In the interest of full-disclosure, let me tell you a few pertinent facts about myself. I'm currently uninsured, so this debate directly affects me. Not only am I currently uninsured, but I was raised poor and spent much of my childhood without health insurance.
Further, I was in a serious car accident as a teen, which has left me with various health issues. I've spent much of my adult life dealing with illnesses and problems which have often resulted in having to have some sort of surgical intervention. I've also been incapable of sustaining full-time employment which, here in the US, means I've never had health-insurance except through either husbands or the state.
I am, for all intents and purposes, uninsurable under our current system.
Given all this, I've been fairly lucky. My grandmother who raised me was British, so as a child I had dental work done in Scotland. When I came down with TB, it was treated by the public health department. After my accident, my multiple traumatic injuries were life-threatening, so I was promptly treated at LA county hospital.
When I regained consciousness a week later and was being kicked out, I'd been fortunate enough to have been in the car with a movie star's kid driving -- his insurance forked out the dough to both pay county and give a cash advance to the other hospital, who wouldn't admit me otherwise.
When I was having complications a few years later, and had been hemorrhaging for a month, I just happened to be dating a guy in the military. They have good benefits. I hastily divorced my first husband and spent the day after my second marriage in surgery.
During that marriage, I had my son, got my teeth fixed, and had several more surgeries. I ended up disliking my second husband quite bitterly, but on paper, we were married for YEARS after the rot set in -- far into my relationship with what would be my third husband, only getting divorced from #2 when he wanted to remarry.
My third husband, who's now out of the picture, uprooted his business and moved with me out of California to Washington state, motivated in large part by the fact that Washington had state-based insurance. My son stayed insured through his father. My insurance kicked in in Washington just in time for me to have my last major surgery which saved my life.
Unfortunately, it wasn't in time to save a large chunk of my bowel, which I'd probably still have had I had consistent treatment and had the surgery earlier.
In the meantime, my parents were getting older and having their own health problems. They moved up to Washington with us and I became, to some extent, their advocate. You might remember my having written about just one of their issues. During those years in Washington, I also dealt with my grandmother's final illness and my Uncle's suicide after years of battling mental illness. I took care of all their bills, paperwork, and arrangements.
I tell you all these personal details for a reason: I've dealt with my grandmother's very good private insurance. I've dealt with the government's medicaid and medicare plans, I've dealt with crappy HMO's. I've dealt with the military's Tri-care basic and their other plans, as well as used their clinics and been in their hospitals. And I've been insured through 3 different plans from private insurance contracted with, and subsidized through, Washington state's Basic Health Plan.
I've battled administrators, clerks, and various and sundry other bureaucrats in hospitals and clinics both public and private in various states. I've fought with insurance agents and HMO supervisors since HMOs were invented. I've tested the facilities and ERs and pleaded with government agencies up and down the west coast and in Hawaii. I have a healthcare corporation in Seattle who have my name highlighted in their computers with a note not to talk to me because I'm "too mean," a fact which, coming from a corporation that routinely denies life-saving treatment to people, does give me a little pause.
In any case, my point being that there's not a whole lot about being sick and struggling in the US system that I don't have at least some experience with.
Currently I'm back in California, my last marriage having crumbled under the weight of my last surgery, subsequent 4 year illness and lengthy, debilitating medical treatments, and the financial devastation that all of that entailed. The stress was too much and the fallout from that breakup has been consuming most of my time.
I couldn't afford to stay in Washington with no source of income. I had to file for bankruptcy and sell my house. I relocated back to my home state of California and had to get my parents settled near my brother and his family. Eventually, Washington caught on that I'd moved. They cancelled me. California has no similar health plan.
As I type this, my step-dad is in a nursing home following a fall on Christmas, my mom is in the hospital with swine flu, my son is recovering from a bout with mono, and I'm a bit worried about needing a mammogram. You see, I'd gotten one in Washington before my departure, but the letter telling me there was something wrong with it didn't arrive till a week after my notice of cancellation did. I'm HOPING it was just one of those blurred imaging problems -- I don't feel any lumps -- but the worry niggles at me.
So this is the back drop from which I, personally, am viewing the current healthcare debate. As you might imagine, given all this, the healthcare bill interests me, to say the least.
I'd been rather busy in the months leading up to the Senate vote, and only cursorily following the blogs. Like most of you, I was not happy about the public option being dropped. There were bits of the bill that I was rooting for or against. But all that said, I was HUGELY relieved when the senate passed the bill on Christmas Eve. I almost wept. I popped into my blog home here on ET to share the moment with some politically like-minded allies.
I don't know if you can imagine how dismayed I was to find this historic event was being met with scorn and derision here. I went looking through the comments and then on to other blogs to see what was going on and was APPALLED to find my allies, in some cases my friends, and activists I like and respect advocating that we "kill the bill."
I was baffled -- maybe there was something I'd missed. I read all the arguments and links. People I generally respected were calling the bill an abomination, a corporate giveaway, worse than the status quo. I went on an obsessive research binge. Maybe there was something in it I hadn't heard about -- some massive betrayal that would make defeating healthcare reform and leaving the millions without insurance a worthy goal. What was in there that could be worse than the status quo?
After reading and researching, I can answer that question with confidence -- NOTHING. There's NOTHING in this bill that makes passing it worse than killing it. Killing it, if accomplished, would be the most boneheaded, self-destructive, devastating political act I'll have witnessed in my lifetime. And that INCLUDES Nader voters who insisted Bush and Gore were the same.
Sorry. I lost my head for a minute. I'll try to restrain myself, to be reasonable. I know this post is overly-long already, but I'd like to address some of the arguments I've been reading about. I realize that most of them have not been discussed thoroughly here on ET and don't expect you to know all the details of our system, but I feel the narrative on this issue has spun wildly out of control.
Even here, my friends are saying things like "I don't know what to think. I know it'll help you, so I think I want it, but it sounds so bad. People we respect are saying it's worse than nothing." Even here, I'm seeing comments bashing the bill and a narrative becoming set that it's a massive betrayal and won't help anyone.
I cannot even describe how angry this makes me.
But I'm trying to be patient and to keep my temper. I'm attempting to bear in mind that the people advocating to kill the bill from the left are most likely well-intentioned. I'm telling myself that it's misplaced passion combined with political naivete. That's the only conclusion I can come up with, because let me tell you, in reading through a lot of the arguments about HCR, I have never heard more misinformed opinions, stated with more conviction, than I've read the past few weeks.
Let's start with the what the bill does. The aspect that would most directly affect me is the medicaid expansion. I've read REPEATEDLY in recent weeks statements along the lines of "sure, it helps the poor, but they qualify for medicaid already." Two problems with this -- first, if I read any more dismissive comments about helping 'the poor,' my head is gonna explode and, second, it's wrong. The benefits of the proposed medicaid expansion are huge.
While people are correct that medicaid is the current government program for poor people, they're wrong in assuming that it helps anyone who's poor. Currently, one can only qualify for medicaid if one is both poor AND either disabled, blind, or a single parent of a dependent minor, in which case the qualifications and benefits vary from state to state. I might add that many states, such as here in California, judge whether or not you're disabled based on the Federal disability SSI and SSDI guidelines.
It's not enough to be unemployable, have doctors say you're disabled, or have insurance companies refuse you due to your shoddy condition, all of which would make me a shoo-in. Getting the government to acknowledge you as disabled is a lengthy, difficult, and usually adversarial and traumatic process. I've heard tell that there was a golden era, usually cited as being some time in the 70's, when 'anyone' could get on disability. If there ever WAS such a time, it's long past.
The senate bill extends medicaid nationwide, based solely on income. All states will have to accept anyone who's income is up to 133% of the federal poverty level. Currently, that would mean any individual making under around $14,500 a year, or $29,500 for a family of 4. States will be reimbursed and will have the discretion to cover people with a higher income. The house version was actually better in this case, with the required coverage extending to 150% of the guideline. The bill would immediately extend this coverage to those with pre-existing conditions, give states the option of extending it to everyone else next year, and requires it in 3 years.
Other benefits that are slated to start immediately include prohibitions on rescissions, which is the currently-common practice of rescinding current insurance when a person gets sick; extends benefits to anyone denied for pre-existing conditions; tax breaks for small businesses; lifts lifetime limits on coverage and restricts annual coverage limits; covers preventive care without it applying to deductibles; extends coverage to children through their parents' plans up to age 26; monitors costs and gives consumers rebates for excessive charges; helps cover early retirees; shrinks the Medicare D 'donut hole' in prescription coverage for seniors by $500 and reduces the cost of certain drugs; stops some cuts to Medicare that are scheduled to take effect this year; and expands student loans for healthcare workers.
Things that are scheduled to phase in are bonuses in Medicare payments, eliminating cost-sharing for preventive services, funding for public health clinics, forming insurance exchanges, limiting executive compensation, monitoring/limiting insurance profit; and providing premium tax credits for individuals making up to 400% of the federal poverty limit.
This doesn't nearly cover everything in the bill -- it's a massive piece of legislation. But the upshot is that it will extend coverage to millions of people who currently don't have access to it and it will impose regulations and price controls on an industry that currently has none.
I keep hearing it argued that we need health CARE, not insurance COVERAGE and, while I agree that this is the goal, not to mention a catchy talking point, I think it ignores current conditions. Almost all of the healthcare system in the US, almost all of the infrastructure, is run privately. There is very, very little by way of public hospitals or clinics and even much of that is run by, or in conjunction with, the private sector.
The fact of the matter is, is that even a lot of medicare, medicaid, and military coverage is outsourced to managed care plans overseen by none other than the evil insurance empire. I agree it sucks, but these are the kinds of nuts and bolts changes that our 'friends' on the hard-working right have spent the last few decades implementing in their quest to shrink government.
In reality, if we kill the insurance industry, we'd pretty much have to build from scratch. I see this bill as a step in co-opting some of their resources WHILE we're funding healthcare workers and building public clinics, which the bill provides. Unlike the "pharma giveaway" that was medicare part D, extending prescription drug coverage to seniors, this bill contains oversight, regulations, and price controls. Medicare part D is largely reviled because it had none of those and simply funneled taxpayer money into private hands. The senate bill addresses many of those issues.
I see most of these issues as being very cut and dried -- it's an unequivocal good to provide coverage for tens of millions of people. It's an unequivocal good to fund education, build clinics, and provide jobs, working towards actually HAVING a public infrastructure. It's definitely a step in the right direction to impose regulations on insurance companies, to limit their profits, and to outlaw the worst of their depredations.
There are other, more controversial, parts that are more open to debate and that seem to be the source of a lot of anxiety. These are the mandates and the excise tax on so-called 'cadillac plans.' I can't state with any authority that these are definitely "good" or that people absolutely have nothing to worry about. But I do have some thoughts on the matter, which may or may not help.
I hear people's fears about being forced to buy 'junk insurance.' There currently is such a thing in the US -- policies that cost a lot and cover little, sometimes only emergency services and often with deductibles that average people never reach in a year, then with catastrophic caps that are quickly exceeded if you do have a medical issue. There's also the concern that we'd be mandated to give our money to private companies or face punitive fines.
This is the scenario I keep reading -- that the entire bill is a corporate giveaway that's forcing us to be customers to a predatory industry in exchange for junk policies that do nothing for us and we still go bankrupt and die. It's usually added that Obama is a sellout, bowing to his corporate masters, and that the Dems will now be reviled and lose elections for the rest of eternity. Sometimes it's argued that either this was Obama's plan all along, or that he's too inept or... let's say 'unmotivated' to push for the public option or anything better.
My response to these concerns are, first, the bill pretty much regulates these sorts of 'junk insurance' policies and already addresses many of the problems with them -- it limits deductibles, provides preventive care with no deductibles, limits premiums to a percentage of income, and limits annual costs to a percentage of income. There's also tax credits to go towards these costs for people making under a certain amount of money. From what I can tell, the new regulations will probably significantly lower most people's existing premiums.
As far as the mandate, it, and the penalties, don't start for several years. The first year the penalty, for the year, is $95 and eventually maxes out at $750 a few years after that. The penalty is waived or reduced if you can't afford it. That doesn't seem excessively punitive to me. I don't like that we don't have a public option and must choose between private options, but the bill seems to guarantee affordability.
Having had the personal experience in Washington state with a similar plan, I would welcome such a thing -- I could choose between several private plans, contracted with the state. I picked the lowest premium plan with the least benefits -- it cost me $17 per month and saved my life. I went through catastrophic treatments and never paid more than $500 in a calendar year for hundreds of thousands of dollars worth of hospitalizations. I know from experience that government regulated private insurance can work.
What I like about the mandate is that it establishes the government's acknowledgement that EVERYONE should have healthcare. That's a huge step in this country. It makes everyone invested. And IF the companies can't control costs and can't provide the care to the WHOLE POPULACE, not just to a SEGMENT, then the government will be in a position to set up it's own public care. It builds an excellent foundation for future improvements.
RIGHT NOW, the industry is completely unregulated and profit unrestricted. RIGHT NOW there is a huge portion of the population who does not want government interfering in healthcare. RIGHT NOW the MAJORITY of our public servants think healthcare is a private matter and not the government's concern.
When I hear arguments from the LEFT that we have no guarantee the government can control the insurance industry, I don't know what to think. Aren't we the ones arguing FOR government as a tool for good? Isn't it our stance that government can regulate industry, run correctly, and help its people?
Because it seems to me that if we don't trust them enough to do the things the bill intends -- if they can't rein in costs, if they can't provide affordable healthcare and stop us from dying and going bankrupt over medical emergencies, then it seems to me that we may as well abandon the notion that a 'public option' will make anything any different. If one is to think they're powerless to enforce what's in the bill, then what makes us think a public option would be affordable or well run or make any difference whatsoever?
At some point politics is a leap of faith -- the outcome will determine how this is viewed. If the federal government is so powerless and/or corrupt that it can't regulate premiums and enforce annual costs, then including their own plan at this beginning stage isn't going to make a difference. If, however, they do get healthcare for a vast majority of the populace as the bill provides for, then it will go a long way to restoring the people's faith in government as a force for good.
Killing THIS bill, the bill that's gotten further than any bill in my lifetime, the bill that will help millions of people and save thousands of lives, the bill that regulates one of the most powerful industries on the planet restricts their profits, killing this bill will kill all hope of healthcare in our lifetimes.
If you think there'll be a do-over, you haven't been paying attention. Defeat will not galvanize public support -- it will reinforce the negative opinion of an already-scared populace. Defeat will not encourage politicians who are wavering, it will scare them worse than the Clinton debacle and reinforce their belief that it's something that's politically impossible. Defeat will mar the current administration's chance of accomplishing ANYTHING and taint whatever else they try to do.
Passing the bill will save lives and stops people from having their lives ruined. Just in my circle of acquaintance, MOST of the uninsured people I know would be eligible for medicaid. Just in my family alone -- THIS YEAR -- it would save my parents at least a thousand dollars, it would let my son get back on his father's insurance, and it would cover me. When the cost restrictions in the bill are in place, everyone I know WITH insurance who I've discussed it with would have lower premiums than they're currently paying. Me, my family, and everyone I know can't be THAT outside of the norm. Surely we're not the only ones.
Screaming NOW, before we've implemented the bill, before we have ANY legislation whatsoever, that the dems are corrupt, weak sellouts and advocating killing the bill does no one any good at all and doesn't further the cause in any way. It doesn't move the Overton Window. It doesn't help the poor. It doesn't save anyone any money. It doesn't save anyone's life.
I still haven't changed my opinion about the insurance industry. I still believe what I wrote in 2004. I still hate them and want to see profit eliminated from our system. But I see this bill as a huge step towards that goal. It's a good start and I, for one, intend to keep working and fighting and going forward. Just as soon as I get that mammogram.