BIDEN'S HEALTH PLAN SHIFTS EVEN MORE PUBLIC DOLLARS INTO PRIVATE HANDS
By Margaret Flowers, Truthout.
February 20, 2021 | EDUCATE!
Above photo: Billionaires for Wealthcare. YouTube.
As the American Rescue Plan (ARP) winds its way through Congress, some
progressives are hailing its health provisions as the greatest expansion of
the Affordable Care Act (ACA) in 10 years, while conservatives are claiming
that it is a slippery slope to a national Medicare for All system. Democrats
have decided to forego seeking Republican support for President Biden's $1.9
trillion promise of relief to those suffering from the COVID-19 pandemic and
recession by using the budget reconciliation process. This has Republicans
worried the legislation will be used to advance the progressive agenda to
expand government health care programs.
However, at the end of the day, while the bill may be used to strengthen
some provisions in the ACA, it will not move the United States's health care
system any closer to the popular national improved Medicare for All system
that we need. It is more likely to enrich private health insurers and delay
broader health care reform.
To understand why, it is important to note that the ACA, passed in 2010, was
crafted to prevent national improved Medicare for All, not to create a path
toward it. Following the financial crash of 2008, nearly 50 million people
in the United States did not have health insurance, primarily because the
premiums were unaffordable. Something had to be done, and public support for
a single-payer health care system, which would replace private health
insurance with a universal Medicare-like system, was growing.
The medical-industrial complex - consisting of the private health insurance,
pharmaceutical, hospital, and other related corporations - viewed
single-payer as a threat to the industry's bottom line and worked overtime
to stop it. Health industry corporations and trade groups donated heavily to
campaigns for federal office in 2008 and invested billions in lobbyists to
shape the ACA in their favor. The Center for Public Integrity reports that a
total of $3.47 billion was spent to double the number of health care
lobbyists in Washington, D.C., in 2009. There were eight lobbyists per
member of Congress. Millions were also spent on public relations campaigns
to portray Medicare for All negatively and to convince people that what they
really wanted was a choice of health insurance.
Progressive organizations also played a role in preventing national Medicare
for All. Tens of millions of dollars were donated to establish a front group
called Healthcare for America Now (HCAN), which was intentionally given a
name similar to the national grassroots Medicare for All group, Healthcare
Now. HCAN convinced advocates for universal health care that a single-payer
system was not achievable, and that a more practical demand would be a
public health insurance plan called a "public option." It worked, and
progressives became the loudest defenders of a bill that former Cigna
executive Wendell Potter renamed the "Private Insurance Profit Protection
and Enhancement Act" - even though it didn't include a public option.
The ACA Made For-Profit Health Care More Powerful
While more people in the United States gained health insurance because of
the ACA, the biggest winners were private health insurance, pharmaceutical
companies and large hospital corporations. Private health insurers insisted
throughout the reform process that people be mandated to purchase their
plans, which is what the ACA did. The only way for the government to achieve
that was to provide subsidies to cover health insurance premiums and
out-of-pocket costs. For this, private insurers receive hundreds of billions
of public dollars each year.
Despite this high spending, the private health insurance expansion only
covered about one-third of the newly insured, around 7 million people. The
vast majority of those who gained coverage did so through the Medicaid
expansion, but even this enriched private insurance corporations. Since the
passage of the ACA, the proportion of people in public health insurances,
both Medicaid and Medicare, that are run by private health insurers has
soared so that the major health insurers now receive most of their revenue
from the government.
Pharmaceutical corporations also benefited. The increased number of people
with health insurance expanded their market. At the same time, no controls
were implemented to limit the prices of drugs. The rise in pharmaceutical
profits as a result of the ACA far outstripped those of the health insurance
and hospital industries.
And the ACA unleashed a wave of mergers and acquisitions throughout the
medical-industrial complex. Hospitals consolidated into large chains and
bought up physician practices and health facilities. These mergers were an
intended outcome of the ACA under the belief that consolidation would lead
to greater efficiency and lower prices. Instead, the mergers drove up health
care costs as these institutions now wield greater bargaining power. The ACA
ultimately made the for-profit parts of the U.S. health care system more
powerful, and these are the industries we must take on to solve the health
care crisis.
Time To Stop Throwing Money At A Failed System
Prior to the pandemic, the number of people in the United States without
health insurance was about 30 million. That number has been rising steadily
since 2017, especially for people aged 18 to 64. Millions more people lost
their health insurance in 2020 due to the recession and pandemic, either
because they lost their jobs or because they could no longer afford the
health insurance premiums. The current number of people who are uninsured is
unknown, but a recent poll found that nearly 30 percent of people in the
United States lost their health insurance in 2020 and less than half of them
regained it.
Health care is a top issue again, as it was in 2008, and support for
national improved Medicare for All has grown as more people are witnessing
the profound flaws of a health care system that prioritizes profits over
health. So, what can we expect from the ARP?
When it comes to health care, we can expect more of the same. The Biden
proposal, if Congress adopts it, would increase tax credits for purchasing
private health insurance, expand the subsidies for out-of-pocket costs to
people with higher incomes, subsidize the cost of COBRA (a program that
allows people to maintain their employer insurance when they lose their
job), provide more money to the health insurance exchanges, and provide
incentives for states to expand Medicaid. This is throwing more money at a
failed system that changes nothing fundamentally.
The Biden plan matches the requests of the medical-industrial complex. In
this press release, a coalition of private health insurers and their lobby
group, hospital corporations, physician organizations and the Chamber of
Commerce laid out their priorities. Each of their priorities would funnel
more public dollars to them either directly or indirectly while the impact
on people's ability to receive health care will fall far short of what is
needed.
Once again, the private industries are being bailed out and the people are
being sold out. Even though Biden campaigned on a public option, it is not
in the plan. The Commonwealth Fund finds that the ARP leaves out people who
live in states where they don't qualify for Medicaid and don't earn enough
to purchase health insurance through the exchanges. A cynic might believe
the Biden administration is less concerned about that population since the
states that rejected the Medicaid expansion are majority-Republican states.
Most people who purchase private health insurance plans on the health
insurance exchange will continue to face significant barriers to receiving
health care. The plans have restricted networks that limit where people can
go for care and have out-of-pocket costs of thousands of dollars before
coverage begins. Subsidizing the cost of premiums doesn't change the fact
that many people don't have the cash on hand to cover the copay or
deductible required before they can get care.
None of these changes move the health care system closer to a national
improved Medicare for All, and in fact, the ARP may make it more challenging
to achieve it. The most obvious reason is that the ARP shifts even more
public dollars into private hands. Another concern is that the ARP may
result in cuts to Medicare. Politico reports that the "pay-as-you-go" rules
required under the budget reconciliation process will result in reductions
in spending in other programs. Restoring that funding requires passing
legislation dependent on Republican support, which is not guaranteed to
happen.
Medicare has been under attack over the past few decades, which is why
advocates for single-payer health care promote improving it to expand
benefits, get rid of out-of-pocket costs and do away with the need for
supplemental insurance. Further deterioration of Medicare will make it less
popular and provide ammunition for opponents to scare people away from
Medicare for All.
Finally, the measures taken to shore up the ACA will be used as
justification for not implementing broader changes to the health care
system. The ARP will be hailed as the "greatest expansion of health care
since the passage of the ACA." The public will be told that the priority
will be to make the ACA work, not replace the whole system with Medicare for
All. This is what happened in 2010. And, as Robert Blendon states in
Politico, emphasis will be put on what the ARP does to address the crisis of
the pandemic through expansions of testing and vaccination, which will push
the persisting overall health care crisis out of the discussion.
We cannot solve the health care crisis by tweaking the current complicated
for-profit health care system. Throwing more money at it will cover more
people, but it won't cover everyone, and it won't guarantee that people will
get the health care they need even with insurance. Health care is a public
good, not a commodity. It can't be treated as both at the same time. They
contradict each other.
While single-payer advocates are often told that we need to achieve Medicare
for All through incremental steps, the reality is the smallest measure that
can be taken to create a health care system that treats health as a public
good is a national improved Medicare for All - a system that is universal,
comprehensive in benefits, publicly financed and administered, and that
removes profits. This will generate the savings in health care spending
needed to cover everyone and build out the health care infrastructure so
that everyone everywhere in the country has what they need to live a healthy
life.
President Biden has already declared his opposition to Medicare for All. As
it has been for every great achievement for social change in the United
States, we must build a movement that moves Medicare for All from being
impossible to being inevitable.
