The official sponsor of the House healthcare reform bill was Michigan Congressman John Dingell. Historians of the epic struggle to provide basic medical care to all Americans will recognize that Dingell, the longest-serving member of the House, is the son of the Congressman who proposed legislation to establish a national medical care and hospitalization fund during FDR's third term. That pioneering proposal did not pass in the 1943 Congressional session, nor did ensuing versions proposed by Dingell Sr. and then his son over the next sixty-six years.
This historical context is vital because it reminds those who have advocated for healthcare reform for the better part of a century that something remarkable happened on November 7 when the House voted 220-215 for legislation that the Congressional Budget Office says will extend insurance coverage to 36 million uncovered Americans. Wisconsin Representative Tammy Baldwin, a key Democrat on the House Energy and Commerce Committee, which drafted much of the legislation, captured the excitement of veteran reformers when she said, "I truly believe that we'll look back years from now and view the passage of this act to be as significant as the passage of the Social Security Act in 1935 and the Medicare and Medicaid Act in 1965." Baldwin's enthusiasm is appealing, but it will take more than enthusiasm to make the bill into a program equal in character and value to Social Security and Medicare.
Unlike the Medicare-for-all plan championed by this magazine, the House bill does not provide universal coverage. It does too little to control rapidly inflating insurance costs and does almost nothing to rein in the price of prescription drugs. By mandating that the uninsured purchase coverage, it provides a boon to insurance companies. The subsidies it gives to low-income families are not as robust as they should be, and the public option it offers as an alternative to private insurers lacks the necessary muscle to compete and bars undocumented immigrants from participating. Perhaps most offensive, the bill includes an amendment, written by Michigan Congressman Bart Stupak, that bans access to reproductive health services in public and private insurance plans funded under the act--a last-minute compromise designed to win the votes of antichoice Democrats (see Katha Pollitt's column on page 9).
These are serious flaws. But the legislation is also a historic advance in the long battle to create a more rational and humane healthcare system. In addition to expanding coverage to two-thirds of those uninsured, it prohibits companies from denying coverage to those with "pre-existing conditions," bans them from dropping people when they get sick and forces insurers to cover a range of essential benefits and services. These are undeniably progressive measures, and over time they can be improved upon.
We respect those advocates of single-payer like Congressman Dennis Kucinich, who voted against the plan, and California Nurses Association executive director Rose Ann DeMoro, who has called the bill a "massive bailout for the private insurance industry." But the reality is that there may never be a better moment to get the United States on the right track. And so, as the bill moves to the more treacherous terrain of the Senate, we believe that the task of progressives is to fight to preserve the House bill's best elements while ridding it of as many defects as possible and laying the groundwork for an expansion of its programs.
In that regard Senate Democrats, led by California's Barbara Boxer, may have the necessary votes to remove the Stupak amendment. It is vital that they do so and that the White House support their efforts. Other efforts, led by Vermont independent Bernie Sanders--to establish better protections for consumers and patients and to control insurance-industry profiteering--could improve the final bill. But the defenders of a for-profit healthcare system in the Senate, including not just all Republican members but also Joe Lieberman, are formidable obstacles. They intend to remove the public option, perhaps replacing it with an opt-out mechanism, state insurance coops and nonprofits, or a public-option trigger. These are all inferior plans and, for progressives interested in moving toward something like Medicare for all, paltry building blocks to work with. Proposals to prevent undocumented immigrants even from purchasing insurance with their own money are also on the table--and promise to become a public health nightmare should they go through. There is a very real danger that the final version of the reform bill will include sops to antichoice and anti-immigrant forces and yet still lack adequate limits on the insurance industry it generously subsidizes. But for the moment, in the House bill there is certainly something to work with, and something to fight for.