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 Some on the left believe that the health care bill needs to pass no matter what and others feel it is just too bad to pass. Below are missives from two of those groups.
The first from Amy Smoucha, Health Care Organizer for the statewide Missouri Jobs with Justice
Dear friends:
A lot of folks have been asking me about health insurance legislation making its way through Congress. I think we will get a great Christmas present from the Senate, and then we have to gear up for a difficult and important fight in Conference Committee. I have been studying and thinking about what we can gain and what's at stake. I hope the following is helpful:
"An open letter to progressives: ideology kills people
I have been amazed at the rancor and deceit that many politically “right wing” and conservative leaders have demonstrated during the long, heated struggle to pass health reform legislation. I’m amazed that for political, partisan and ideological reasons, Republicans and Libertarians are willing to lie to their own voters. I’m awestruck at the monumental steps people are taking to protect corporations, defend outrageous profits and protect a status quo that working people in any political party cannot afford much longer.
Of course, we expect that sort of vitriol and cynicism from the right wing and from conservative political operatives who have lost ground in the last election and are bitterly losing the health care fight.
I am having a much harder time understanding the fierce attack by some folks who are thoughtful, independently-minded and progressive. Like any significant human and civil rights struggle, we are in a place where we’ve won a lot, we’ve lost some of our demands, and there’s more work to be done to get a final bill out of conference. Both the House and Senate health care bills represent an incredible step toward real, affordable, quality health care for every person in our country. Neither of them accomplish everything we need.
I hope we all evaluate the bills and what they accomplish based on the ambitious reforms they include and an understanding of the context in which the measures are proposed. The bils do many things for our communities--like funding clinics and doctors. It’s important to consider the flaws in the bills alongside a balanced understanding of just a few examples of what we are gaining and winning:
1. The Senate bill delivers health coverage to 94% of Americans --31 million uninsured people will gain access to affordable health coverage. (The House bill would cover 36 million—95%.)
2. The proposed expansion of Medicaid will provide a lifeline to 15 million low-income and disabled Americans. Congress is about to enact a significant expansion of Medicaid for both individuals and families up to 133% of the federal poverty level. Currently in Missouri a family of three is eligible for the state health insurance program if their income is less than $292 a month. Both House and Senate bills lift the income rules for the whole country to about $2029 a month for that same family of three. For the first time adults without dependent children will get this coverage. These 15 million uninsured, low income individuals will gain insurance through a public health insurance program that is affordable and has very nominal out of pocket costs. This provision will help laid-off workers and part-time workers. This expansion will revolutionize life for people with disabilities and people living with mental illnesses. For many of us, when disability strikes, we will no longer have to prove that we are “permanently and totally disabled” and unable to work just to have access to the public option of Medicaid. We won't have to stop working just to get health care.
3. Corporate abuses are curtailed and health Insurance companies have been significantly pushed back in both bills. The Senate bill went much farther than we imagined in reining in insurance company abuses. What’s really in the Senate bill? Insurance companies will not be able to turn us down or charge us more if we have pre-existing medical conditions. Insurers will be required to spend 85 cents out of every dollar they receive in premiums on health care rather than profits and administrative costs. If not, people would receive rebates from their insurance companies for the difference. Insurance companies will be banned from issuing policies that have lifetime or annual limits on benefits. Consumers gain the right to an independent appeal of any decision by an insurer to deny coverage.
4. Both the House and Senate bills bill create a national, non-profit, publicly accountable option for health insurance coverage. The House bill contains a national public insurance option. However, even in the Senate bill, people purchasing insurance in the Exchange will be able to choose from national plans, including at least one non-profit plan, supervised by the same department of the federal government that selects health insurance plans for federal employees. Before the recent invention of a “public plan” demand, progressive health care activists were asking Congress to either open up Medicare for all or allow people to buy into the plans administered by the Office of Professional Management—the same plans that Congress and Federal employees have. We just won a long-standing demand.
5. We cannot “start over” and get more progressive reform through Congress any time soon. Getting landmark legislation passed is a treacherous, long chess game, especially when that legislation has powerful corporate enemies or extends significant civil and human rights. Unprecedented political capital and economic capital have been spent—the years spent making health reform a key issue in the last election, the storybanks, the canvasses, the phone calling. We all put our best game on the field. It’s time for a final push to improve the legislation in conference committee and to plan on how we will take this momentum and build and expand on our victory. Many leaders in the health reform movement predict that if health reform fails now, we will not have another meaningful effort for 15 to 20 years, if at all. If health reform fails now, the insurance companies and for profit health care corporations will laugh (at us) all the way to the board room.
This fight has been long and vicious because Congress is creating federal rules that make insurance companies behave. Insurance companies are going to be regulated, and they don’t like it. So much is at stake. It is very dangerous to forgo these incredible victories because they are not far enough, especially since losing means millions of struggling Americans will have to continue in the health care system as it is for many, many years. I’ve spent the last three years talking to hard working people throughout Missouri who will get real, measurable, concrete help from these legislative changes. For some of them, their lives literally hang in the balance. We have a responsibility to stand beside and for the uninsured working people who will gain much from these bills.
As a few progressive groups send emails around to “kill the bill” (along with the tea party) or “a bad bill is worse than no bill,” insurance companies and right wing political operatives throw fuel on that fire. All of us should deeply consider the consequences of squandering this opportunity to move our health care system several strides forward. Kill the bill, and insurance companies win. I believe we are better than that.
Fighting for health reform for Christmas,
Amy Smoucha
St. Louis, MO
asmoucha@gmail.com; amy@mojwj.org"
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"This from the Physicians for a National Health Plan
To the Members of the U.S. Senate:
It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation's broken health care financing system inflicts on our patients. We make no common cause with the Republicans' obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill's passage would bring more harm than good.
We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers' most egregious practices. Yet these are outweighed by its central provisions - particularly the individual mandate - that would reinforce private insurers' stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers' inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.
Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources - including funds diverted from Medicare - into the very private insurers who caused today's health care crisis. Social Security's first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!
While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:
* The bill's anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.
* The new 40 percent tax on high-cost health plans - deceptively labeled a "Cadillac tax" - would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men's), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.
* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go - a human rights abuse.
* The bill would leave hundreds of millions of Americans with inadequate insurance - an "actuarial value" as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.
Congress' capitulation to insurers - along with concessions to the pharmaceutical industry - fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS' own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick - front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.
We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach - an expanded and improved Medicare-for-All program - which prioritizes the advancement of our nation's health over the enhancement of private, profit-seeking interests.
Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program"
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