The first step

Tuesday March 23, 2010

It’s not the best bill that could have been written, but given the circumstances, the health care reform bill passed by the House Sunday night is a good start.

The United States is the only advanced nation without universal health care. It also has the world’s highest health care costs. This bill is the first step toward changing both these realities.

After a century of attempts, we now have enshrined into law the notion that everybody ought to have health insurance. That alone is a major accomplishment. It is legislation that expands coverage to most of the uninsured and protects those who already have insurance.

According to the Congressional Budget Office, this bill does four things.

-- It cuts the deficit by $130 billion in the first 10 years (2010-2019) and cuts the deficit by $1.2 trillion in the second 10 years.

-- It reduces annual growth in Medicare expenditures by 1.4 percent per year, while improving benefits and lowering costs for seniors. It extends Medicare’s solvency by at least nine years. It also closes the coverage gap known as the "doughnut hole" for Medicare beneficiaries enrolled in Part D drug plans.

-- It expands health insurance coverage to 32 million Americans and helps guarantee that 95 percent of Americans will be covered.

-- It is fully paid for, at a cost of $940 billion over a decade. (Americans spend nearly $2.5 trillion each year on health care now and nearly two-thirds of the bill’s cost is paid for by reducing health care costs).

Are there flaws in this bill? Mandating health insurance without a public option to keep the insurance companies honest is a huge flaw. Universal access to health insurance is good, but the bill fails to provide universal care. It offers subsidies for people who can’t afford to buy health care insurance. Unfortunately, outside of Medicare, the middle class will remain entirely dependent on a system of for-profit medicine.

The rollback of reproductive rights for women remains one of this bill’s most troubling flaws. It not only restricts abortion coverage, but allows insurance companies to discriminate in their pricing against women.

There are no effective cost controls on pharmaceutical companies. As a result, we will spend about $2 trillion more than necessary on prescription drugs over the next decade.

And millions of undocumented workers won’t even be able to spend their own money on insurance, for they have been completely cut out of this bill.

These flaws are balanced by some good elements, such as increased funding for community health centers, the end of discrimination against people with preexisting conditions and more money to help states pay for an expansion of Medicaid for poor people and those with disabilities.

President Obama and the Democrats will claim a major political victory with this bill. We say it’s not quite a victory yet. We define victory as the day when the United States joins the rest of the civilized world and provides universal health care for all of its citizens. Again, this is only the first step.

For health care reform to really work, a public option is still needed. Rep. Alan Grayson, D-Fla., has a offered a bill -- H.R. 4789, which is listed as the "Public Option Act," or the "Medicare You Can Buy Into Act" -- that would extend Medicare benefits to anyone from birth to age 64 with a simple "buy-in."

Grayson said the Medicare buy-in will generate cost savings by using already existing Medicare networks of providers and hospitals and would introduce competition in places where only one or two private insurers have a de facto monopoly on coverage.

This is a logical next step for health care reform, and it should be a legislative priority.

Of course, there will not be any Republican cooperation. The GOP has committed itself to opposing any steps that would change our health care system, in keeping with its long tradition of being on the wrong side of history. They opposed Social Security. They opposed Medicare. And they think they can win back Congress in 2010 by opposing this bill.

If history is a guide, they will fail.


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