Health Care Reform: One Step Closer to Reality

My favorite Dickens' novel, A Tale of Two Cities, begins with the line, "It was the best of times; it was the worst of times..." It's a seemingly contradictory statement, but I think that Dickens got it right. Darkness and light, good and evil, joy and sadness, everything comes in pairs. Thus it is that landmark health care legislation passed in the Democratic controlled House on Saturday night, legislation that proposes to provide health care coverage for 96% of Americans; however, women who are receiving a federal subsidy to aid in securing insurance under a private plan will be denied coverage for abortions.

The vote in favor of the health care legislation was close, 220 to 215, with one lone Republican, Rep. Joseph Cao (Louisiana) joining 219 Democrats in favor of the legislation, with 176 Republicans and 39 Democrats opposed. The vote on restricting access to a legal abortion for certain individuals and small groups was passed by a vote of 240 to 194.

However, as I read the news about the House vote, I am nonetheless encouraged by the overall victory, even though it was by a slim margin. The House's vote was historic, approving the broadest overhaul of US health care in 50 years and providing President Obama with a significant victory on his top domestic priority. To all the naysayers who said that he couldn't do it, I say a very adult, "Na, na, na, na, na!"

I am reminded why I voted for President Obama. He has the patience and tenacity that most of us lack. This was a hard fought battle, not at all an easy victory. The Senate will also be a difficult vote and I expect the victory to be by a narrow margin but I do expect there to be a victory.

Following is a summary of the key provisions of the legislation passed by the House:
1. Requires most Americans to carry health insurance;
2. Provides federal subsidies to those who cannot otherwise afford health insurance;
3. Requires large companies to offer coverage to their employees;
4. Imposes penalties on consumers and employers who do not comply with the government's mandates regarding coverage;
5. Prohibits insurers from denying coverage based on pre-existing conditions;
6. Prohibits insurers from charging higher premiums on the basis of gender or medical history;
7. Removes exemptions from federal anti-trust restrictions on price fixing and market allocation that have been held by the insurance industry; and
8. Creates a federally regulated marketplace where consumers may shop for insurance and allows the government to sell health insurance.

My personal favorite is #7. It means that the insurance companies will have to be competitive in attracting consumers. This should make everyone happy who believes in free market enterprise.

What's missing from this legislation is a robust public option; what's left of the public option has been watered down considerably. It also does nothing to alter health insurance as a for profit industry. I don't believe that this legislation is what is needed to provided health care to all. My dream is a single payer, not for profit, health care system. In the midst of celebrating this step forward, I wonder if perhaps now is the time to fight for more meaningful reform. However, I can't help but think of the protesters and elected officials shouting about socialism and I wonder if perhaps I expect too much, and that this is an incremental step towards broader reform. The best articulation that I've read on the weakness of the passed legislation is by Rep. Dennis Kucinich, who explains why he didn't vote for the bill. He's either got chutzpah or he's an idealistic dreamer, or maybe he's both.

According to news reports, Speaker Nancy Pelosi compared the passage of the health care legislation in the House to the passage of Social Security in 1935 and Medicare 30 years later. This is huge step forward and I like to think that all of our telephone calls and emails made a difference. However, there's no time to rest. The Senate has to pass this legislation before a final version ends up on the President's desk, awaiting his signature. The good news is, you only have two state senators to contact.