An Inglorious End to the Promise of Reform

The greatest tragedy of the current health reform bill is that it may lock into place a dysfunctional and inhumane system that threatens to move beyond the reach of more comprehensive reform for generations to come.
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After all the fanfare and high expectations that accompanied the prospect of national health care reform at the outset of this year, the legislation is staggering to a particularly inglorious end.

At its heart, the single biggest weakness of the bill rapidly advancing in the Senate, which mirrors the central flaw of the House bill as well, is that it "cedes far too much power to the tyranny of a callous insurance industry," as Karen Higgins, RN, co-president of the 150,000-member newly created National Nurses United, the largest union and professional association of nurses in U.S. history, has said.

In a year when lobbyists, led by the health care industry, are poised to smash all records for influence peddling in Washington, we should not be surprised.

But the greater tragedy is that the current bill may lock into place a dysfunctional and inhumane system that threatens to move beyond the reach of more comprehensive reform for generations to come.

For those who counsel us to accept the steady stream of concessions to the obstructionists and the health care industry with the anticipation that the legislation will be improved in the House-Senate conference process, or in future years, the experience of this year suggests a very different outcome.

As Jean Ross, NNU co-president noted, "the bill seems more likely to be eroded, not improved, in future years due to the unchecked influence of the health care industry lobbyists and the lessons of this year in which all the compromises have been made to the right."

Advocates of the current bill say it's most important feature is that it expands coverage to 30 million Americans. But their method for accomplishing what NNU Co-president Deborah Burger calls a "wishful statement" is an individual mandate forcing the uninsured to buy private insurance or be criminalized and subject to fines, in fact symbolizes the power of the insurance industry.

Individual mandate was the top priority of the insurance industry, which also succeeded in fending off meaningful restraints of its predatory pricing practices. The likely outcome is that far too many people will still face health care insecurity or medical bankruptcy due to ever rising out-of-pocket costs, or continue to skip needed medical care because of the high prices.

Indeed, discouraging provision of care as the preferred way to control costs, rather than rein in the pricing practices of the insurance and drug giants, is a central tenet of the insurance industry and conservative policy wonks.

That is also symbolized by the Senate bill's excise tax on comprehensive insurance, deceptively labeled as "Cadillac plans." In practice that tax will push employers to further reduce benefits for workers, and shift more costs to employees. Especially as more and more plans are subject to the tax every year due to the weak price controls on insurers in the legislation.

The Senate amendment exempting certain "high risk" occupations only serves to remind us of the inequity of the entire provision. Why are some protected, but others are not? It has not escaped notice that the targeted occupations are all male dominated -- mining, construction, police, and fire -- yet another gender imbalance in legislation that further erodes reproductive choice for women.

In exchange for lining up millions of new customers for the insurance giants, while failing to stop their price gouging or significantly cracking down on denials of claims they don't want to pay for, we're told that the legislation is historic for "ending" the worst industry abuses by banning exclusions of patients with pre-existing conditions and the shameful practice of dropping people when they become sick.

Yet both of those provisions are seriously marred by gaping loopholes for an industry which has perfected the art of adverse selection and gaming the system.

As the NNU has said in its statement on the bill, the loopholes include:

  • Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.

  • Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
  • Allowing insurers to charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
  • Insurers may continue to rescind policies for "fraud or intentional misrepresentation" - the main pretext insurance companies now use to cancel coverage.
  • The health care industry hardly needs the help. Within the last 35 years or - at least dating to the 1970s the Nixon administration's push for the HMO Act to stave off the 'threat' of a single payer system - we have witnessed the emergence of 'corporate giantism" in the health care sector:

    • The top five sectors have squandered more than2 trillion on mergers and acquisitions since 1993 with the end result that care is even less accessible and costs have skyrocketed.

  • The top ten pharmaceutical corporations reported nearly77 billion in profits last year
  • The top 19 HMOs made about17 billion in profits last year.
  • In California, the home of the managed care, just six insurers control more than two-thirds of the market. Overall, one or two companies dominate the top 94 metropolitan areas, severely limiting choice and competition
  • Helping these giant corporations become even bigger and more powerful is not a compromise with an eye to history or a step on the way to something greater; it is an historical blindness to the uniqueness of the current historical era and an ultimate surrender to corporate domination of our nation's health.

    But nurses, who sustain the current flawed system and are highly motivated to continue to campaign for real change, are neither discouraged, nor giving up.

    "NNU and nurses," said Ross, "will continue to work with the thousands of grassroots activists across the nation to campaign for the best reform, which would be to expand Medicare to cover everyone, the same type of system working more effectively in every other industrial country. The day of that reform will come."

    Rose Ann DeMoro
    is executive director of the National Nurses United.

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