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GRAY MATTERS: Health Care Reform

Posted Mar 27 2010 2:30am

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman ( bio ) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here . Saul's Reflections column , in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Amid all the well-deserved celebrations and self-congratulations on the passage of the health insurance reform bill, I thought I heard a dog bark. I was wrong. From the very beginnings of the late great debate, this dog didn’t bark.

I speak of the one most popular alternatives to provide guaranteed comprehensive and universal health care coverage – not just private insurance - for all of us; Medicare for All was not even considered.

As a state legislator, senator and candidate, that was Barack Obama’s choice. But despite what he now says, he does not tell the truth when he says every idea was truly considered. In fact, he refused to allow others to consider any proposal for single-payer health coverage.

As a result, Obama, Nancy Pelosi, Harry Reid and most health research groups, and the mainstream press boycotted and wouldn’t permit discussions of the simplest, most straight forward possibility for health care reform, Medicare for All. It was shut out of White House meetings. Not even Kaiser or the Commonwealth Fund or AARP responded to my repeated appeals to at least give an airing to the single-payer alternative. Eventually, the process passed it by.

So it was ironic that John Dingell, a Michigan Democrat and the longest-serving member of the House was given the honor of calling for the decisive vote on the reform bill. But the universal health care legislation he and his late New Dealer father championed for years was ignored. Nevertheless, Dingell gallantly praised the passage of the Obama bill and was at the signing.

But the second longest-serving member of Congress, John Conyers, Jr., also from Michigan, was nowhere to be seen in the celebrations. His bill, HR 676, the U.S. National Health Care Act, Expanded and Improved Medicare for All, just 30 pages long, had nearly 100 congressional sponsors, including several blue-dog Democrats who voted against the Obama bill, plus more unions, doctors, nurses, advocacy groups and consumers than the White House was able to enlist for its proposal.

But Conyers was gracious, praising passage of “the first comprehensive set of reforms to our ailing health care system.” He noted that he “would have preferred a different approach,” but he didn’t repeat an earlier observation, that after a year of debate and compromises and deals with insurance companies and drug makers, the Obama bill passed the House by only three votes more than needed.

Conyers reiterated his support for a public health option which Obama gave away, “because I fundamentally believe in the value of public health insurance and remain an ardent supporter of universal single-payer health care,” like Medicare. And he called for a new campaign to achieve it.

Obama has said he would have favored Medicare For All “if we were starting from scratch.” So let’s review what might have been and may yet be.

The Conyers legislation would have established a “publicly financed, privately delivered health care system that uses the already existing Medicare program...”

It would cover, at no charge, all medically necessary services, dentistry, long term care with patients having the right to choose their providers. And because the free care would be paid for by taxes and premiums, private health insurers would be unnecessary and would be prohibited from selling coverage that duplicates the benefits.

And unlike the plan that has passed, HR 676 would eliminate the need for dozens of fragmented, wasteful programs by including the Children’s Health Insurance Program, Medicaid, and other government funded programs with the exception of the VA health program, which may eventually become part of the system. And it sets a goal of converting to a non-profit system in 15 years. Read for yourself here .

One problem with the bill that has passed is that it leaves in place all the federal, state and private insurance bureaucracies for the dozens of competing and duplicative agencies with their complex rules that differ from state to state. Premiums for Medicare Advantage and the Part D drug benefit, for example, may differ from one county to another. While subsidies for Medicare Advantage insurers are to be eliminated over time, the current system is to remain in place, although these plans will be required to spend at least 85 percent of their revenues on the care of patients.

Indeed, to give the Obama bill its due, while it is not a health care plan, it is a health insurance reform which can be strong measure to regulate and restrict the behavior of health insurance providers.

Insurance companies will be barred from dropping people from coverage when they get sick. They will be barred from excluding children for pre-existing conditions; later that will apply to adults as well. They must provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition. Children will be able to remain on their parents’ health plan until age 26.

In addition, insurers cannot impose lifetime or yearly caps on benefits, and new plans are required to cover preventive services such as mammograms, colonoscopies and immunizations without cost-sharing. That’s to become a standard Medicare benefit for all beneficiaries, who have been required to pay for co-insurance.

As expected, the 40,000-member Physicians for a National Health Program, which supports HR 676, worried that the bill that has passed will take too long to implement, that it will further enrich the for-profit insurance industry by $447 billion, that costs will go higher and that the new regulations are riddled with loopholes.

All we can do is see how it works. Here is the best and clearest graphic to explain the bill . (pdf)

If things don’t really change for the better and Democrats remain in the majority in Congress, maybe we can come closer to the Conyers bill, and hear the dog bark.

Questions? Write saulfriedman@comcast.net

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