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The Congress has finally passed and President Obama has signed a health reform bill. What shall we make of it? If we can somehow get beyond the screaming and exaggerations, we find that while the bill does include some positive changes, it is far from producing the health care system we need.
Most importantly it leaves in place, or in fact actually strengthens, the central role of private insurance in financing health care in the U.S., which means determining the nature and distribution of health care services in the country.
Here are some of the most problematic parts of the bill as described by the group Healthcare-NOW! (which supports a Medicare for All system):
* About 23 million people will remain uninsured nine years out resulting in an estimated 23,000 unnecessary deaths annually. One-third of these will be undocumented immigrants who will be excluded from purchasing private insurance.
* Millions of people who are not eligible for public health insurance programs Medicaid and Medicare will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.
* Those remaining uninsured will be fined up to 2.5% of their income.
* Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.
* The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.
* People with employer-based coverage will be locked into their plan’s limited network of providers, face ever-rising costs and erosion of their health benefits. As the cost of insurance grows, they will be taxed on their benefits.
* Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates. The industry lobbying group, American Health Insurance Plans, came just short of announcing the industry’s next rate increase in its brief statement in response to the bill: “The access expansions are a significant step forward, but this legislation will exacerbate the health care costs crisis facing many working families and small businesses.”
* The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.
* It allows insurers to expand so-called wellness programs that let insurers penalize subscribers by hundreds—and even thousands—of dollars for not meeting certain ‘wellness targets,’ such as a particular cholesterol number, blood sugar measurement or body-weight target.
* Women’s reproductive rights will be further eroded, due to segregation of insurance funds for abortion from all other medical services.
To learn more about the positive features and severe limitations of the bill I recommend the following two (short) articles:
Diary of a wimpy health care bill
What’s in the health insurance bill, what’s not
Reports from the Economic Front 
