Back to Basics
As Congressional negotiation heats up, what health care reforms can't be compromised?
The proposals offer versions of many of the solutions we've been looking for: a public insurance option, the regulation of private insurance, more emphasis on primary and preventative (rather than expensive specialist and emergency) care, banning the denial of coverage based on pre-existing conditions. But some of the details—strict limitations and disincentives for accessing the public plan, for example, or weak cost controls—are crucial enough that they could cripple lasting reform.
The plans are immensely complex, the results of intense compromise and negotiation designed to bring in support from industry groups, political factions, and lawmakers from both parties (President Obama praised the HELP proposal's 160 Republican amendments). Whatever bill finally passes will do so only after another round of negotiation.
In other words, proposals become more complicated, and more reflective of powerful interests, as they get closer to becoming reality. In the process, the strength of their reforms may also be diminished.
As with the various "compromise" solutions that have surfaced, and still may make their way into future plans (like the proposal to only enact a public plan if it's "triggered" by further failures of the present system, or the one to replace it with regional co-operatives that wouldn’t provide an effective counterbalance to the power of insurance companies), these proposals demand that we be very savvy about telling who’s offering real, comprehensive reform and who’s come up with a clever imitation of it.
We know what we need: universal access to quality, affordable health care. But what elements are critical to achieving that goal, and what are not? Everyone from insurance industry groups to Blue Dog Democrats has weighed in, detailing what they will and won't accept in a plan. But what about those of us who this legislation will affect the most? Where do we draw our line in the sand?
In Congress, the Progressive Congressional Caucus and the Black, Hispanic, and Asian Pacific American Caucuses—not to mention millions of Americans at the grassroots level—have pledged not to support any plan that doesn't include a robust public option. Still, as compromise proposals and amendments proliferate, we're learning that it matters a great deal what that option looks like.
Health Care for America Now (HCAN, formed just a year ago and now representing some 30 million advocates for the option of a public plan) developed what you might call an Occam’s Razor for cutting through to the core of the issue. HCAN listed a series of simple principles that must all be present for a plan to really offer an acceptable public option, and with it a road to real reform:
National and available everywhere: A strong public health insurance option will be a national public health insurance program, available in all areas of the country. The insurance industry is made of of conglomerates that have national reach. In order to have the clout to compete with the insurance industry and keep them honest, the public health insurance option must be national as well.
Government appointed and accountable: The entire problem with private health insurance is that they aren't accountable to you or me. A public health insurance option must have a different incentive. A public health insurance option doesn't have to be a government entity necessarily, but its decision makers must be appointed by government and must be accountable to government.
Bargaining clout: The whole point of health reform is to lower health care costs. Clearly, the insurance industry has failed to lower costs when left to their own devices. As the President says, we need a strong public health insurance option to lower rates, change the incentives in our health care system, and keep the industry honest.
Ready on day one: The private health insurance industry has utterly failed to control health care costs or provide their customers the quality they've paid through the nose for. With one person going bankrupt every 30 seconds due to health care costs, we cannot afford to wait any longer for a real fix. We need the public health insurance option to start lowering prices now. That means no trigger.
Clarifying our needs makes it easier to decide whether these new proposals meet them. To avoid being left with an inadequate solution, it’s important that we, too, set out our list of demands—we, the 76 percent of Americans who support a strong public health plan. As historian Beatrix Hoffman has argued, the lack of a strong grassroots movement was the missing factor that kept past health care reform efforts from succeeding.
The final bill will certainly include many compromises. But we must remember whom this bill is meant to help: the millions of Americans who aren't getting the health care they need. If we want real, comprehensive reform, there are certain principles we can't compromise or allow to be undermined.
Note: Voters nationwide are coming together to let their Senators know that a real public option includes these four principles.