Roger Bybee says, "Health Insurers won the pot. Reformers need a new game." In his article, "Fixing the Big F*%#ing Deal," Bybee says that passing this comprehensive health plan legislation is a step forward. However, there is still much to do.
In a too-loud whisper to President Barack Obama, Vice President Joe Biden famously characterized the signing of the Patient Protection and Affordable Care Act as “a big f—-ing deal” at a triumphal White House news conference.
On a political level, the new law is indeed a “BFD.” But in terms of healthcare policy, many reformers believe that the law fundamentally reinforces insurers’ stranglehold on affordability and access. Consequently, the law will fail to restrain the market forces inexorably driving up healthcare costs, thereby forcing another confrontation further down the road as costs climb and coverage shrinks.
Still, America’s first comprehensive health plan represents a step toward establishing healthcare as a basic American right. The new law includes an extension of healthcare to 32 million uninsured people, some valuable protections against insurer abuses, and a badly needed expansion of Medicaid and community health clinics.What about the pitfalls of the bill?
Health Care for America Now!, a coalition of 1,000 organizations, views the Patient Protection and Affordable Care Act in distinctly positive terms. “First of all, the most important thing is that it establishes that people will get decent health coverage that they can afford, and that government has a responsibility to provide that,” HCAN Executive Director Richard Kirsch told In These Times. “That’s a fundamental transformation, from it being a privilege to a right.”Kirsch ticks off some vital areas for improvement. “We will need to improve the affordability for many families in the exchange [a government-sponsored offering of insurance plans for the presently uninsured to choose from], especially those just above the Medicaid level and adding some more help for the upper-middle class.”
Insurance industry triumphs
Non-HCAN reformers are distressed by what they see as a fundamental defect with the new reforms: The new healthcare law enlarges and fortifies the throne from which for-profit insurers dominate the healthcare system.
Regardless of the policy differences among reformers, the law’s basic contours reflect the remarkable political power—exerted through campaign contributions, lobbying and television ads—of the for-profit insurance industry, according to Steffie Woolhandler of Harvard Medical School and Physicians for a National Health Plan, a 17,000-member organization advocating a single-payer or Medicare-for-all plan that would replace for-profit insurers with a single government entity.
“The big problem in this fight about trying to introduce the single-payer idea into the debate was actually the insurance industry and how they were allowed to write the bill and check the language of the bill throughout the process,” she told In These Times. Former WellPoint insurance company Vice President Liz Fowler, an “aide” to Senate Finance Chair Max Baucus (who ruled single-payer “off the table” early on in 2009), has been credited with writing much of the legislation.
Given the central role that the new law preserves for for-profit insurers, former Labor Secretary Robert Reich placed the new law in proper historical context when he cautioned in Salon.com: “Don’t believe anyone who says Obama’s healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama’s health bill is a very conservative piece of legislation, building on a Republican [a private market approach much like Mitt Romney’s] rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option.”
Consequently, the guiding logic of the current system—under which insurers maximize profits by minimizing care, and ever-expanding “provider chains” (hospitals, clinics and physician networks) seek to enlarge their revenues and market share without regard to health needs—will remain intact. “Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need,” says Rose Ann DeMoro, executive director of the National Nurses United union.
A single-payer future?Developing a much stronger media operation to properly frame the healthcare players and issues will be just one of the challenges facing the reform movement. The upward trajectory of health costs and premiums may help to define the solution and to arouse a much broader swath of Americans in the next round of the healthcare reform fight. [...]
Some experts predict that the new law’s utter failure to rein in insurance premiums, trim the $400 billion dollar burden of insured-imposed administrative costs, and control the excess costs created by provider chains will ultimately make a Medicare-for-all or single-payer system unavoidable.
Writing in the New York Times , William F. Pewen, former senior health analyst for Sen. Olympia Snowe (R-Maine), put it this way: “When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated—and the likely outcome will be the single-payer system that Republicans most abhor.”