Why We Should be Happy with the Health Care Bill

The shrillness of the contentious partisan debate surrounding the health care reform has truly drowned out any rational discussion of it (and here I am blaming all sides). In particular, I have to say I have been disappointed with some on the left who have reacted to Reid's stripping of the public option from the bill in such a knee-jerk reaction that they single handedly obscured many good things that are in this bill and that make liberals' threat to kill the bill sound like an act of lunacy. Here are some of the things that make this bill an historic attempt to reform the health care system in America, and that should make all of us progressives giddy as we await President Obama's signature. To quote Paul Krugman in today's NYT: "Count me among those who consider this an awesome achievement. It’s a seriously flawed bill, we’ll spend years if not decades fixing it, but it’s nonetheless a huge step forward."


Let me group the good things in this bill under three themes.

ACCESS AND AFFORDABILITY.
--The bill extends coverage to 30 million Americans by offering government subsidies to those who earn less than 400% of federal poverty level and by expanding both Medicaid and the CHIP (Child Health Insurance Program). Analysts estimate that some 94% of Americans will have access to affordable health insurance because of this bill. This fact alone should be enough for any progressive to support this bill.

--Many low-income people who previously have not been eligible for Medicaid, will now be covered. It raises the eligibility level to 133% of the federal poverty rate. It further expands the wonderfully successful Child Health Insurance Program.

--It mandates that every state establish an insurance exchange program which will be available on the Internet, and which will basically be a list of all insurance programs available in your area that you can buy into. The language has to be simple and uniform for all insurance programs with no small print. In addition it mandates that the Health and Human Services Secretary sign a contract with the Federal Insurance provider that currently insures our Congresspeople to create a national insurance program that we will all be able to buy into.

--It expands the age of dependent coverage to 26, so if you are fresh out of college, you can be on your parents' insurance until 26. (I could have used this after college).

CUTTING COST
The bill makes serious attempts at cutting health care costs.

A lot has been made of Senator Reid's stripping of both the public option and Medicare expansion from the bill in winning the support of the so-called centrist Democrats and the former Democrat Joe Libermann. Now, don't get me wrong, even a brief appearance of that sorry excuse for a human being named Joe Libermann makes me cringe, but it is far from certain that either the public option or the Medicare expansion would by themselves solve the skyrocketing health care costs. The New Yorker had a brilliant article about this a few months back in which it argued even with the public option, health care costs would continue to skyrocket, increase our deficit, bankrupt Medicare, etc, if we did not change our health care compensation system (by ending the disastrous pay-for-quantity rather than quality, system). The Medicare expansion proposal was even more problematic as it would saddle the government with an enermous bill and funding for it was far from certain, creating the potential for an even more monstrous deficit and the possible insolvency of Medicare. So, how does this bill attempt to cut cost?

First it recognizes that we don't really know how exactly to cut cost. It acknowledges there is no one silver bullet to solve our problem. European countries, including those who have a single payer system (France) or those who have a mixture of single payer and private insurance (Germany) have struggled to keep their costs down and their health care delivery systems functioning. So, there is no easy solution.

The Senate health care bill creates numerous pilot programs to test the ways of cutting cost. Most innovations come in Medicare. It establishes experimental programs for Medicare to pay hospitals in bundles rather than for each operation and hospital visit, thus providing incentives for doctors to share their evaluations of patients, effectiveness of medical procedures, follow up hospital visits to reduce the number of second-hospital visits for each patient. It establishes the so-called Accountable Care Organizations which would pool all these methods and share the savings that come from them.

It creates the Medicare Advisory Board which would conduct thorough evidence-based research on methods, procedures (including testing), all with the purpose of figuring out which health care delivery systems work, and which do not. Most importantly, the recommendations that the Medicare Advisory Board makes to Congress will become EFFECTIVE AUTOMATICALLY lest the Congress pass measures that would make savings equivalent to those proposed by the Board.

The bill also empowers the Health and Human Services Secretary to coordinate all pilots programs and report to Congress.

--It also establishes a number of community-level wellness programs and prevention programs that promote preventive care, including school based programs. And it makes all preventive care free by prohibiting insurance companies from charging out-of-pocket fees.

As an article in the last New Yorker argued, a pilot program is how the US reformed its troubled agriculture system in the early 20th century. There is no reason to believe that these pilot programs cannot do the same in health care. In fact, it is the only way we can figure out how exactly to tamp down these costs.

INSURANCE REGULATION
--The bill imposes serious regulation on the previously barely-regulated insurance industry. Starting in 2014, it prohibits insurance companies from denying coverage to people with pre-existing conditions, from upping premiums for people who get sick (or dropping them altogether), charging different fees based on gender, it limits the amount insurance companies can spend on their administrative costs, and the amount they can charge in annual out-of-pocket expenses; and prohibits them from setting up an arbitrary annual limit it will pay for individuals.
--It also mandates that each insurance company create an accessible appeals process open to every customer through which he/she will be able to contest a denied claim. (I could have used this back in 2003 when an insurance company refused to pay for an expensive medical procedure I had had, and because of which I had to incur some debt).

There are many more things in this bill that are good, but these are the main ones that caught my attention.

Considering all these things that are in the bill, I cannot understand how anyone can fathom voting against it (unless you are a heartless Republican of course). It does so many good things that us progressives should be happy about. And this is why I shall be opening a bottle of the bubbly when President Obama finally signs the Patient Protection and Affordable Care Act into law sometime in January.