a citizen’s journal by Thomas Nephew

Health care reform: an activist-annotated scorecard

Posted by Thomas Nephew on March 26th, 2010

The passage of H.R. 3590 — the Patient Protection and Affordable Care Act — last Sunday, followed by President Obama’s signature on Tuesday, created a set of broad minimum improvements to health care and health care insurance practices in America, by enshrining a prior Senate bill into law.

These may or may not be followed by additional changes in H.R. 4872 — the Health Care and Education Reconciliation Act — now under debate in the Senate, chief among which are provisions delaying and reducing the so-called “Cadillac tax” on high-cost health insurance, a subject rightly of concern to unions protecting coverage for higher levels of work-related injuries and diseases.  Passage of this bill seems likely, since the reconciliation process can’t be filibustered under Senate rules, and thus requires only a simple majority.*  Even if Republicans vote unanimously against the bill (as is also likely), Democrats are likely to command that majority even if several Democratic Senators defect.  [UPDATE: the Senate and House have passed bills fixing minor infractions of reconciliation rules, but without amendments for a public option or anything else; it’s done.]

The legislation promises to improve access to health care for millions, and may well rank as a milestone in American social policy — it’s been billed by New York Times business writer David Leonhardt as “the biggest attack on economic inequality since inequality began rising more than three decades ago”, and by conservative writer David Frum as a conservative ‘Waterloo’ that will not be undone.

But the cost to liberal values and goals has also been high.

Public option dead, right to choose denied care
As rehearsed in a post earlier this month, neither House action included a public option — the popular idea of a federally administered health insurance plan to compete with private insurors that was a cost-saver in its own right, and a possible way station to a ‘single payer’ health insurance system.  Instead, an individual mandate to purchase health insurance will further fatten the bank accounts of health insurance companies.

Moreover, in the negotiations preceding Sunday’s vote, Rep. Bart Stupak (D) agreed to vote for the bill in exchange for an Obama Executive Order confirming that the executive branch would prevent federal funds from being used to pay for abortions — thus enshrining the so-called Hyde Amendment, passed annually, as a matter of permanent federal executive branch policy.  Together with provisions in H.R. 3590 — inserted by Sen. Ben Nelson (D-NE) to the original Senate bill — researchers are predicting abortion insurance coverage will will not just be eliminated from insurance plans operating under health insurance exchanges, but will also decline overall.  Dana Goldstein (of “The Daily Beast”) writes, “To get the health-care bill passed, a pro-choice president reneged on his pledge to support reproductive rights for rich and poor alike.”

In a second article, Goldstein captured how whipsawed liberal groups could be about the events of the past weeks with the example of Feminist Majority president Eleanor Smeal.  On the one hand, Smeal vowed to go after Stupak by raising money for primary opponent Connie Saltonstall, –while on the other hand she celebrated the passage of a health reform bill won at the expense of reproductive choice: “If you turn down half a loaf, you get nothing,” Smeal said. “Given the realities of the vote count, I am glad that 15 million people will have access to Medicaid, most of whom will be women, and another 17 million will have access to these state insurance exchanges. I think to have nothing would have been horrible.”

Online and on the ground activists score the reforms
But quite aside from what’s not in the bill, there’s also the nagging feeling that what is there is less than meets the eye.  Last Friday, Jane Hamsher of “firedoglake,” who was among the most steadfast supporters of a public option in the run-up to Sunday’s vote, published Fact Sheet: The Truth About the Health Care Bill, an itemized list of “myths” about the pending health care/ health insurance reforms, along with her footnoted rebuttals to each one.

I asked a friend who is active in the health care reform movement — on the ground and on line — to have a look.  For ease of discussion, I’ve copied the original FireDogLake fact sheet and added a column for her anonymous responses.

Annotated FireDogLake Health Care Reform Critique

She added these comments:

This is a bad bill. It is, as [the FireDogLake site] said Pelosi said, a conservative bill.  It’s my worst nightmare, which was that we’d get a great big Medicare Part D.

The bottom line to the health care crisis is costs and the fact that we waste money protecting what Atrios calls the skimmers [link added — ed.].  If we could do price controls, we’d be on the right road but we don’t do that.  If we could have had the PO and a national exchange, we would have been on the exit ramp to the right road but hospitals objected and so that was that.  As long as industry writes our legislation, we’re going to be in trouble.  I don’t agree that the bill won’t help reduce costs though.  It does what it wants to do through Medicare. That’s where reform is going to come from.  I’m with Maggie Mahar on that (“I Am Not Bound to Win, But I Am Bound to Be True”).

Lastly,  I’m not happy because the bill is good.  It’s not.  I’m happy because as bad as it is, it’s a move in the right direction – the status quo was unsustainable – [and] passage may mean that Obama gets elected again with a Democratic Congress and maybe we get more stuff that sucks but not as much as the stuff we’d get under one of the GOP psychos. I’m glad [FireDogLake] is fired up.  I hope they primary the worst Democrats out there because what we really need is an overhaul of the Democratic party, which right now is basically the GOP of the 70s.  That’s a multi-year or even multi-decade project.  We didn’t have that time to wait on health care.

The “move in the right direction” part echoes comments Congressman Dennis Kucinich made to Esquire Magazine after his “defection” from opposition to the bill:

When it comes to analyzing the law we’ve just passed, it’s hard to use terms like good or bad. Because ultimately what was decisive for me was not the bill, but rather the potential to create an opening for a more comprehensive approach toward health care reform. If the bill were to go down, this whole discussion about anything we might hope to do in health care in the future is not going to happen in this generation. We had to wait sixteen years after the demise of the Clinton plan to come to this moment. And the angst that members are feeling about this bill — the temperature that’s been raised in the body politic over this bill, the characterizations of the bill in a debate that’s been quite distorted — all of those things argue against bringing up another health care bill in the near future if this bill were to go down.

We got beat
For those of us who wanted more, there’s no way around it: we got beat.  And some of that is some of our fault too.  Adapting comments I made on Facebook, a lot of us excoriate Democrats for giving up on the public option in order to ‘just pass something.’ Yet many of us also settled for advocating for a lesser goal (public option) when a bigger one (single payer/Medicare for all) was even more worth fighting for. We made a calculation that a “public option” was doable and single payer wasn’t. We made that calculation in good faith — compared to the fairly bad faith by Obama and the Democratic leadership — but it was a calculation and it turned out it was wrong.

And unlike unions, Democratic officials, HCAN, etc., many of the public option advocates weren’t answerable to anyone but themselves.

I’m not saying people are wrong to be mad about the demise of a public option, at least for now.  But we might have done better to push for single payer as hard as we did for the public option, and even instead of that option; among other things, ironically, we might now have had a public option to show for it. Given how narrow the victory was for the bill we got, public option (and single payer) advocates can take some credit for providing proof of a public desire for real reform — proof that countervailed the “Tea Party” and other yahoos agitating to ‘kill the bill’ for its alleged ‘socialism.’  A more radical, less self-compromising approach on my part and that of many public option advocates might have netted a better result.

* An overview of the legislative process thus far can be seen at the Health Care for America Now! (HCAN) web site.

UPDATE, 3/26: Other critiques, resources, praise: Diary of a  Wimpy Health Care Bill, (Rose Ann DeMoro, exec.dir. of Natl. Nurses United/CNA); Health Reform is no New Deal (former Labor Secretary Robert Reich); CBO Score of Manager’s Amendment to Reconciliation Proposal (.PDF, 36p; CBO), 16M low-income Americans receiving public health insurance is a progressive accomplishment (Bowers, OpenLeft).; Health reform: theirs and ours, Paul Street,

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