Selling out health care reform

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INTERVIEW: DR. ANDY COATES
Selling out health care reform
December 9, 2009

The battle for health care reform is heating up in Congress. The House has already passed one bill, and the Senate is debating another version. But as Dr. Andy Coates explains, both bills will fail in solving the health care crisis--and, in fact, place a greater financial burden than ever on working people.

Coates is a member of Physicians for a National Health Program (PNHP), co-chair of Single Payer New York and a steward in the Public Employees Federation in New York. He talked to Ashley Smith about what's wrong with the health care proposals in Washington.

WE'VE HEARD lots of hype from the Democrats about the House and Senate bills. What's in these two bills, and what will they mean for workers?

THE CRUX of each bill is compulsory private health insurance. The government will use its power to compel every individual to purchase private health insurance, or enroll in Medicaid. The bills don't make private health insurance affordable; they propose to subsidize private insurance premiums for those who live on modest means.

For example, the House bill will subsidize the premiums of those whose income is 400 percent of the federal poverty level and below. Taxpayers would pay for this. But it would still mean that people who earn 200 percent to 400 percent of the federal poverty level would have to pay 8 to 12 percent of their income for private insurance premiums, or pay a fine and stay uninsured.

That would be the so-called "choice." For the uninsured, paying for expensive insurance would amount to an enormous wage cut. And then they'll get skimpy coverage, with high co-pays, high deductibles and all those other onerous and unworkable measures that come with very expensive private insurance.

ONE OF the justifications that Obama and the Democrats used for these bills is that they will control the cost of health care. Are they telling the truth?

TOTAL HEALTH care spending will not be brought under control by either of these bills. It will not bend the cost curve. As health care costs continue to increase dramatically, the crisis of unaffordable health care will continue, for ourselves and our families, with increased out-of-pocket costs, new mandatory premium payments and ongoing medical bankruptcies, will remain acute.

WHAT ABOUT the so-called public option? What impact will it have on the health care system?

THE PROPOSALS for the public option as they stand are meaningless from the point of view of reform, and ridiculous as a way to influence the insurance market. There are so many compromises, it might be renamed the incredible shrinking public option. And also, as a TV talking point, it has often eclipsed a focus on what's really in the bill.

But I think that there's more fundamental point. The public option was never a proposal for workable reform. It's actually a neoliberal concept. Marie Gottschalk, a professor at the University of Pennsylvania, has written an article in the new Socialist Register 2010 entitled "U.S. Health Reform and the Stockholm Syndrome."

She argues that when it comes to health reform, American reformers are like hostages who identify with, and even defend, their captors. I heard her speak in New York, where she said it seemed that if a window opened to permit real health reform, many "reformers" wouldn't even try to climb out.

WHAT DO you mean that the public option is in fact a neoliberal proposal?

THE PUBLIC option idea is basically that the insurance market will will magically meet our needs, as long as there is consumer choice and fair competition. This is the ideology popularized by Ronald Reagan. If only a government agency could be added alongside these giant, highly profitable insurers with their oligopoly control, then the marketplace would magically reform itself. Does that make any sense?

The insurance market rewards insurers that avoid paying for the care of sick. The public option would have to play by the same rules and compete on the same market. So in the best-case scenario, the public option would tend to enroll the sickest patients, and, in turn, would have higher, not lower, expenses. The Congressional Budget Office recently made this very point in a report on the House bill.

So a successful public insurer next to the private companies might instead put us on the fast track to permanent two-tiered health care, a deplorable trend already well underway.

But most likely of all, if enacted, the public option would turn out nationally just as it has in Maine--a failure, not a reform. In Maine, a state-funded public insurance called DirigoChoice has been around since 2003. Since then, it has enrolled fewer than 10 percent of the uninsured, it has not done a thing to control costs, and this year, it faces a fiscal crisis that threatens its future existence

WHAT IMPACT will these bills have on the health care crisis?

IMMEDIATELY ON the passage of the bill, very little would change. There is some insurance regulation, but we should note that this is regulation the industry itself proposed.

For instance, the insurance companies will have to stop rescissions--arbitrary cancellation of policies that come usually with the "coincidence" of the patient getting sick. But they can still cancel policies if the policyholder commits "fraud"--or if you simply can't pay your premiums. And over the decade, the insurers stand to gain tens of millions of new customers and hundreds of billions in taxpayer subsidies.

So I think that passage of the bill is virtually irrelevant to the everyday crisis. The main features in the House bill are not scheduled to start until 2013, and those in the Senate bill won't start until 2014. Then it still won't lessen disparities, or guarantee access to everyone, or improve the quality of care, or reduce costs. In fact, the main things in the bill have already failed at the state level, including the public option, including mandatory insurance.

FOR MOST people, health insurance will still be tied to their jobs, right?

YES. WHEN you lose your job, you will still lose your health insurance. Even worse, illness can lead to job loss and loss of insurance. Not just for the patient. If someone in your family gets very sick, the illness can cause you to miss work, too--going to appointments, to chemotherapy, waiting after surgery, coming home from the hospital, going to the pharmacy, going back to the hospital.

In such situations, people often lose their jobs in the United States. That's the purpose of the Family Medical Leave Act. But even so, in our insane system, people lose their health insurance because they have no paycheck. These cruelties will remain a fact of life. Can we swallow such a bitter pill with a bit of tonic that more of the people who lose their jobs will now be eligible for Medicaid? I don't think so.

WOULD IT be better if no bill passes than one of the proposals in Congress today?

SINGLE PAYER New York, the coalition that I am a co-chair of, had a steering committee discussion a few months back. It was our opinion at that time that it would be better to keep arguing for singe payer, and not take a position on a bill that hadn't come out. More recently, Single Payer New York put out an unequivocal statement that recommends a "no" vote. We have also applauded Rep. Eric Massa of western New York for his principled vote against the House bill.

Personally, I think we should embrace any dialogue that advances the grassroots, kitchen-table debate about health care in this country.

more at link:
http://socialistworker.org/2009/12/09/selling-out-health-care-reform