Momentum to enact health-care reforms in the next Congress seems to be building. Sen. Max Baucus, D-Mont., the pro-business moderate chairman of the Senate Finance Committee, recently put out a 98-page white paper on health care and declared that There is no way to solve Americas economic problems without solving health care.
Baucus proposes to make health coverage more affordable by providing a public health insurance exchange to offer coverage to individuals and businesses in competition with private companies. Small businesses would get subsidies to offer health insurance. Larger businesses would have to offer health insurance or pay a percentage of payroll into a public pool that subsidizes coverage for the uninsured. Insurance companies could neither deny coverage nor discriminate against individuals with pre-existing conditions. The Baucus proposal is in line with the progressive Health Care for America plan, as well as President-elect Barack Obamas platform, although it adds a mandate of health coverage from the proposals of John Edwards and Hillary Clinton.
Such a plan would be a great improvement from the patchwork private insurance system that now leaves 47 million Americans uninsured and an estimated 50 million underinsured, who think they have coverage until they need it.
Baucus outline appears to jibe with proposals of incoming Health and Human Services Secretary Tom Daschle, the former Senate majority leader, in his book, Critical: What We Can Do About the American Health-Care Crisis, published in February.
Sen. Ted Kennedy, D-Mass., chairman of the Senate Health, Education, Labor and Pensions Committee, also has promised to work with Obama to move a healthcare overhaul in 2009.
Still, progressives should not give up on the goal of expanding Medicare to cover all Americans.
Baucus has declared expansion of Medicare off the table, reportedly because a single-payer plan is not politically feasible. Many Democratic leaders dont want to pick a fight with some of the nations most powerful financial interests, which have the resources to turn public opinion against meaningful reforms. Total spending on health care is estimated at $2.4 trillion in 2008thats 16.6% of the gross domestic productso there are plenty of vested interests. They include the health insurance industry, pharmaceutical drug companies, hospitals, medical specialists, medical suppliers and others who now profit from our current broken system. A single-payer system might impose cost controls on health-care profiteers.
HR 676, which would create a single-payer system by expanding Medicare, was introduced in 2003 by Rep. John Conyers Jr., D-Mich., and it has been refiled in every session since then. It has 93 co-sponsors in the House, but failed to get a hearing. But the bill has prominent supporters, including the Healthcare-NOW Coalition (healthcare-now.org), the Leadership Conference for Guaranteed Health Care (pdamerica.org/leadership), the California Nurses Association (guaranteedhealthcare.org) and Physicians for a National Health Program (pnhp.org). The AFL-CIO is divided over whether to support Obamas plan or single-payer, but nearly 600 labor groups have endorsed the HR 676, including 20 national unions, 119 central labor councils and 39 AFL-CIO state federations. The Labor Campaign for Single-Payer Healthcare plans a Jan. 10 conference in St. Louis to kick off the project. (See laborforsinglepayer.org.)
A single-payer program would help big businesses, such as the struggling car manufacturers, and it would help unions by taking off the table the responsibility for negotiating basic health benefits. But it would be an even bigger boon for small businesses that increasingly have trouble finding affordable health coverage for their employees. Responsible businesses are now at a competitive disadvantage to skinflint employers who cut costs by not providing health insurance for their employees.
Tying healthcare to employment means workers are afraid to quit their jobs to start their own businesses for fear of losing coverage. But universal health coverage is even more critical for those who will become unemployed during this extended recession. Federal law allows people to keep their health coverage for up to 18 months after they are laid off, but the unemployed must pay the entire cost of the insurance, so this option frequently is unaffordable. The Des Moines Register recently noted that the average employer picks up 84% of the premium for individual coverage and 73% of the premium for family coverage. Lose your job and insurance costs for your family could jump from $300 a month to $1,200 a monthat a time when your income has plummeted. And if you set out to buy insurance on your own, youll find that coverage plans are confusing and limitations may be hidden until symptoms appear and you find out youre not covered. Older people may have pre-existing conditions that make the cost of insurance prohibitive. But going without is risky: Half of all bankruptcies in the US were filed by people who cant pay their medical bills, according to a 2005 study by Harvard researchers. Of those bankruptcies, 68% were filed by people who started with health insurance.
Physicians for a National Health Program estimates that universal coverage could be financed with a 7% payroll tax, a 2% income tax and current federal payments for Medicare, Medicaid and other state and federal government insurance programs. The US Government Accountability Office has estimated that savings in administrative costs would offset much of that expense.
So reform is needed and solid majorities say the federal government should guarantee health insurance for all Americans. An Associated Press-Yahoo poll in December 2007 found that 65% said the US should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.
Obamas new White House chief of staff, Rahm Emanuel, recently said the economic crisis provides the opportunity ... to do things that Americans have pushed off for years. As long as theyre getting into health reform, Democrats should seize the opportunity to expand Medicare to cover everybody.
As critical as we have been of US carmakers, we see little choice for Congress but to lend the Big Three the money to retool their factories so they can produce fuel-efficient models and make payrolls into the New Year. Some 240,000 jobs at the Big Three are at stake, as well as 2.3 million jobs of domestic suppliers. That amounts to nearly 2% of the US workforce, and the car industry already has lost 100,000 jobs in the past year.
We certainly dont think that auto workers should be punished for the bad decisions of overpaid executives, who shelved plans for the fuel-efficient models that were developed in the 1990s with prompting from the Clinton administration. Instead, they bet all on high-profit-margin SUVs once Bush took over. But foreign models arent selling in this recession, either. Now the carmakers are asking for billions of dollars to help them compete with foreign manufacturers that operate in countries with taxpayer-supported health insurance for their citizens. Such as Canada.
Republicans see bankruptcy as a tool that would allow the carmakers to get out from under contracts that require them to pay expensive benefits to auto workers and retirees. The GOP sees this as a chance to cripple a union that played a key role in electing Obama and other Democrats. Some senators, particularly in the South, also have divided loyalties as they represent foreign carmakers who have opened manufacturing plantsmainly non-unionin their states.
Weve bailed out bankers and their shareholders. We also can bail out the Big Three and their auto workers. JMC
From The Progressive Populist, December 15, 2008
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