A big debate is raging on the progressive blogosphere on health care. Do we have the votes to pass the Senate bill as-is in the House? Does the Senate have the votes to pass through reconciliation the things that most activists pushing for reconciliation want? What will the political consequences be if the Democrats pass nothing? What will those be if only the Senate bill passes? Hell, can a progressive vote for the Senate bill as is and not be assailed as a sellout?

That's a fine debate to have. It's great to say that because the Senate bill expands the private system of coverage without giving people the option to choose a public, government-run plan, it is so outside of one's principle that one is willing to take a principled defeat rather than compromised victory. But for 47 million Americans without health insurance coverage, millions of Americans who are losing their homes and filing bankruptcy because of medical costs despite having health insurance, seniors in the Medicare donut hole who are cutting their pills in half or choosing between a meal and prescription medication, the working poor who do not have a Community Health Center close by or a free clinic close by, the status quo is deadly.

For Nataline Sarkisyan, the status quo was deadly. So damn popularity, and damn politics. Damn the bloviating. Damn the political warnings. Let's look at people. Let's look at the enormous human tragedy of the status quo that is our current health care system and let's look at what the Senate bill does to at least treat this societal ailment that is crippling America. Let's look at why, at the minimum, we must at least pass the Senate bill.


Status Quo: By 2019, 57 million Americans will be uninsured if we do nothing. Right now, one out of every thousand Americans without health insurance dies every year due to the lack of health insurance. If that statistic holds, and there is no reason to believe it will not if we change nothing, by 2019, 57,000 non-elderly Americans will be dying every year because they do not have health insurance. The situation is made worse by the fact that those who lack insurance find it a daunting task - and mostly impossible - to find affordable care.

Senate Bill: The Senate-passed bill fails to eliminate that number, but it sure as hell cuts it down. In 2019, it will reduce the number uninsured to 23 million - still a shame, but better than 57 million uninsured, don't you think? Even more will have access. Community Health Centers are not just a great investment in the health of our people, but an incredible leverage to find additional funding for delivering access to care. In fact, the government tells us that only 20% of the total funding for Community Health Centers are federal funds. That means for every dollar invested in Community Health Centers by the federal taxpayers, we get $5 worth of medical access and service. Community Health Centers currently serve 20 million people every year. That is less than one-half of the number uninsured. Sen. Bernie Sanders says that the House's $14 billion CHC funding will expand that access to 45 million. The Senate bill's funding for CHC's is $10 billion. Doing the math, the Senate bill bill will expand access to 38 million Americans through Community Health Centers. Watch what happens when you combine these numbers. For the first time in history, Community Health Centers will have the capacity to serve a total number of people greater than the total number of uninsured once the Senate bill kicks into gear (23 million uninsured, enough capacity to serve 38 million people in Community Health Centers). I repeat: this is unprecedented in American history.

Status Quo: Insurance denials if you have a pre-existing condition (including, mind you, acne), denial of coverage when you get sick, jacking up your insurance premiums when you get sick, and no limit to how much your insurance company can make you pay send-of-pocket. If you cannot afford coverage, no one will help you obtain it. No restrictions on how much what they make in premiums insurance companies must spend on providing care. Your coverage might not include mental health parity or substance abuse care

Senate Bill: Comprehensive coverage, including mental health and substance abuse care. No more denials based on pre-existing conditions once the exchanges start in 2014, and no denials based on pre-existing conditions for children beginning immediately. No more rescission when you get sick, no more jacking up your premiums when you get sick. Premium assistance through the exchange for those who have trouble affording coverage, up to 400% of Federal Poverty Level (and no requirement to get coverage if your portion of the premium costs more than 8% of income). Sure, the assistance could be more generous. But are we really going to throw away whatever assistance is provided?  Out-of-pocket expenses are limited on a sliding scale (as are premium caps) for people up to 400% of poverty, and above that, to $5,950 for individual plans and $11,900 for family plans.  And remember that's the individual market only; in the small group market, deductibles over $2,000 for an individual plan and over $4,000 for a family plan are prohibited.  No out-of-pocket expense for regular checkups and preventive care. In the group market, insurance companies must spend 85% of your premiums on care, or cut you a check at the end of the year. A patient's bill of rights on steroids, according to President Obama.

Status Quo: Medicare donut hole is making seniors choose between food and medication, between cutting a pill in half and paying their heating bill. Letting insurance companies rip off Medicare recipients by making them pay extra copays and ripping off taxpayers by charging 14% extra in "Medicare Advantage" (talk about Orwellian framing) to the government.

Senate Bill: Advantage subsidies for big insurance cut by $118 billion. Over time, the Medicare "doughnut hole" is closed completely. This won't just save our health care system money and provide more efficient care. It will stop millions of seniors from having to make those heart-wrenching choices between medication and food, or prescription drugs and fixing the roof.


I will cover costs in greater detail in the next few days, but here is a summary rundown of what happens to cost in the status quo vs. the Senate bill.

Status Quo: Well, let me draw you a picture:

healthcare cost explosion by 2019

By 2019, we will be spending nearly 20% of our GDP on health care if we do nothing. By 2014 alone, Medicare and Medicaid spending will be at nearly a trillion dollars. That's a Trillion with a T. And that's for that one year alone.

Senate Bill: Kick out the Medicare Advantage subsidies, find efficiencies and cost savings in Medicare, streamline, and save $483 billion in Medicare over 10 years. Cost of uncompensated care will decrease dramatically as coverage increases and as Community Health Centers expand. The Community Health Centers play a rather significant role in reducing the cost of uncompensated care. As Sen. Sanders puts it,
the emergency room will treat you for the common cold and charge $600 to $1,000, and the community health center will cost $100. If we spend on community health centers, you actually save money.
The CBO estimates that the Senate bill will shave $132 billion off the top of the budget deficit over the next decade, and by over $1 Trillion over the following decade. Cost containment measures within the health care system itself also includes the 85% Medical Loss Ratio (MLR) requirement, the excise tax on high-cost plans (but not necessarily more effective plans), streamlining medical billing and electronic medical records, etc. A diverse coalition of groups ranging from the SEIU to the American Medical Association to PhRMA have pledged, in writing, to produce a $2 Trillion saving in the system, but also said that that would only be possible under restructuring of the system and improving health of the population under comprehensive reform. Realizing even half of that would be a small miracle. None of those health improvements or systematic streamlining can take place quickly if we pass nothing. The Senate bill does put investments and incentives in place for all of these things, even if you think (as I do) that it doesn't go far enough in squeezing health insurance companies.

Folks, the status quo is deadly. And we must break it by passing the Senate bill as is in the House, and following it up with a reconciliation bill to improve it even more (but we have to be careful about what can be expected in such a reconciliation vehicle).

So, ultimately, that's the context in which we are talking about health reform. We're talking about a choice between the deadly status quo and the Senate bill which goes a long way towards treating our health care ailments. That's what I'm talking about when I ask if one can, in good liberal conscience, kill the bill. That's why I was so encouraged when news came this morning that President Obama has scheduled a half-day televised meeting with Democratic and Republican Congressional leaders on health care for February 25 (mark your calenders, people!). Indeed, it seems Obama is ready to accelerate health care reform following that meeting. And that's why you need to call Congress at (202) 224-3121 and ask for your member of Congress, and demand that they pass the Senate bill and follow it up with a reconciliation fix.

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Senate bill out-of-pocket and premium caps

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