by Chuck Idelson
California Nurses Association blog
February 26, 2009
Hours after President Obama’s speech to Congress in which he laid down a marker for achieving “comprehensive” healthcare reform, and getting it done this year, top administration aides have outlined the goals of what they want to achieve.
What Politico called “the 8 keys to his health plan,” certainly reflect a bold determination for action and a grand vision.
There’s only one problem. Virtually all the proposals being bandied about in various Congressional committees — and the administration made it clear this week they will let Congress figure out the details — fail to meet the test of those “8 keys.”
With one important exception — single payer reform, or expanding and updating Medicare to cover everyone.
So what are those lofty goals set by the administration?
Obama has endorsed eight guiding principles for health reform, the White House officials said on the conference call. They stressed that they intend to work with lawmakers and other stakeholders on how to accomplish the goals, but the principles will lay down a marker for any congressional plan.
Drum roll, please. A healthcare plan, they told reporters, should be:
* Universal, everybody in, nobody out
* Portable, not tied to your job, if you even have one
* Maintaining choice of doctor and insurance
* Ensuring affordable coverage
* Protecting Americans financial health
* Investing in prevention and wellness
* Improving patient safety and quality of care
* Fiscally responsible and sustainable
To the administration’s credit, these should be the benchmarks of any real reform. And to give them further props, the administration is even projecting progressive tax reform as a financing mechanism.
The combined effect of the two revenue-raising proposals, on top of Mr. ObamaĆ¢ā¬ā¢s existing plan to roll back the Bush-era income tax reductions on households with income exceeding $250,000 a year, would be a pronounced move to redistribute wealth by reimposing a larger share of the tax burden on corporations and the most affluent taxpayers.
But on the construct of the plan itself, a huge barrier stands in the way. The present private insurance-based system is an implacable impediment to every one of these goals.
The insurance giants, of course, are not care providers. They are big corporations. They exist to make money, primarily to return profits for their shareholders. Every aspect of their operations are geared to that end.
Private insurance plans:
* Aren’t universal because they exclude people based on pre-existing conditions or age or anyone else they think will be expensive to cover.
* Don’t guarantee choice of physician or hospital, but limit you to their network of providers.
* Won’t assure affordability because they are constantly raising premiums, deductibles, co-pays, and other fees to generate high revenues and profits.
* Can’t guarantee safety and quality because they actively discourage the delivery of care or deny treatments, diagnoses, or referrals because they don’t want to pay for it.
* Will never be fiscally responsible because there is no independent oversight, decisions are made in secret in closed board rooms or CEO offices, and, again, their priority is profits.
Thus any plan which sustains, protects, or expands the role of the insurance industry in healthcare cannot, by definition, achieve any of these worthy aims.
One bill, however, does succeed in all eight areas. That is HR 676, the U.S. National Health Care Act by Rep. John Conyers, which also happens to be the one reform that has a broad, national grassroots constituency led by nurses, doctors, patients, and health care activists.
With the administration having laid our a vision, but deferred implementation to Congress, that should be a signal to all of us to put their feet to the fire and push for real reform, like HR 676.