Health care reform: A giant step or a pyrrhic victory?

By Max J. Castro

It looks increasingly certain that in a few weeks the President and the Democratic Congress will be able to enact a health care reform bill and declare victory. But what will be left of reform once all the vested interests — the insurance companies especially — have excised many of the progressive provisions in the new law?

The power that these interests wield is most clear in what was not considered in the health care reform debate. The simplest, most equitable, and most cost effective reform plan, a single payer system (call it Medicare for all) was not even on the table.

That means that progressives had to give away half the store just to get the conversation going. Barring single payer, the most progressive alternative became “the public option,” a government-run insurance entity that would compete with the private insurance companies.

The public option would not be state-subsidized but it still raised the specter of serious competition with the private sector. For the insurance companies who hated the public option, and their many friends in Congress (including all Republicans and a substantial minority of Democrats), the public option became Moby Dick. It had to be killed.

The amount of money spent on lobbyists and media to slay the public option can only be characterized as obscene. Still, the public option survived in the House of Representatives. But the Senate caved in and removed it, substituting instead a program that would allow individuals 55-64 years of age to “buy into” Medicare. It also would create two national private insurance policies to be overseen by the U.S. Office of Personnel Management, the agency that administers health insurance for federal workers.

Now the next step is more debate and a vote in the Senate. Assuming the legislation is approved in the upper chamber, a conference between House and Senate representatives will attempt to bridge the differences in the bills, which are substantial. Inevitably, the more progressive House version will be cut down to satisfy a dozen or so Senators, including a handful of Blue Dog (conservative) Democrats, turncoat Independent Senator Joseph Lieberman, and two moderate Republicans from Maine.

For all its flaws and concessions, it is important that the Democrats pass the health care reform legislation because it will represent a needed victory for the party and for Obama, whose approval ratings have been decreasing steadily. But the present legislation must be seen as the first step in a long fight to transform American health care from a commodity to a human right. While the health care bill that is finally approved might help curtail the cost of insurance and help millions of uninsured Americans get coverage for the first time, it will not replace our current model of mercenary medicine with one based on human needs.

Even a tainted victory on health care will give Obama momentum for what he must concentrate on in 2010: jobs and the economy. The health care reform law will become part of Obama’s historical legacy. But what is at the forefront of American voters today, as we head into the midterm elections, is the crisis of unemployment. Today, every poll shows that the American people care most about employment and the economy. Obama must do much more in this area or he will be a one-term president.

Beyond the immediate battles, progressives must look for ways to elect more true Democrats and fewer Blue Dog conservatives. The health care debate has shown conservative Democrats represent a small but potent fifth column within the party, one willing and able to eviscerate even landmark legislation like health care reform.

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