[Peace-discuss] What's Next in the Struggle for Health Care for All? Wed. April 21st

[ISO Champaign]

What's Next in the Struggle for Health Care for All?
Panel Discussion
Wednesday, April 21st, 7 pm,
UIUC Campus, Gregory Hall Rm. 307
The Health-care debate has shown us that grassroots activism, as well as
Michael Moore's film SICKO, have forced the political establishment to
address health care and health insurance in some way.  But is it sufficient?
 What does the health care legislation do, and what doesn't it do?  More
importantly, what is the next step in forcing that very political
establishment to pass Single-Payer/Medicare for All?
This event will be a panel discussion including grassroots health-care
activists from different backgrounds.

Speakers and co-sponsors include:
Dr. Sachi Kuhananthan - Emergency Room Physician, and member of Physicians
for a National Health-Care Program
Jim Duffett - Executive Director of Campaign for Better Health Care
Jesse Phillippe - Member of the International Socialist Organization

For more information contact iso.champaign at gmail.com

http://socialistworker.org/2010/03/29/cure-doesnt-treat-the-disease

INTERVIEW: DR. STEFFIE WOOLHANDLER

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This cure leaves the disease untreated

March 29, 2010

Millions of people hoped the new Obama administration would finally confront
the disastrous injustices and inequities of the American health care system.
But after an agonizing year of debate, discussion and deal-making, the law
that Barack Obama signed last week will be a terrible disappointment to
anyone who correctly sees the medical-insurance-pharmaceutical complex as
the source of the problem.

Dr. Steffie Woolhandler is a professor of medicine at Harvard Medical
School, a prolific writer and co-founder of Physicians for a National Health
Program (PNHP). She talked to SocialistWorker.org about what's in the new
health care law and why it won't solve the crisis.

[image: President Obama signs the new health care bill into law]President
Obama signs the new health care bill into law

THE MAIN thing you hear from supporters of the health care law is that it's
a historic expansion of coverage for tens of millions of people. But there's
an underside that doesn't get as much notice, isn't there?

THE BIG problem with the bill is that so much money and power is being
handed to the private health insurance industry, which is the cause of the
problem in the first place.

There are two ways that coverage will expand. One is a Medicaid expansion.
Now if middle-class Americans want to tax themselves to pay for health care
for the poor--and I think we should--we could have done this without the
rest of the legislation.

The other big expansion is the so-called individual mandate that basically
tells people that they have to buy private insurance. So if you have
insurance through your employer right now, you have to keep it--whether you
like it or not. If you don't have insurance, you'll be forced to turn over
thousands of dollars to the private health insurance industry.

Under the new "exchanges" set up under the law for the uninsured to go to
buy insurance, people will have to spend up to 9.5 percent of their income
for policies that cover only 70 percent of health care costs. So you would
still be in a situation of having insurance that was so skimpy that you
would have difficulty getting care when you needed it.

As you know, Massachusetts has the prototype of this reform. If you go on
the Internet to look at our insurance exchange, it's called the
Massachusetts Connector.

For someone in their mid-50s, the cheapest policy available that would meet
the mandate for someone who is paying the full rate--which is anyone who
makes more than $33,000 in income a year--costs more than $5,000 per year in
premiums. Then, if you get sick, there's a $2,000 deductible--so you have to
take another $2,000 out of your pocket before the insurance kicks in. And
then, for the next $15,000 in health spending, you're responsible for 20
percent of everything--$3,000.

So it's extremely expensive if you get sick and have to use it once you buy
it. That means that many people will *still* lack access to care--because
they won't be able to afford to use their insurance policy, even if they own
it.

IS THERE anything in the law that would control the cost of these policies
sold through the government-run exchanges?

THERE WERE regulations attached that sound like they would be very helpful,
but those regulations are full of loopholes. There's a possibility that the
government could review insurance rate increases, and there was a limit of
15 percent placed on insurance companies for what they could charge per
policy for overhead.

But 15 percent is still a huge overhead. That means that if you buy a
$10,000 a year insurance policy, $1,500 of that premium never leaves the
insurance company--it stays right there for their overhead and profit. For a
large insurance company, 15 percent is quite attainable as an overhead. This
is really just a restriction on the smaller companies that sell individual
policies.

There are some other regulations on the insurance industry. I do think that
regulating insurance is better than no regulation, but because the bill is
actually written by the insurance industry, there are huge loopholes in
almost all of those restrictions.

For example, there's the ban on the policy called rescission. Basically,
what it means is that once you have insurance, and you get sick and use your
insurance, the insurance company can't go back and cancel you--that would be
called a rescission.

But what the law says is a company can't do a rescission *unless* there was
fraud. Well, that's always what the insurance company says when they do a
rescission. It's already illegal under contract law for them to agree to do
something and then not do it. So rescissions were always based on the
insurance companies alleging that the insured committed fraud.

It looks good to say "no rescissions unless there's fraud," but the fraud
loophole is huge. They can tell you, "It was fraud because you forgot to
tell us that 20 years ago you once had an abnormal pap smear. Oh, you didn't
tell us that 10 years ago, your blood pressure was elevated once, even
though it's been normal ever since."

They go back and search the records to find things you didn't tell them. You
might have forgotten about it, but they can allege that you committed fraud
by not telling them about that one abnormal pap smear and that one abnormal
blood pressure. That's a huge loophole, and unfortunately, it means that the
rule against rescissions isn't airtight.

There *is* a group that will benefit from this bill, and that's important to
say. Around 7 percent of Americans buy their insurance in the so-called
"individual market," where they have to go out as an individual family or
individual person and buy insurance.

That market is a terrible place to be because people get stuck with very
high costs. This bill will help people in that market by regulating it and
making it somewhat easier to get insurance. Nonetheless, there are loopholes
even there--because, for example, the bill allows insurance companies to
charge older people three times as much as it charges young adults.

So there's regulation, but there are plenty of loopholes for the insurance
industry.

IF WHAT you say about this law working out to the insurance industry's
advantage is true, then why was such a big deal made of insurance company
opposition? Were the companies really opposed to the legislation, or were
they working together with Democrats to shape the bill behind the scenes?

ONE WAY to think about this is to follow the money and see where they spent
their lobbying and advertising dollars.

You can think of this debate as having a left, a right and a center--with
President Obama in the center, with Republicans as the right, and the left
being the single-payer/Medicare for All forces. The insurance industry gave
tens of millions of dollars to the Obama Democrats, and they also gave tens
of millions of dollars to the far-right opposition.

In doing this, they cleverly positioned the debate as being between the
center and the right--that's where the bulk of the political debate occurred
this time around.

If you look at the donations, plenty of insurance industry money did go to
the Democrats. An insurance industry vice president, Elizabeth Fowler,
actually came to work for Sen. Max Baucus, the head of the Senate Finance
Committee, and was the author of the Baucus Framework for the legislation.
If you go to the Baucus Framework on the Finance Committee's Web site, and
right-click on the Properties box, you can see that the Baucus Framework was
written on Elizabeth Fowler's computer.

ONE OF the most significant aspects of this legislation that has gotten
almost no attention is the cuts to spending and benefits for Medicare. Can
you talk about this issue?

THE MEDICARE cuts are a bit of a mixed bag.

Some of the cuts will be at the expense of the so-called Medicare Advantage
plans--which are the private HMOs that can step into Medicare, recruit
Medicare enrollees and get the federal government to pay the HMO premium.
Those Medicare Advantage plans have been overpaid relative to traditional
Medicare, and part of the Medicare cuts will be reducing the overpayment to
the Medicare Advantage HMOs--to level the playing field, if you will. So
that's okay with me.

But some of the other cuts are very harmful. For instance, $40 billion will
be taken out of safety net hospital payments. The safety net hospitals,
where uninsured and underinsured Americans go when they get sick, are going
to be shrunk by at least $40 billion.

PNHP HAS talked about how this law will have the effect of continuing the
downward pressure on employer-provided insurance, which still covers a
majority of Americans. Why is that?

YOUR EMPLOYER-sponsored coverage, if you have it now, is now mandatory.
Under the new bill, you can't leave it when the mandate goes into effect.

President Obama liked to say, "If you have private health insurance and you
like it, you can keep it." But he neglected to say, "If you have private
health insurance through your employer, and you hate it, you still have to
keep it." So that's the first thing.

Then, if costs continue to escalate--and based on the Massachusetts
experience, we have every reason to think they will--many people with
employer-sponsored coverage will be subject to the excise tax that goes into
effect by 2018. It's a very steep tax--a 40 percent tax on the value of your
benefits. And you would have pay no matter what your personal income
is--even if you're a low-wage janitor, but you happen to have a good health
care plan, the tax will be imposed.

This means that people in high-cost states, such as Massachusetts or New
York, are likely to be forced to pay the excise tax. This is widely seen as
an attack on unions, particularly public-sector unions, many of which have
traded wage increases in order to maintain very high health benefit levels.

Unionized workers in high-cost states are the ones most likely to end up
paying that excise tax.

YOUR GROUP has also pointed out that this law will make the insurance
industry richer and more powerful still--and therefore that much harder to
challenge.

THE TAXPAYERS will be subsidizing premiums to private insurers for some
middle-income uninsured people. The value of those subsidies will reach $447
billion by 2019. So that's $447 billion to strengthen the financial and
political power of the private health insurance industry, and make it more
capable of obstructing future health care reforms.

That's probably the most negative aspect of this bill from my point of view.
I think the private health insurance industry is the cause of our
problems--it's the reason that we're in this conundrum. I think decades of
experience show that the private health insurance industry cannot control
costs, nor can it provide the American people with the coverage they need.

I think the need for single-payer nonprofit national health insurance is
just as clear as it ever was. I think there may be a dip in activity around
this as people are exhausted and they're also confused. But very quickly, it
will become clear that what was passed was no solution--that we still have
all the cost problems, we still have all the access problems, we have all
the same need and the same reasons for single payer that we've always had.

If people want more information, I strongly suggest that they go to
the Physicians
for a National Health Program <http://pnhp.org/> Web site--there are many
scientific articles and fact sheets, and, of course, there are contacts for
other organizations working on single-payer national health insurance.

I think there will be a continued movement for that. Certainly our group,
Physicians for a National Health Program, plans to continue advocating for
national health insurance and educating the American people about why it's
so necessary.

*Transcription by Rebecca Anshell-Song*

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ISO Resources:
isochampaign.org
internationalsocialist.org
haymarketbooks.org
socialistworker.org
isreview.org
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