In several conversations about health care legislation over the course of the past year, I argued for taking whatever we could get. I reasoned that a defeat now would likely be a defeat forever, as national health care would face its second consecutive failure under its second consecutive Democratic president, and would strengthen the argument that the people of the U.S. would never accept national socialized medical care. I have theorized that the smallest victory now would establish a base camp of sorts that future legislators could work to move toward more all-encompassing health care coverage.
Today, I am of a different mind. The health “insurance reform” that the Senate has crapped out is a vile, dishonest rape of the notion that Americans will see any sort of relief from the corporate, for-profit machinery of the insurance industry. The bill must die.
En varias conversaciones que sostuve durante el pasado año acerca de la legislación del programa de salud, yo alegaba a favor de conformarnos con lo que pudiésemos obtener. De la manera que yo lo razonaba, una derrota ahora sería muy probablemente una derrota permanente, ya que el programa nacional de salud estaría sufriendo su segunda derrota consecutiva bajo un segundo presidente demócrata consecutivo y eso reforzaría el argumento que la ciudadanía americana jamás aceptará un programa social de salud pública. Yo he especulado que la menor victoria ahora establecería una base sobre la cual los futuros legisladores pudiesen construir para lograr una cobertura comprensiva.
Hoy, he cambiado de opinión. La “reforma a la cobertura de seguro médico” que el Senado ha arrojado es una vil y deshonesta violación a la idea de que los americanos verán mitigado el acoso de la maquinaria corporativa con fines de lucro que es la industria de los seguros. La propuesta de ley debe morir.
President Obama’s stated desire for a reform of our health care system was predicated on the belief that no person in America, the richest country in the world, should go without needed medical care. No person should be unable to afford that care, and no person should be made poor by paying for care. Those ideas are sensible and obvious, and I don’t understand how so many people have been convinced to argue against them, but we’re now beyond that point of the conversation.
Our elected representatives have done our country a great disservice in moving to finalize this piece of legislation. Through gross campaigns of misinformation on one side of the aisle and spineless, cowardly compromise on the other, Congress has boldly pledged its allegiance to the true enemy of the American people, corporate industry.
Three crucial points have been conceded to the insurance industry that completely undermine the heart of the reform originally verbalized by the president.
First and foremost, the complete elimination of a government-run public option guarantees that insurance companies will face no outside pressure to keep costs low and offer substantial coverage. The notion that these companies will compete with one another to control costs is absurd, and fails completely when one realizes that bigger companies will merely buy up the weaker companies until we are left with only two or three mega-corps, completely in control of the entire industry.
Second, the refusal to allow Americans to buy FDA-approved drugs from outside the U.S. at lower costs benefits no one except pharmaceutical companies collecting astronomical profits by overcharging U.S. consumers. Our lawmakers have effectively stated that they know Americans are being grossly overcharged, and they are o.k. with that.
Third, allowing insurance companies to sell across state lines will allow those companies to relocate their corporate headquarters to states with corporate-friendly laws and fewer consumer protections. This provides the insurance industry with another layer of armor to protect against customer complaints and legal action.
The only winner if this law goes through is the insurance industry. They get 30 million new customers, by law. The winner if this law doesn’t go through? It’s still the insurance industry, as they continue doing business as usual, maximizing profit by minimizing the money they spend to heal people. The loss in either scenario is reserved for the people, as we continue to pay top dollar for what we have now or the less-regulated, more expensive, weaker coverage that they’re allowed to sell us once they’ve been “reformed”.
This reform bill is a slap in the face. I no longer feel that we can move forward taking anything that we can get. The United States could and should have a national single-payer health care system for all of its citizens. We’re not going to get it right now, but it doesn’t mean that we should let Congress get away with bending us over and violating our trust. We must hope that some of the Congressional progressives show mercy on the American people and kill the proposal. If the loss now equates to a loss forever, I sadly accept that loss. A victory under the currently proposed terms is a more insidious defeat.
The opinions expressed in this commentary are solely those of Jake Negovan.
Jake Negovan strives to shine a light on truth and hypocrisy when the mainstream media overlooks those small details. “…For the People,” Jake’s column, is his platform to address the issues that our country faces as we continue growing toward a society of equality, as well as to provide him a place to tell you that he’s always right.
El deseo expresado por el Presidente Obama para una reforma al sistema de salud se fundamentaba en la creencia de que ninguna persona en este país, el más rico del mundo, debería carecer de atención médica. Ninguna persona debería verse imposibilitada de costear dicha atención médica, y ninguna persona debería verse reducida a la pobreza como consecuencia de pagar por la atención médica. Esas ideas son sensibles y obvias, y no comprendo como es posible que tantas personas hayan podido ser convencidas de alegar en contra de ellas, pero ya estamos más allá del punto de la conversación.
Nuestros representantes electos han hecho un enorme daño a nuestro país apresurándose a finalizar esta propuesta de ley. A través de una enorme campaña de mala información en un lado del pasillo, y una componenda cobarde y falta de carácter en el lado opuesto, el Congreso ha tenido el atrevimiento de jurar lealtad al verdadero enemigo de la ciudadanía americana, la industria corporativa.
Tres puntos cruciales concedidos a la industria del seguro, socavan completamente el corazón de la reforma expresada originalmente por el presidente.
El primero y más importante es la completa eliminación de una opción pública administrada por el gobierno, lo que garantiza que las compañías de seguros no sufrirán ninguna presión externa para reducir costos y ofrecer cobertura sustancial. La idea de que estas compañías competirán entre ellas para controlar los costos es totalmente absurda y falla por completo en cuanto uno se da cuenta que las compañías más grandes sencillamente adquirirán a las más débiles hasta que queden solamente dos o tres mega corporaciones que controlen totalmente la industria.
Segundo, la negativa a permitir que los americanos compren drogas aprobadas por la Administración Federal de Drogas fuera de los Estados Unidos a costo más bajo no beneficia a nadie más que a las compañías farmacéuticas que amasan utilidades astronómicas por el precio excesivo que cobran a los consumidores americanos. Lo que nuestros legisladores han logrado es aseverar que saben que los americanos están siendo castigados con costos masivamente excesivos, y que están conformes con ello.
Tercero, permitir a las compañías de seguros vender sus productos a través de las líneas estatales permitirá a esas compañías reubicar sus sedes corporativas a aquellos estados que cuentan con leyes que favorecen a las corporaciones y ofrecen menos protección a los consumidores. Esto le brinda a la industria del seguro otra capa de protección contra las quejas de los clientes y las demandas legales.
El único ganador si esta propuesta de ley es aprobada, será la industria del seguro. Ellos, por ley, obtienen 30 millones de nuevos clientes. Y quién será el ganador si esta propuesta es derrotada? También la industria del seguro, ya que seguirán haciendo su Agosto, maximizando las utilidades minimizando el dinero que gastan en aliviar a la ciudadanía. El perdedor en ambos casos es la ciudadanía, que continuaremos pagando un precio muy alto por lo que ya tenemos, o por la cobertura débil, más cara y menos controlada que podrán vendernos una vez que hayan sido “reformados”.
Esta propuesta de reforma no es más que una burla. Yo ya no pienso que podemos mejorar aceptando lo que podamos obtener. Los Estados Unidos podrían y deberían tener un sistema nacional de salud para todos sus ciudadanos, con un solo pagador. No lo vamos a obtener ahora, pero eso no significa que deberíamos permitir que el Congreso se saliera con la suya, violando nuestra confianza. Debemos esperar que algunos de los progresistas dentro del Congreso demuestren piedad por la ciudadanía y derroten esta propuesta. Si una pérdida ahora significa una pérdida para siempre, con gran tristeza acepto esa derrota. Una victoria bajo los términos propuestos actualmente, es una derrota más insidiosa.
Jake Negovan busca sacar a luz la verdad y desenmascarar la hipocresía siempre que los medios informativos se olvidan de esos pequeños detalles. La columna de Jake, “. . . .For the People”, es la plataforma que utiliza para comentar los problemas que nuestro país enfrenta a medida que seguimos progresando hacia una sociedad equitativa, y también le brinda un espacio para hacer saber a usted que él siempre tiene la razón.
December 21st, 2009 at 9:58 pm
We can indeed create a healthcare system that works! It will take some innovative thinking, some compromises, and some determination, but unfortunately, these skills are completely absent in this health care debate. First, we have to recognize that the free market system does NOT work in healthcare, and that, on multiple levels, the current “system” is on the verge of collapse. Second, we need to realize that the biggest bang for our collective buck will come from restructuring the delivery system. Third, we have to stop calling whatever it is that Congress is doing now healthcare reform.
Philosophically, we have to answer three primary questions that will require a sustained public debate.1) Is healthcare a right or a privilege? As it stands now, it’s a privilege until it becomes life threatening. 2) Do we want a healthcare system that chases the last red corpuscle around, or do we want a system that truly empowers the quality of life as much as mere existence. 3) Are we, as a public, passive recipients of healthcare, or are we active participants in demanding healthy environments and striving for healthy lives?
Structural changes must deal with four main areas, access, the practice of medicine, secondary and tertiary system administration, and financing. By opening the front doors of access, we can entrain more people into the system. I have yet to understand the obstinate refusal on the part of the State Medical Associations in allowing ARNP’s to practice independently with prescriptive authority. The studies are OVERWHELMING in support of this, 42 States have allowed independent practice, 10 full prescriptive authority, and not one of these states have suffered ill consequences. Given the growing shortage of primary care physicians, this selfish and paternalistic position is completely illogical. The key to long term health is getting more and more people (especially women) into the healthcare process. Women are the key determinants of the health status and relationship of the family to the health care system. Nurse practitioners are well grounded in providing health care and health education to underserved populations, especially women, often with innovative and out-of-the-box- solutions.
The practice of medicine has to be changed. We need to create a community based primary care provider system which is rewarded for keeping patients out of the high cost medical centers, and a medical center physician/provider core which is NOT rewarded for keeping people IN the hospital. We should do away with payments for providers in the secondary and tertiary systems and make them employees, working regular shifts and providing care/interventions/diagnostics around the clock. Trying to force an around-the-clock care system into a 9-5 business model is inefficient and wasteful. Malpractice rates can be adjusted based on the performance of the entire medical staff, thus creating an empowered peer review process which would demand excellence.
We need also to look at how the healthcare system is administered. If we want to create true community based healthcare systems, then we need to restructure that system. Each secondary/tertiary hospital would be assigned a geographic area, and then made accountable for the delivery of services. Nursing homes, rehab facilities, and even home health services would fall under the control of the community system, doing away with the compartmentalized for-profit entities. Thus, significant corporate/administrative savings would be evident as well as retention of profits into the not-for-profit community system. No more stockholders, no more corporate overhead, no more wasteful bribery to physicians for services. I believe this system should be put under the control of nursing in order to balance out the ethical forces. Yes, CFO’s would still be needed for financial direction, but we could focus on services with both long term and short term benefits. It would amount to a social contract with nursing, and we could then hold nursing accountable for the results.
The financing of this system is also important. Physicians deserve to get paid for services, no one argues that. They also need protection from exorbitant malpractice and/or pity awards. The community system will need stand-by revenues as well as operational reimbursement. We can do all this with the revenue we have, since we currently spend between 30 and 40% in administrative fees and around 25% in the last two weeks of life. An actualized healthcare system can begin to significantly reduce this. In terms of taxes, we now tax cigarettes (#2 cause of morbidity) and alcohol (#3 cause of morbidity) but not the #1 cause, junk and fatty foods. This tax alone would generate enough revenue to fund Medicaid in every State and have enough left over to activate a true public health force. Vital systems within the health care system should not be paying for utilities or utility system service. Consider this the public contribution, since we will in all possibility be able to eliminate all or at least a significant portion of the county and state homeowners tax in those districts currently paying for health care!
Now we have to ask ourselves if we have the legal/social power to do all this? YES. In 1935, Congress enacted the PUHCA (Public Utility Holding Corporation Act) legislation, essentially taking over the access, distribution, and cost of (primarily) electricity. This is the model we have to look at. After all, health care and health education serve us all in the long run. We can do all this, but it will require talking to each other, compromise, and the generation of political will. Let’s talk!
December 21st, 2009 at 11:00 pm
Great column Jake! Very insightful, I believe I was in the same boat you were in at the beginning of this circus, now it seems as if they’ve stretched this thing so far it seems nothing to what President Obama wanted for our Nation. I have full faith in the President, but I have to ask where his leadership has been in all this? I expected him to have a stronger voice with these Legislators and push for all the changes needed for a good health bill. It is sad to think what kind of cheap piece of legislation will be left for our children to bear.
December 22nd, 2009 at 4:42 am
Jake, your writing on the issue has been a compass for me before. I wish we could pull the plug on this whole concoction Congress has Frankensteined for us. I feel it started out with good intentions during the Presidential campaigns, and then became a matter of political survival for the President and the Democratic leadership. Most tellingly, I think it’s the ultimate example of how America has not gotten the “change” that was promised by Obama because the way they’ve gotten to the point that they’re at in this so-called “reform” is no different from past legislative processes. It is how our legislative system is structured. Those with power and money control it. And it’s frankly scary what they are about to ram down all of our throats, a bitter pill with God knows what negative side effects in the name of better health as defined by the insurance companies and greedy legislators looking to keep their seats by bringing home the pork.
December 22nd, 2009 at 9:41 pm
Jake,
Good article and good points. This bill is not perfect and it does not contain every provision we would all like in reform (public option). However, I am of the mind that we must not, and cannot, lose the progress we’ve made so far with the legislation that is going to pass the Senate side. The big winner after the final legislation is passed will be the American people.
Here are a few things this bill will accomplish These are important reforms that people need now:
– Extend coverage to 31 million Americans, the largest expansion of coverage since the creation of Medicare.
– Ensure that you can choose your own doctor.
– Finally stop insurance companies from denying coverage due to a pre-existing condition.
– Make sure you will never be charged exorbitant premiums on the basis of your age, health, or gender.
– Guarantee you will never lose your coverage just because you get sick or injured.
– Protect you from outrageous out-of-pocket expenditures by establishing lifetime and annual limits.
– Allow young people to stay on their parents’ coverage until they’re 26 years old.
– Create health insurance exchanges, or “one-stop shops” for individuals purchasing insurance, where insurance companies are forced to compete for new customers.
– Lower premiums for families, according to the non-partisan Congressional Budget Office — especially for struggling folks who will receive subsidies.
– Help small businesses provide health care coverage to their employees with tax credits and by allowing them to purchase coverage through the exchanges.
– Improve and strengthen Medicare by eliminating waste and fraud (without cutting basic benefits), beginning to close the Medicare Part D donut hole, and extending the life of the Medicare trust fund.
– Create jobs by reining in costs — fostering competition, reducing waste and inefficiency, and starting to reward doctors and hospitals for quality, not quantity, of care.
– Cut the deficit by over $130 billion in the next 10 years.
It’s a long list. But that’s only because this bill represents the most significant health reform our nation has seen since the creation of Medicare.
I also believe, that when the House and Senate versions are conferenced together, we will have a bill that will begin to improve the lives of countless Americans without health insurance.
Lastly, as with many other pieces of legislation, this will represeant a start. A great start, from which additional reforms and changes can be enacted moving forward. Remember that the original Medicare bill passed in the 60s is not the same one we have today. It’s been worked on and improved upon since. I think that is the nature of our democracy.
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