Health Care All Day, Every Day

September 29, 2009

As we near the end of September and think about the issues that have dominated our conversations and consciousness during the first month of autumn 2009, the theme is obvious.  It has been health care reform.  Day and night, and night and day and on and off the air, everyone has been talking, thinking, complaining, hoping, regretting, threatening, persuading, bemoaning, waking, sleeping, eating, drinking, breathing health care reform.  September's focus  has been health care reform every day, all day, during every hour of every 24-hour news cycle.  And, at the beginning of the last week of the month, after a summer that was nearly ruined by a profound lack of civility and acrimonious debate, and a Labor Day week end marked by a re-invigorated commitment by progressives to pass meaningful healthcare reform to honor the life work of Senator Edward [Ted] Kennedy who died on August 25, after wall-to-wall commercials and dueling full-page ads in the nation's newspapers, after ranting and raving and wringing of hands and pointing of fingers at Fox News and MSNBC and everywhere in-between, in response to a rousing health care reform centered speech delivered to both houses of Congress and millions of TV viewers and radio listeners across the country by President Obama on September 9, and after contending with e-mail in-boxes and Twitter screens overflowing with "Action Alerts," on the day when debate is finally set to begin in the Senate, no one knows yet what will happen.

Health care reform has been on presidential agendas for nearly a century, and yet, we still don't know if we'll get it done, or if we do, whether the changes we make will be more or less substantial or cosmetic.

What we do know is that President Obama intends to get it done, whether or not intransigent Republicans decide to go along with health care reform legislation, and that we can expect some kind of reform to emerge from long months of often acrimonious debate by the end of the year.

Another thing we do know is that reform is a necessity.  Even the most vociferous of right-wing politicians who characterize nearly every reform suggestion as "socialism," and threaten that tax Hikes to pay for health care reform will send the fragile economy into a dissent from which we cannot recover (and these are the polite ways they describe proposed reforms), concede that some kind of reform is inevitable, and, most grudgingly admit, necessary.

On the other side of the debate, and usually speaking publicly in far more civil tones than the Libertarians and so-called "Tea Baggers," who attempted to disrupt reasonable debate with name calling, fictional scare stories, and other methods of intimidation during much of the month of August, are those on the left who maintain that no health care reform will be acceptable unless the solution includes a public option that can cover health care costs for the more than 30 million Americans who have no coverage and for the many more for whom their existing coverage is not likely to be enough, and which is necessary to (This is how the advocates state it nearly every time) keep the insurance companies honest. 

Then there are the polls.  Have you picked up a newspaper or magazine since September 1 that didn't cite some poll result or another?  polls indicate that between 52 and 69  percent of the American people believe that a public option is essential.  And, when the "New England Journal of Medicine"  surveyed physicians over the summer, researchers found that 57.4 percent of physicians favor the inclusion of a public option.  Polls of nurses and other medical professionals yield similar percentages.

Before the August recess, the House of Representatives managed to get health care reform bills through their committees on Education and Labor, Ways and Means, and Energy and Commerce, and all include a public option in one form or another. The Senate has four bills finally out of committee and under consideration.  The Finance Committee bill for which bipartisan agreement was held out as the reason for prolonged discussions and attempts at compromise, finally made it out of Senator Baucus's (D, MT) committee in mid-September with no support from the three Republican members of the so-called "Gang of Six."  That bill does not endorse a public option, but it does mandate that every American purchase some kind of health insurance coverage, it opens up Medicaid to more potential consumers, and it establishes some kind of insurance co op where consumers would be able to shop for a plan they could afford.  And Senator Baucus has stated that, even though his committee's bill does not endorse a public option, if the compromised healthcare reform bill that finally emerges from Senate debate mandates a public option, he will vote for it.

Senate debate begins today, and, with 14,000 more Americans losing their health coverage every day,   with companies large and small filing for bankruptcy because they cannot begin to meet the staggering costs of their employees' and retirees' health insurance coverage, with people dying because of lack of health care, it's time, past time, to reconcile differences, respond to the electorate's wishes, and get it done!

Over the long months of debate, the disability community has reached consensus on the need for health care reform and the specific measures most want included in the final reform bill that ultimately emerges from the Joint Senate-House Conference Committee.  On September 17, representatives from disability rights organizations, including the Disability Coalition for Health Care Reform, the ARC, United Cerebral Palsy, the National Council on Independent Living, and the Justice for All action Network, met by teleconference with interested members of the disability community to discuss healthcare reform and the goals they insist final reform legislation must include for people with disabilities.  The statement they shared with teleconference participants says, in part:

National Health Care Reform for People with Disabilities [must include]:

Guaranteed, affordable health coverage for all with a choice of private or public plans that cover all medically necessary services.

People with disabilities need a wide range of health care, durable medical equipment, mental health and home and community-based services.  Individuals with disabilities [currently] experience many barriers including costs, limits on types and amounts of benefits, pre-existing condition exclusions and lack of specialists and primary care physicians that understand specific disabilities.  Proposals that offer acute care programs modeled on Medicare or rely solely on private insurance plans will not meet the needs of people with disabilities.

We support health reform that will:

End the costly two-year waiting period for Medicare;

Provide Medicaid health care coverage to all Americans living at or below 100% of the federal poverty level;

Eliminate pre-existing condition exclusions and rating based on age, health status and gender;

Reform the long-term care system to increase choice and access to home and community-based services so individuals with disabilities can live in their own homes;

Include subsidies for lower-income Americans who cannot afford health care costs.

Too many people are going without necessary health care and are incurring medical debt.  And too many businesses - large and small - are unable to compete due to the high costs of health care.  In our current economy, we cannot afford not to provide guaranteed, affordable health care coverage with a choice of private or public plans that covers all medically necessary services."

At this point in time, it appears that all of the bills that have emerged from committees in the House and the Senate meet, to some extent, these stated goals. 

This is what the four healthcare reform Senate bills and the three bills that have emerged from House committees have in common:  Insurance market reforms, including  prohibition of pre-existing condition clauses and discrimination based on health status, annual and lifetime caps; and requirements for guaranteed issue.

Even the bill that emerged last week from the Senate Finance Committee after Committee Chair, Max Baucus spent weeks attempting to craft a bipartisan bill that would satisfy the Republican members of the so-called Gang of Six, and hopefully, by extension, appeal to other Republican and Blue Dog Democratic Senators, meets many of these stated goals, although even without requiring a public option (so loathed by those on the right, especially the insurance companies)  , not one Republican committee member has signed onto the bill, and within a week of its introduction, there were already more than 500 proposed amendments up for discussion.

Within a day of the bill's introduction, Senator Charles Schumer (D-NY)  sponsored the Community First Choice Option in Medicaid amendment to the Senate Finance Committee's health care reform bill. and disability rights advocates were celebrating inclusion of the amendment.  Of all the Senate bills under consideration, this one is the most modest in terms of changing the healthcare patchwork that characterizes our current system, and rocks the insurance company dominated status quo the least.  Was introduction of the amendment a calculated way to rally a whole group of otherwise apathetic constituents to the cause, or did Senator  Schumer  simply take advantage of an opportunity to get something that has needed to be done accomplished?  I guess what you ultimately believe about Schumer 's introduction of the amendment which would give the states an option to provide a wide range of community-based services to people who would otherwise qualify for only the institutional level of care, depends on your level of cynicism about the process and the various priorities of all the various players.  Or maybe the Senators' motivations simply don't matter to you if Medicaid's institutional bias can cease to exist and money follows the person can finally make it into some kind of legislative mandate.  If you are one of the more than 300,000 people with severe disabilities who are currently desperate to escape from segregated nursing-home care situations, you probably don't care how or why community choice funding that might get you out of your predicament happens, just that it does.

So, as debate is scheduled to begin in the Senate, here is where we stand.  I count a total of seven healthcare reform bills, three in the House and four in the Senate, that are waiting for an opportunity to become the law that will finally change our fragmented health care system and provide decent, affordable medical coverage for all Americans.  Six of the seven include a public option for people who cannot get coverage from their employers or who do not want to have to rely on existing health insurance companies for health care, and all of them require the insurance companies to change the way they've been doing business.  The fight has already been long and ferocious, and we can expect the situation to heat up dramatically as the health insurance industry increases the pressure on legislators to hang onto as much of the status quo as possible.  Now is the moment for us to become hyper-vigilant because we're closer than we've ever been to meaningful reform and we can't let it slip away from us as the amendments are debated and the votes are cast. We can expect the name calling and the hyperbole and the scare tactics to escalate as reform opponents pull out all the stops to forestall change.  As a person with a disability, a mother and a grandmother, an an American, I urge the Senators who have worked so long and so hard to achieve meaningful healthcare reform to stand strong on behalf of all of us who know how important universal, affordable healthcare is. Every day 14,000 more Americans lose their health coverage.  We spend more than any other industrialized country on earth supporting the inequitable patchwork of health insurance provision that currently passes for healthcare in the USA, but our system leaves too many people out, it is too expensive in too many ways, it is not sustainable, and it is not compatible with our democratic ideals or with our own image of ourselves as a nation and a people.  As I turn to CSPAN to follow the debate and I check my e-mail in box to keep up with the action alerts, that will inevitably arrive with each e-mail download, I am cautiously optimistic and also determined not to allow this opportunity for real, meaningful change to slip away.