(Note: This will be my last major OP on health reform. I assume that it will pass the House today, and we will all have to live with the consequences of that. There won't be much more to say about it until we can start gathering some data on the bills actual effects - a process that will probably take years. So this will be it. Good luck.) Previous Parts:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7956377">Part 1 - The Trillion Dollar Wealth Transfer
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7964125">Part 2 - The Facade of Reform
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7965878&mesg_id=7965878">Part 3 - The High Cost of ReformLINK:http://practical-vision.blogspot.com/2010/03/is-something-really-better-than-nothing.html|Is Something Really Better than Nothing? (Health Reform Part 4 of 4)>
By Political Heretic
March 21, 2010
The final installment of this series on “health” reform takes place on the day in which the Senate reform bill is expected to pass the House. We as Americans will all deal with the consequences of passing this legislation - good and bad.
Virtually no one discussing this insurance reform will argue that this is a “great” bill. Instead the central argument for passing this legislation is that “something is better than nothing.” But is this really the case?
The Perfect vs. The GoodSupporters of insurance reform are quick to point out that the “prefect” must not be the enemy of the “good.” We will never have a perfect bill, they argue, and we must not let that be an excuse for doing nothing. However this argument disingenuously mischaracterizes left-leaning opposition to this legislation.
The implicit accusation is that those who oppose this bill on liberal or leftist grounds do so because they are ideologically entrenched, unreasonable and unwilling to compromise.
This intentionally ignores the fact that many of us have compromised when we remained willing to support reform after a single payer health system – a system that works for the rest of the industrialized work and which the American people truly deserve – was deemed off-limits for this debate.
Many of us compromised when we remained willing to consider reform after backroom deals were made with the pharmaceutical industry promising not to pursue policy that would dramatically lower the cost of prescriptions drugs.
Many of us compromised when we remained – reluctantly – willing to consider reform after all the of facade of support for a public option finally dissipated and it was confirmed that no public option would be part of insurance reform.
Many of us remained willing to consider the merits of passing insurance reform legislation after any notion of “perfection” had long passed.
Something Better than Nothing?Supporters of this insurance reform legislation then fall back to the claim that something is better than nothing. But overlooked in that argument is the fact that everyone can agree that “anything” is not always better than nothing.
Let’s be clear on what the argument actually is. No one is denying that many American families – millions even – will see a short term improvement in their ability to purchase insurance. Millions of individuals who were previously denied insurance based on preexisting conditions will have the opportunity for coverage.
But is previously described in earlier parts of this Health Reform series, this insurance reform legislation only illustrates one of the greatest tragedies of Washington politics. Partly because of reelection concerns, party because of our culture of immediate gratification and partly because of generations of basic economic calculations built on unproven assumptions that bear little resemblance to reality, politicians choose a system of short term benefits at the cost of long term disasters.
It is the fundamental and dangerous flaw of short term verses long term thinking.
While it is true that millions of Americans will see short term benefits after insurance reform legislation, those benefits will be only temporary thanks to the critical flaws inherent in the bill. Additionally, millions of other American families, like the median income family of four in Oregon used as an example in Part 3 of this series, will not see their situation improve at all. Furthermore, millions of other Americans (15 million to be precise) are simply ignored wholesale by this legislation, treated as irrelevant and unimportant.
Here is the critical truth about this insurance reform legislation: the millions of Americans who will see modest benefits from this legislation in the short run will watch as those benefits shrivel and fade away in the long run.
Why?
Given the fact that there is no direct control of prices for either insurance premiums or medical services, these costs will continue to exponentially rise year after year. Even with a 85% MLR requirement (Medical Loss Ratio, the proportion of health care insurance premium dollars spent on health care claims,) without related price regulation mechanisms, such a cap only encourages rising prices to expand profit margins.
So each year both the cost of health services and the cost of insurance is going to go up. This means more and more families will be maxing out the out of pocket cap for co-payment medical expenditure. This means that more and more families will be breaking the $10,000 barrier on health care each passing year, thus pressing family after family into financial crisis.
Likewise as premium costs increase one of two things will happen. Either the government’s tax credits for families below 400% of FPL (Federal Poverty Line) will fail to keep up with rising costs, passing more and more of the burden back to families until the point where they are right back to where we all started – with premiums so expensive they cannot be paid. Or, the government will continue adjusting tax credits to offset rising premium rates, in which case the supposed “savings” to the federal deficit will be eviscerated as the government spends unsustainable amounts of money desperately trying to prop up a faulty system.
Either way, we are passing legislation that does not really fix our health care problems, leaves millions completely excluded from the system, leaves millions more families still going bankrupt and facing health care expenses topping 30% of their annual income if they ever face serious medical crisis, and the people who will immediately benefit from the legislation will watch as those benefits wither away year after year after year. Until ultimately, we have the exact same crisis that we have right now.
These are the long-term harms we are accepting for the sake of some short term, temporary gains. Like cowards, our politicians have chosen to punt our health care crisis to our children to let them deal with it. Because sooner or later, rising premium and health service costs will bring us right back to the crisis we face today.
Laying the Foundation for the FutureSupporters of insurance reform argue that this legislation will lay the foundation for better solutions in the future. This argument is based on absolutely nothing but wishful thinking, especially when every indication is that this legislation will eventually put us right back into the same state of crisis we face today.
The notion that this bill is a “first-step” is not the only way to view things. Given the evidence we already have, it is more realistic to predict that this legislation will become a huge obstacle to any better health care future. If costs for our private insurance racket once again become unsustainable for even the people this bill helped in the short run, we will be faced with a situation where most of this legislation will have to be undone before meaningful steps forward can be taken.
Simply passing anything with “heath reform” slapped on the title does not mean it lays a foundation for the future. If anything it destroys what little foundation we might have had, but codifying this system of predator private insurance and giving it deep roots, rather than uprooting the exploitative corruption in place of health care policy that puts the interests and needs of poor and working class families first, ahead of the whims of the financial elite.
A foundation for the future? No. It is a great impediment to any positive future change that will have to be undone before moving forward.
So here we are. We have a bill that constitutes a near trillion dollar wealth transfer to the financial elite. It leaves millions of Americans completely out of consideration. It leaves millions more American families, like the median income family of four described in Part 3 in the same situation they were in before insurance reform – going bankrupt from medical costs. And of the people it does immediately help, those benefits are only temporary thanks to lack of any meaningful price controls or regulatory oversight.
This is not “something” that is better than nothing. It’s worse than nothing in the long run. We who object to it were never seeking something “perfect” – only something that would at the very least do no harm. And this legislation does not lay a foundation for future health care gains. Rather it stands as a huge obstacle in the way of future progress.
This is what is about to pass the House of Representatives today. Forgive us if we do not cheer.
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