”

The House bill would do many other things, too, familiar to the readers of this space–from the creation of a public plan to the creation of pilot programs that would begin to change the way we deliver medical care. And while it wouldn’t do nearly enough to make health care less expensive–the drug industry, among others, remains a source of untapped savings–the House bill certainly wouldn’t cause the cost of medicine to go up even more quickly. If anything, it’ll cause the cost to go up a bit more slowly.

As I’ve argued repeatedly, the House bill is not close to perfect. Neither is its Senate counterpart. But we don’t pass perfect laws in the U.S. We pass imperfect ones and then do our very best to improve them over time.

It happened that way with Social Security and Medicare. It can happen that way with comprehensive health care reform, too. But only if we do something, rather than nothing.

*Note: I originally wrote “millions” of people die or go bankrupt every year. That’s rather overstated. It would be more accurate to say “tens of thousands,” as I’ve now rewritten, although one could plausibly argue it’s more like “hundreds of thousands” depending on your definition of “medical-related bankruptcy.” In any event, thanks to reader “adsprung” for correcting my error–and for reminding me that I should read over my blog entries a little more carefully before hitting “publish.”


Congressman Kucinich addresses vote on H.R. 3962

Congressman Dennis Kucinich after voting against H.R. 3962 addresses why he voted NO, stating:

“We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system.”

“Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.”

“But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies – a bailout under a blue cross.”

“By incurring only a new requirement to cover pre-existing conditions, a weakened public option, and a few other important but limited concessions, the health insurance companies are getting quite a deal. The Center for American Progress’ blog, Think Progress, states, ‘since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.’ Similarly, healthcare stocks rallied when Senator Max Baucus introduced a bill without a public option. Bloomberg reports that Curtis Lane, a prominent health industry investor, predicted a few weeks ago that ‘money will start flowing in again’ to health insurance stocks after passage of the legislation. last month reported that pharmacy benefit managers share prices are hitting all-time highs, with the only industry worry that the Administration would reverse its decision not to negotiate Medicare Part D drug prices, leaving in place a Bush Administration policy.”

“During the debate, when the interests of insurance companies would have been effectively challenged, that challenge was turned back. The ‘robust public option’ which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million. An amendment which would have protected the rights of states to pursue single-payer health care was stripped from the bill at the request of the Administration. Looking ahead, we cringe at the prospect of even greater favors for insurance companies.”

“Recent rises in unemployment indicate a widening separation between the finance economy and the real economy. The finance economy considers the health of Wall Street, rising corporate profits, and banks’ hoarding of cash, much of it from taxpayers, as sign of an economic recovery. However in the real economy – in which most Americans live – the recession is not over. Rising unemployment, business failures, bankruptcies and foreclosures are still hammering Main Street.”

“This health care bill continues the redistribution of wealth to Wall Street at the expense of America’s manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.”

“Notwithstanding the fate of H.R. 3962, America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system, which is good for the American people and good for America’s businesses, with of course the notable exceptions being insurance and pharmaceuticals.”


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