post based on viewing speech; it may be modified once I comb thru written texts
Most ppl on the left are in agreement that President Obama brought the moral high ground back to the health care debate and placed it firmly in the hands of those who support reform.What is less clear, is what exactly underpins that high ground. What plan is he offering and will that plan actually cover the most in need.
As President Obama pointed out:
- 1 in 3 people go without continuous coverage in any given 2 year period in the United States
- 1 in 13 lose coverage every year
- ppl live in fear of being dropped mid-treatment or denied coverage of existing conditions b/c of losing or changing their jobs or their insurance company exploiting loopholes.
And he was right to implicate the leadership of our nation by pointing to “our collective failure” that has led to so many N. Americans living in poverty or homeless because of health care.
His discussion of “insurance exchange” seemed to be the most confusing. Some heard the public option wrapped in capitalist competition language. Others wondered if this was a new name for health care coops. Still, the more cynical among us heard insurance exchange smack of laissez faire liberalism in the health care industry that has failed to produce positive change for marginalized people in the restructuring of socio-economics abroad nor in the health and banking industries domestically. Ultimately, this key piece of the plan lacked clarity about what it was, what it will look like, and how much good it will do with a 4 year timeline for implementation.
He was however, very specific on things he was committed to:
- if you already have insurance nothing in new plan will require change providers or insurer
- it will be against the law to deny coverage for pre-existing condition
- it will be against the law for insurance companies to drop ppl for getting sick or needing care
- no arbitrary cap on coverage you can receive in yr or given lifetime
- limit on out of pocket expenses
- quality affordable choices – insurance exchange
- tax credits (ie unemployed and under-employed ppl who need care the most will get no benefit here)
- supports fines (ie the Baucus plan to charge families $3800 for not being insured is still on the table)
- hardship waiver
- no coverage for undocumented people
- no coverage for abortion
- will protect medicare
- will only support deficit neutral plan
- will charge insurance companies fees for most expensive plans based on percentage, so cheaper the fees the less likely they’ll have to pay – lowering costs
- preventive care mandatory
- malpractice reform – which got standing ovation from Republicans
- ability to keep insurance from job to job or when opening own business
The President did not explain how this new plan would determine “reasonable cost” and what would happen to families who were unable to meet that cost when mandatory insurance went into effect. He entreated the N. American people to care about those who are struggling, to support them b/c it is the right and just thing to do. But I find myself worried that Congress has largely failed to show that kind of care and that Republicans have stirred up the exact opposite while using health care to do it. How will we meet reasonable cost without care that some have dismissed as socialism?
As someone who has worked in health care with immigrants, I also find their exclusion from the plan extremely problematic. President Obama, whose family includes immigrants, offered no information about the social effect of excluding undocumented people (who often work in high risk and high exposure industries). He did say that we pay $1K a yr per taxpayer to pay for uninsured emergency care and that he believed that savings there would equal savings in the over all plan. However, the plans currently on the table still include large numbers of uninsured N. Americans and an entire excluded group (undocumented workers and their families).
On the plus side of the immigrants equation is that the bill prevents doctors and other health care providers from asking a person’s legal status. The assumption some are making is that failing to ask will ensure that undocumented people will be able to receive care. However, if they do not have insurance through an employer (and most do not get benefits in their jobs despite long hours and minimal safety conditions) they are not allowed to have the government plan either, so how hard will it be for providers to figure out the status of patients? The absence of insurance can then also trigger the fine system that President Obama says he is committed to and a waiver option would likely trigger a status inquiry. See the problem? Ideologically the provision provides a loophole but realistically I am not sure it does.
I worry about what ER services will look like under a mandatory health plan if it is not also affordable, as some health care providers feel emboldened to refuse care to the poor, the homeless, working class youth, poc, GLBTQI people in the ER now. And my experience advocating for them, especially late at night or during major crises, makes me wary about how many more overtaxed and/or biased providers will feel bold or how much more bold they will feel toward those the president described as “willfully refusing” health care.
As most of us already knew, women’s reproductive coverage will not include abortion. For those women who cannot afford a private option, this could mean any number of problematic complications to their health care: 1. expensive private abortions or botched cheap ones, 2. compromised consent for sterilization or long term birth control that otherwise might not be chosen, 3. medical complications caused by delayed access to care and 4. the potential rise in cost for such procedures for those who with private insurance because it has no checks and balances in the “public” option . The possibility for re-opening the grossest of abuses of marginalized women as a result of this intentional omission from a plan that millions may depend upon is unthinkable.
At the same time, in some ways this is an inherited problem. Under the Bush administration the government passed the Hyde Amendment, stating that abortions could not be federally funded. Until the Amendment is addressed, no health care reform package can include abortion options to women. However, the government plan would be outside of the purview of the Hyde Amendment through another loophole which ties the Amendment to existing health programs and not a new overhaul hcr will create. While this does not provide an ideological cross check to the express denial of abortion coverage stated in the bill and by the President last night, it may help cross check the potential for gross abuses mentioned above.
President Obama offers a more comprehensive bulleted plan on the White House site here. These reforms include protections for seniors and women, including access to mammograms and flu shots and an end to age and gender discrimination in insurance rates. His ideas and commitments are strong here. The needs met are ones that people have been living and dying without for far too long. And it is good to see him specifically supporting women’s health in general especially since his “these are not welfare recipients” comment seemed to slight subsistence level women as much as those making reproductive decisions; tho clearly his point was to check some of the misinformation about who needs health care in this country and who is “safe.”
I would also like to see some of the more abstract ideas he lists tied to actual structures of implementation and enforcement. Congress, of course, is charged with this piece of it but I think we need to get concrete here especially when some things are causing such confusion. What is Congress committed to? And while the President cannot give a speech on that, he did make it clear that he felt those in Congress who were for public option or nothing were as “fanatical” in his eyes as “deathers.”
Ultimately, there is much to delve into here that benefits people with health care needs. Some of the missing pieces are beyond the President’s control but the absence of others is cause for question in my mind. Congress now needs to step up with a plan that does not penalize the poor and those in need. When the final Bill is proposed, I will of course review it here.
You can read President Obama’s full speech here, his closing remarks (which was a powerful rallying cry) here and the letter from Kennedy he referenced here. When you are done, I am curious to hear from you what you thought of the speech and what you think is the next step in making sure that the moral message of ensuring that no N. American goes without care is realized in practice.
Warning: I’m going to take a minimal role in the discussion of this post