Image by BrianWestChest via Flickr
The last couple of weeks in politics has been one of the most emotionally charged weeks I can remember. I have several good friends who are very upset about the passage of what is a middle-of-the-road healthcare bill at most. Some are so upset I've decided to not discuss it with them for a while because I'm concerned about their mental health. So, I let this post kind of stew a while before posting it. A kind of cooling off period. There are charges of nazism and socialism, members of Congress have been physically threatened and the opposition to the bill is using language used to justify the overthrow the British government during Revolutionary times. "Don't Tread On Me" flags". Are you serious?
Conservatives/Republicans are making a big deal of the poll numbers that show that less than a majority of Americans are happy with the healthcare bill. The assumption is that if less than half the people would have voted for the bill themselves, Congress shouldn't have passed it. There are several things wrong that assumption. One, we do not have a direct democracy. Sometimes Congress has to do what it thinks is the right thing, regardless of popular opinion. Congress is supposed to take care of the rights of the minority and the weak in addition to just doing the "will of the people". Two, polls are not infallible. How you ask a question influences the outcome greatly. Three- This is related to two and the point of this post. Depending on how you ask the question, ardent supporters of health care reform might answer that we are not happy with this healthcare bill. I'm not happy with this bill and I've been pushing for healthcare reform since Clinton. We are not disappointed because it goes too far. We are not happy with it because it does not go far enough. So, if you ask us "Do you like this healthcare bill?" many of us will answer no.
No one, even those who supported the bill, should feel that we have somehow solved the health care crisis in this country. Rather than health care reform, this should have been called health insurance reform. I heard Obama refer to it as a Patients' Bill of Rights on steroids. That's pretty much what is it. It pretty much only addresses the health insurance industry predatory practices. Our problem with the out-of-control costs of health care are not going to be solved solely by putting restrictions on the health insurance companies. There is still a lot of work to do on the cost control front.
But, even as far as health insurance goes, this bill does not go far enough. In an attempt to work with Republicans (and maybe to appease Blue Dog Dems), the Democrats did not deliver on the vision of universal health care that was the dream of Obama's based. And it did not deliver as much on reigning in the insurance companies as many of us would have hoped. There are some things about it we just don't like. There is no public option in the bill. But, there is a mandate to be covered. So, citizens are being forced to buy insurance from private insurance companies. I guess the justification is the insurance companies need more customers to offset the more expensive coverage they are going to have to provide to people with pre-existing conditions. But, that is not what Obama campaigned on. If we were going to have a mandate, we were supposed to have a public insurance company that we could go to. This appears to me, to be a windfall for the health insurance companies.
Secondly, the bill does not address one of the key problems with health insurance that is so deeply ingrained into culture that most people don't even notice it anymore. That is that health insurance is largely an employer based thing. It's part of our compensation from the company we work for. That's makes health insurance costs transparent for a large portion of our population. They don't realize the problem in the system because they don't directly feel the pain. Their wages are being held down as their employers look at larger and larger percentages of their compensation being set aside to pay the insurance companies. They have limited options for health insurance as their companies shop for the best deals. Companies are reluctant to hire employees because of that variable that is always out there. "How much are we going to have to pay for their health insurance?" Hidden costs are rarely a good thing. People should be responsible for paying their own health insurance directly. I think if more people were paying their own health insurance and seeing their premiums skyrocket like mine have in the last couple of years more people would realize the urgency of the need for this bill. A good friend of mine is concerned about the healthcare bill already because he is a retiree and his company is reevaluating his health insurance benefits in light of a pretty convoluted tax deduction the company will lose due to the change in law from the bill. The double-dipping loophole the company was taking advantage closes up and the employees feel the pain.
Another problem with the bill, as I understand it, is I'm not sure it addresses the exceptions the health insurance companies have to anti-trust laws and it doesn't allow us to buy insurance across state lines. I don't really understand the insurance exchanges. But, I hope there's a lot more competition for the insurance companies in exchange for the masses of people that will be forced to buy their product. Picking up people with pre-existing conditions is not enough in exchange for that.
For all of its flaws, the healthcare reform will ensure coverage for a huge number of Americans who currently cannot get insurance. It will make health insurance affordable for a number of people who cannot currently afford it. It allows children extra time to find a job and get on their feet and to stay on their parents' policies. Whether it lowered the deficit one dime or not, those are things that needed to be done, morally. What I don't understand is fiscal conservatives saying "We can't afford this" when the Congressional Budget Office (the official scorer of congressional bills) says the bill will save us tons of money over the coming decades. The fiscal benefits of this bill are great. But, the people I know who were working to get this done were doing it more for the social justice reasons than to save money. Personally, I don't know if the reform will benefit me at all. I don't expect to see a huge reduction in my premiums. I already have coverage. Thank G-d my family's "pre-existing conditions" haven't pushed past what my insurance agent calls the "three strikes and you're out rule" (I only have two strikes) and we can get companies to take us on.
So, you have a lot of people unhappy with this bill. Maybe even a majority of people. Conservatives think it goes too far. Liberals say it doesn't go nearly far enough. When asked about the individual provisions in the bill, most people both liberal and conservative agree with most of the provisions. It's the overall bill that people are not happy with. Some because of things it contains and some because of things it doesn't contain. But, even if the majority of people would not have voted for this particular bill, that does not mean it was not the right thing to do. I am hopeful that is just the first step in a series of steps that will need to be taken on the road to getting some sanity in our health care system.
Good post as usual, Brian. Thanks for sharing your thoughts.
Insightful thoughts about healthcare being transparent because it is a part of a company's compensation package. I have had company sponsored health insurance all of my adult life and thought of it as part of the price I payed to work for the man instead of for myself.
I was telling my wife yesterday that it is a shame that Walmart does not use it's amazing buying power and influence to help it's employees buy health insurance. Probably one of the reasons so many do not have health insurance.
Not sure what the answers are. I do agree with the title of your post though.
I worked for Walmart in the late 90's and we had health insurance that wasn't awful. As of a year ago, it looks like they were improving things.
At Wal-Mart, a Health-Care Turnaround
Thanks for the update Mike! Sounds like I am a bit ignorant regarding WM.
Don't worry, they are still evil. ;-)
Read the comments - with a smile on my face - do you know that WalMart buys Dead Peasant Insurance - on employees? Do you realize they are also self insured - so if you get an insurance settlement for some accident outside of work, they will sue you to reimburse themselves - I do not shop WalMart - as Mike said - they are still evil.
Brian - thank you so much for the posting - its a start on very shakey ground - I personally wish all insurance companies would be declared evil - it would be cheaper to provide everyone coverage as medicare or tricare (military style coverage) than deal with the skanks of Insurance and Pharma - I feel so sold out - so disappointed and sick of it all - Corporate American - fascism abounds - and we let it.
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