Sunday night was emotional for those of us who have watched the healthcare debate unfold in the United States. After over a year of vacillation during which the deliberative process almost fell into obscurity -- pushed to the brink of failure by warnings of statism and "death panels" -- a piece of legislation, approved by the Senate, emerged victorious by a vote of 219 to 212 in the House of Representatives. You could almost sense Barack and Michelle's fist bump.
The legislation will cost approximately $940 billion over 10 years, but will allegedly reduce the federal deficit by $143 billion. Its major pillars include: expanding healthcare coverage to 32 million currently uninsured Americans, closing the prescription drug coverage gap under Medicare (those over 65 that are affected will receive rebates and discounts on brand name drugs) and expanding Medicaid to include families with members under 65 with a gross income of up to 133 per cent of the federal poverty level. Insurance companies will no longer be able to deny coverage to those with pre-existing conditions and will be subject to other minimally invasive regulations. Parents will now be able to cover dependent children up to the age of 26, and uninsured and self-employed individuals will be able to purchase insurance through state-based exchanges (low-income individuals and families wishing to purchase their own health insurance may be eligible for subsidies). One of the most interesting, and controversial, aspects of the legislation is that any individual not covered by Medicaid or Medicare must be insured, or face a fine.
Nancy Pelosi, the Speaker of the House of Representatives, touted the reforms as being as groundbreaking as Social Security or Medicare, and President Obama called them "a victory for the American people" -- impressive claims from a Democratic Party and Presidential Office that have not had much cause for celebration. However, as the euphoria of definitive progress faded, a disappointed and concerned undertone emerged; this was not healthcare reform, this was health insurance reform and that concession could prove disastrous.
Most of the health insurance coverage mandated by this legislation does not come into effect until 2014, by which time, according to Harvard Medical School researchers, 180,000 Americans will die because they will be unable to afford health insurance to cover diagnosis or treatment. In addition, the bill will still afford many opportunities for insurance companies to further their strategy of maximizing profits by denying claims, restricting the benefits of current and new customers -- who are mandated to buy their policies or face fines -- all backed by billions of dollars of federal subsidies. Instead of protecting patients, this legislation will further entrench insurance companies, and their overarching profit motive, into the American healthcare system.
Obama began his quest for sweeping healthcare reform by advocating a single-payer system that provided universal coverage for all Americans. The legislation that has emerged at the end of this journey -- Obama's supposed victory -- is a ghost of its original intentions, and a scary one at that. It is bereft of any public option, any safeguard for states desiring a single-payer approach, any adequate antitrust protections, any authority for bargaining with drug companies and any regulation of insurance prices. It is a watered-down policy whose potentially progressive ideas are undermined by Congress' inability to wrest healthcare out of the hands of the private sector. It may be appropriate for Obama and Pelosi to cheer for the first step forward -- undeniably a difficult one -- but until a clear path is being walked towards an actual universal healthcare system, I'll be keeping my celebrations in check.