I was surprised at the anger and bitterness in the some of the comments on Monday's post about the Senate Health Care bill. Is it far less than it should or could have been? You bet.
Am I disappointed that President Obama held himself above the fray during the debate and didn't get his hands dirty twisting arms and horse-trading? Absolutely.
Am I furious with the entire Republican contingent who would rather see people die than give an inch to President Obama on any issue? Without a doubt.
However, in the larger picture, something crucial and good has happened: the idea that health care is a commodity to be mined for the profit of a few has lost ground. The idea that health care can be rationed by the ability to pay is no longer acceptable.
Yes, it is true, for the time-being, that private insurers will gain 30 million customers, but they will be severely restricted now from gouging those customers. So let us look at the broad gains contained in the Senate bill.
Within a few broad categories, everyone will pay the same amount for health coverage.
Medicaid will be significantly expanded.
Subsidies for low- and middle-income workers will keep premiums to under 10 percent of their income.
There are caps on out-of-pocket expenses.
There will be no life-time caps on benefits and annual caps will be restricted.
There are limits on emergency room charges for low-income, uninsured patients.
There are new tax credits to help small businesses purchase coverage.
Insurers must take all comers. No longer can benefits be cut off when people get sick, nor can coverage be denied for age, gender and pre-existing conditions.
That last item deserves a bit of explanation – it involves two issues: denial of coverage and denial of care for pre-existing conditions. Both are banned for children and adults as of 2014 when the exchanges, where people will purchase insurance, go into effect.
A dispensation has been carved out for children who, as soon as a bill is signed into law, cannot be denied CARE for pre-existing conditions. That means if you already have insurance covering a child, a company cannot deny a claim for anything they might now label a pre-existing condition.
Not good enough? True. But better than what we have now.
There is another immediate gain for Medicare beneficiaries. The size of the doughnut hole in prescription drug coverage (Part D) is reduced by $500 for 2010. Additionally, beginning on 1 July 2010, low- and middle-income elders enrolled in Part D programs who fall into the doughnut hole will receive a 50 percent discount on brand-name drugs and biologics.
Not good enough? Yes. But better than 2009.
For a century, during seven different presidential administrations before this one, health care reform has been attempted and failed every time. Given that history, we have made remarkable progress this year. The bill is far from perfect and it will take many years, perhaps a couple of decades, for it to become comprehensive, fair to all and for the private profit system to be deemed unacceptable.
But we have a beginning. Listen to Eugene Robinson writing in the Washington Post yesterday:
“[L]et's consider the measure's one great virtue: For the first time, we will enshrine the principle that all Americans deserve access to medical care regardless of their ability to pay. No longer will it be the policy and practice of our nation to ration health care according to wealth...
“For anyone who believes it is shameful that the richest, most powerful nation in the world cares so little about the health and welfare of its citizens, this is the moment. It should be seized, not squandered.”
At The Elder Storytelling Place today, Johna Ferguson: Winter's Blush