Health Care Now
Today marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.
That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.
I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.
What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.
By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.
For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)
And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.
Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.
Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.
In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)
All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.
So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.
Michael Moore is a documentary filmmaker whose 2007 film “Sicko” examined the American health care industry.
Buried deep in the health reform law is Section 10323. It amends the Social Security Act to extend Medicare coverage to individuals exposed to environmental health hazards in the region defined by the Emergency Declaration of June 17, 2009. That declaration limits this benefit to the area around Libby, Montana.
Section 10323 of the Affordable Care Act (ACA) calls it “deeming of Individuals as eligible for Medicare benefits.” People do not have to be age 65, or wait two years following disability, or to have paid into the Medicare system. The victims of asbestos in Libby were simply “deemed” to be eligible for Medicare. It was described as “discretionary deeming.”
Senator Max Baucus, Chair of the powerful Senate Finance Committee, who hired insurance executive Liz Fowler to write the health reform act, slipped Section 10323 into the law assuring that all those with asbestos-related conditions in the community around Libby, Montana get into Medicare, our single payer program for all those over 65. Further, for this designated group of Montanans, Baucus arranged additional special benefits not normally available to Medicare patients.
It’s true. Senator Baucus “deemed” single payer off the table during the 2009 health care debate. He had physicians and others arrested for insisting that single payer be included in the nation’s discussion. Baucus effectively locked out any consideration of such a plan. But he gave our country’s single payer program, Medicare, to the people of Libby. And they got free drugs, too.
The victims of asbestos exposure in Libby, regardless of age, are eligible for traditional Medicare, plus, under an additional program that Baucus included in the ACA, the government also pays for services not included under Medicare, such as home care, medical equipment, counseling, help with travel, and medications not covered by Medicare prescription plans.
Coverage of drugs can be crucial. Outrageous drug prices continue to threaten all who depend on costly medications. While the ACA bars health insurance plans from refusing to cover those who are sick, insurance companies have found ways to keep patients with cancer, Multiple Sclerosis, AIDS, and other conditions out of their plans. Some insurance companies have made the co-pays on the drugs needed by such patients as high as $1,000 to $6,000 a month, effectively excluding those with pre-existing conditions.
Goodness knows the people of Libby deserve to have Medicare—with free drugs and home care and medical equipment and help with travel and much more. After all, the W. R. Grace company whose vermiculite mine poisoned their entire region left thousands, not just the miners, suffering and dying.
But the senator who helped Libby also made certain that all the rest of us would be left out—that the nation could not even consider the merits of HR 676, the Expanded and Improved Medicare for All Act, that would free our country from the health insurance companies that continue to hold us hostage.
As health reform rolls into a new stage where some who have been left out find help but millions more, both insured and uninsured, find the costs of care still beyond their means, let us look to the Libby solution, publicly-funded single payer, for the answer.
Medicare spends more than 98 cents of every dollar on actual health care, while insurance companies spend only 80 to 85 cents on health care. Under the ACA insurance companies still victimize all of us as their narrow networks deny us access to the doctors and hospitals we need. The insurance companies retain their power to deny tests, procedures, and treatment making life miserable for both patients and doctors.
The United States spends about twice as much per person on health care as the rest of the industrialized world. Yet our life expectancy, infant mortality and other health outcomes lag far behind. As the policy experts of Dartmouth and MIT search in vain for ways to cut health care costs while retaining the profit makers, let us keep in mind that unless we remove the private for-profit insurance companies from our health care, any cut in costs means a cut in care.
To expand care while cutting costs, we have to go to a single payer plan—like HR 676, Expanded and Improved Medicare for All, a bill introduced into every congress since 2003 by Rep. John Conyers, Jr. (D MI). With HR 676, we could save over $500 billion a year while expanding coverage to everyone and improving care to assure dental and eyeglasses and hearing aids and drugs and long term care and all the things we need that are not normally covered. And this coverage would remove all co-pays and all deductibles.
Health care would be paid for publicly and in advance with no payment at the point of care. Patients will choose their doctors and hospitals. When we seek care, the question will not be “How will you pay?” but “Where does it hurt?”
This simple legislation would fix our damaged health care. Medicare was rolled out in six months with only index cards in the time before computers. No need to ask how much you make—it is available to all. That’s what we need–not the twisted double-dealing that wins something special for a few, but, instead, a magnanimous, simple, bold, inclusive plan that finally will allow all of our people to enjoy the life-giving benefits that a wealthy and compassionate nation can offer.
Let us dedicate this new year to building the single payer movement that will make this plan possible.