The broken health care system in the US is a certifiable failure. Close to 90 million people went without health insurance at some point in 2007-2008, according to a new report by the advocacy group Families USA. This number adds a new dimension to the commonly used Census Bureau statistic that 46 million who went uninsured for the entire year of 2007, because it suggests that the current health system fails to provide continual, affordable access to about one-third of Americans under the age of 65.
A recent report by the Center for American Progress found that the economic crisis has hit American workers hard on the health care front. Every day in the months of December and January, approximately 14,000 workers and family members lost their health care coverage. Losses for the month of February are expected to continue to grow as the employment picture worsened.
“Inaction on health care reform in 2009 cannot be an option for the tens of millions of people who lack or lose health coverage each year,” said Families USA Director Ron Pollack. “The cost of doing nothing is much too high: more and more people would fail to get the health care they need or would risk being bankrupted by unaffordable health care costs.”
White House agenda
The urgency for reform, downplayed or ignored by the Bush administration for eight years, has returned front and center as President Obama has made it a key piece of his agenda for 2009.
With the release of its first federal budget, the Obama administration announced a proposal for a $634 billion health care fund to help expand affordable access to health care coverage and to control the rising cost of care.
On the heels of that announcement, the White House opened its first health care reform summit, March 5th. That forum brought together health care reform advocates in Congress and congressional Republicans, the representatives of dozens of business groups, labor unions, health care associations and retiree groups, as well as academic experts and experienced activists.
In a teleconference with reporters prior to the summit, White House Domestic Policy Director Melody Barnes stated that the Obama administration's health reform policy centers on three basic principles: expanding access, controlling skyrocketing costs and improving the quality of care.
Barnes added that the White House will not be sending Congress a bill to pass, but will allow the main actors and proponents of reform to put together their own legislative package. President Obama will look favorably on a bill that best adheres to his general principles.
'The president wants to engage with Congress in a transparent and bipartisan fashion,' said Barnes.
Still, the White House has elaborated some of the finer points it supports. Earlier in the week, the Obama administration talked about the need to expand the employment-based system by helping small businesses afford coverage and by allowing the government to take over catastrophic coverage from businesses owners. In addition, the White House Web site calls for providing a public option for individuals and families who lack private health care coverage.
The White House also emphasized the need to require insurance companies to cover preexisting conditions. Said Barnes, 'We can't just treat those who are well.' She also highlighted the president's support for reform that emphasizes preventive and wellness and builds on the nation's system of community health centers to eliminate geographical, class and racial biases built into the current system.
The leading proponent of the most inclusive and cost-effective reform proposal already introduced in Congress, Rep. John Conyers (D-Mich.), also attended the event. His plan, the US National Health Insurance Act (H.R. 676), would expand affordable access by including everyone on the Medicare rolls. It would further provide complete coverage, including vision, mental health, catastrophic care and dental care, and cap out of control costs by eliminating the profit motive from the health care industry.
While President Obama philosophically favors a single-payer plan, Barnes suggested, he has said that given the current political and financial circumstances, realistic reform will focus on expanding the employment-based system and providing additional options for working families struggling with insurance premiums and high prescription drug costs.
Summit opens the conversation
In his opening remarks to the White House summit, President Obama pointed out that over the past eight, years nine million people have joined the ranks of the uninsured, health insurance premiums grew faster than wages and bankruptcies caused by medical bills set new records.
Obama described the health care crisis as the 'greatest threat' the country faces economically and financially.
'The problems we face today are the direct result of actions we failed to take yesterday,' Obama said. 'Since Teddy Roosevelt first called for reform nearly a century ago, we have talked and we have tinkered.'
Obama pointed out that Washington politics and industry lobbying have for far too long stalled meaningful reform. The public is understandably skeptical that as in the past special interests will block real reform, but today a new consensus has emerged that reform is more necessary than ever.
'This time there is no debate about whether Americans should have affordable health care; the only question is how,' the president added.
Chiding special interest associations and the powerful voices who have dominated the health care debate in the past, Obama invoked a spirit of compromise and asserted that there should be 'no sacred cows' in the process of reforming the system. 'No proposal will be perfect. If that's the measure, nothing will get done.' He added that, 'we cannot let the perfect get in the way of the essential.'
Barnes stated that the administration's goal is to get a health care reform bill from Congress this year.
The general issues of health care reform – reducing costs, expanding access and improving the quality of health care – served as the main topic of the break-out sessions of the White House health care reform summit on March 5th.
The five break-out sessions included insurance and business interests, labor and community leaders, health care associations and members of Congress from both parties.
The participants in one of the meetings, moderated by White House Domestic Policy Director Melody Barnes, generally agreed on some basic issues: improving health care information technology, expanding health care infrastructure, increasing the number of health professionals, investing in preventative medicine, requiring coverage for preexisting conditions and addressing questions related to portability.
Debate over the public option
Sharper divisions emerged over the issue of providing a public health care option for individuals and families who find the private market too expensive or do not have access to adequate coverage from private insurers.
Blue Cross Blue Shield CEO Scott Serota described creating or expanding a public health insurance option as creating a new 'government bureaucracy' that would make the private market unsustainable. Serota failed to explain why the private market, whose promoters insist is always more efficient than public programs, would have such a difficult time competing with a public plan.
It is the private market that has a lot to explain with regard to rising costs and the lack of coverage, Rep. Jan Schakowsky (D-Ill.) fired back at Serota. She dismissed Serota's 'bureaucracy' claim, pointing out that compared to private insurers, Medicare, for example, has a very low overhead that makes it far more efficient than the corporate bureaucracies that are driving up prices.
Competition between a public plan and the private market would be beneficial, said Service Employees International Union Healthcare Chair Dennis Rivera. 'That competition is going to drive the cost down,' he stated.
Sen. Sheldon Whitehouse (D-R.I.) added, 'We're past the Harry and Louise moment,' recalling the ad campaign funded by the private insurance industry back in the early 1990s to help block the Clinton's administration's efforts at health care reform. 'We're at the Thelma and Louise moment,' he said. 'We're in the car heading for the cliff. Everybody understands that.'
'Insurance coverage has got to be meaningful,' stated Rep. Allyson Schwartz (D-Penn.). Private insurers impose long waiting periods at the beginning of a plan, refuse to provide coverage for people with preexisting conditions or boot off people who have serious illnesses or health problems. These issues have to be reformed in order to make insurance 'meaningful,' she noted.
Planned Parenthood Federation of America President Cecile Richards noted that for many younger working-class women, family planning clinics are their first interaction with the country's health care system. “As a safety net health care provider with nearly 880 health centers across the country, we know the importance and value of preventive care. Ninety-seven percent of the services we provide every day focus on prevention to ensure women and their families lead healthy and productive lives,' she said. Expanding access to this type of care should be a serious concern for any health care reform agenda, she added.
Echoing the general concern to promote urged passage of reform that emphasized preventative care, addressed the desperate need to to provide care for Native Americans, and added that Congress must pass a law to allow the re-importation of FDA-approved prescription drugs in order to lower costs.
With this, Sen. Orrin Hatch (R-Utah) agreed that preventative care could get a huge boost by eliminating barriers to stem cell research erected by the Bush administration, but inexplicably described the re-importation bill as 'B.S.'
Other participants expressed concerns about imposing mandates on coverage, or requiring individuals and/or employers to buy insurance coverage or get access to a public plan. Rep. Jo Ann Emerson (R-Mo.), for example, said that while she understands and supports requiring people get coverage saves money by increasing the size of coverage pool, she believes her constituents will resist the government ordering them to get insurance. The way the concept his framed has to be modified in order to be made palatable, she recommended.
In a separate session of the summit, Edward F. Coyle, executive director of the Alliance for Retired Americans, said, 'Any health care reform passed by Congress must allow Medicare to negotiate volume discounts with drug manufacturers; close the ‘donut hole’ in Medicare Part D coverage; and provide early retirees age 55-64 the option to purchase Medicare coverage.'
In his remarks following at the close of the summit, President Obama fended off calls by congressional Republican leaders to establish a commission on 'entitlements' to gut Social Security and Medicare outside of the normal legislative process. Medicare should be reformed by eliminating waste created by the Bush administration's 2005 privatization plan and by reforming the health care system generally to control costs, the Obama insisted. In addition, Obama has stated that Social Security reforms should not include raising the retirement age or reducing benefits, but by bumping up the income cap on FICA payments to increase the program's revenue.
Overall assessment
It seems that the Obama administration has a clear estimate of what kind of health care reform is possible given the current balance of forces in Congress and in the country at large. Corporate forces, especially private insurers, still too strongly dominate the debate.
While President Obama could have excluded them from this conversation, it is certain that such a move would insure that no meaningful steps toward reform would be enacted any time soon.
Proponents of the single-payer cause, especially of Rep. Conyers' plan, including this publication, should never give up on that cause. But we should also not insist on the perfect plan to the point where we exclude ourselves from the general debate and the reform process that the Obama administration has launched.
In 2009, the struggle for health care reform will focus primarily on the question of the necessary expansion of public options for working families as viable alternatives to expensive and inadequate private insurance. While a single-payer program may not itself be on the table in 2009, still on the table, however, are expanded public options like Medicare, Medicaid and S-CHIP as well as federal insurance plans that can reduce the numbers of the uninsured and the tens of millions of people who go without coverage for a portion of the year.
If such reforms are implemented, the first goal of all health reform advocates – making sure everyone can get adequate care – can be achieved. Private insurers who profit from illness and disease will then be forced to compete with a more humane and affordable system.
Perfecting such a system by putting in place a universal single-payer plan will be an ongoing struggle, and it is one we cannot afford to surrender or become cynical about just because it may not be won in 2009.
