Health Care Coverage Facts
Let's not confuse this with Social Security and Medicare. Those two programs are social insurance. The burden is placed on the collective to help vulnerable seniors age with dignity and security. The government does not simply force seniors to purchase mutual funds and health coverage or face a tax penalty.
Unlike social insurance, this health reform bill places most of the cost burden on the individuals who are being "helped," particularly the middle class. As Jane Hamsher’s team at Fire Dog Lake has pointed out, a middle class family of four making $66,370 could end up paying more than $14,000 in a given year – over 20% of their income – on premiums and out-of-pocket costs. If this family did not previously have insurance, it was probably due to issues of affordability.
Now, we’re telling families like this one they need to go out and purchase private health insurance, and voila- they’re covered. When we hear that this bill will expand coverage to 32 million Americans, it’s because many of those people are being coerced into buying what may be for them an unaffordable product.
To quote Robert Kuttner, "There is a world of difference between true social insurance and a mandate to purchase a private product. The former reinforces the value of government and of social solidarity; the latter signals a coercive state in concert with private industry profits."
Moving beyond the terminology of who is "covered," a second issue I have with the historic nature of the bill is how some are calling it "universal health care." Again, using the disingenuous definition above of who is covered, this bill reaches 32 million out of about 52 million uninsured, or about 60%. You simply cannot say that we’ve made health care a right in this country, in the same way Canada and other countries have – unless those 20 million uninsured don’t count.
In addition, there are all the groups that were shoved under the bus to reach this point: women and pro-choice voters, first and foremost; union members; immigrants.
And finally, this bill may well end up turning into the biggest piece of corporate welfare since the Wall Street bailout. Health insurance companies won’t have their anti-trust exemptions revoked, there will be no national insurance rate authority to monitor premium increases, and there is no government payer to keep prices in check.
So we’re putting an awful lot of faith into the idea that state-based exchanges won’t end up being controlled by a few firms with monopoly or oligopoly power.
The Democratic Party has replaced an ideal of social insurance with a coercive form of corporatism while it utterly caves on reproductive rights. In many cases, Democrats also chose backroom deal making with powerful interests over the needs of many working and middle class families, which negates the core purpose of the Democratic Party.
We’re going to see a lot of stories over the next few weeks about how historic this vote is, but I hope we’ll remember that Obama is not the successor to FDR and LBJ, and this bill does not carry on the legacy of social insurance that defined Social Security and Medicare.
Failure to make that distinction means we’ve set the bar way, way too low as a progressive movement, and that we’ve lost our vision of a truly just society.