For those of you who don't know who Paul Starr is, here's a thumbnail biography:
He is a professor of sociology and public affairs at Princeton University.
He and Robert Kuttner are the co-editors and co-founders(with Robert Reich) of The American Prospect.
In 1984, Paul Starr won a Pulitzer Prize and Bancroft Prize for his book The Social Transformation of American Medicine
In 1993,he was the senior advisor for President Bill Clinton's proposed health care reform plan.
Basically, nobody knows the ins and outs of healthcare policy and the politics of healthcare policy better than Prof. Starr, whose biography and associations should, give him a lot of credibility with the progressive community.
Here's what Prof. Starr has to say recently about the Senate Healthcare Reform Bill:
If Congress can complete work on health-care legislation and send it to the president (as of mid-January, the final bill is still under negotiation), it will be a stunning historical achievement and the most important liberal reform since the 1960s. It may also be the most underappreciated social legislation in recent history. Never in my experience has such a big reform been treated as so small. Never have Democratic members of Congress who are putting their careers on the line for something they believe in been so vilified as sellouts by influential progressives. And never have those progressives been so grudging in their endorsement of landmark legislation or so willing to see it defeated.
How this happened is clear. Facing united Republican opposition, Democratic leaders made a series of concessions to win over centrists in their own caucus and to neutralize key interest groups. One point of contention -- the public option -- came to symbolize hopes on the left, and when that provision was unable to pass the 60-vote hurdle in the Senate, some progressives such as Howard Dean concluded that the entire bill had been gutted.
But that conclusion is wrong. The legislation would be a major advance in two important respects. After a long period of rising inequality, it would boost the living standards of low-wage workers and their families and improve economic security for the middle class as well. And it would be the most ambitious effort in recent history to reorganize a major institution on a basis that agrees more closely with principles of justice and efficiency.
Please read the entire article and if you still don't think the Senate bill as is represents major beneficial change, snap out of it!
Paul Starr's not a lone voice in the wilderness on this either. Here is what Dr. Atul Gawande has to say:
For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage. Those gaps have widened to become graves—resulting in an estimated forty-five thousand premature deaths each year—and have forced more than a million people into bankruptcy. The emerging health-reform package has a master plan for this problem. By establishing insurance exchanges, mandates, and tax credits, it would guarantee that at least ninety-four per cent of Americans had decent medical coverage. This is historic, and it is necessary.
In deference to my friends at firedoglake, I'll leave out what Jonathan Gruber of MIT has to say about the bill.
Ezra Klein and Jonathan Cohn are the two liberal bloggers/journalists I've trusted the most to provide even-handed and extremely well-informed reportage and analysis of healthcare reform over the past several years. Here's what they had to say about the Senate bill right after it passed:
The U.S. Senate has voted to pass the most ambitious piece of domestic legislation in a generation--a bill that will extend insurance coverage to tens of million Americans, strengthen insurance for many more, and start refashioning American medicine so that it is more efficient.
It is, without doubt or competition, the single largest social policy advance since the Great Society.
Paul Krugman isn't necessarily a healthcare expert, but, as a Nobel Prize winning economist, he's certainly better equipped than average to determine the validity of claims about the effectiveness of the Senate bill and nobody ever accused him of carrying water for the Senate or White House. This was his admonition to liberals regarding the Senate bill:
[L]et's all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.
Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.
The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.
Here's a handy chart prepared by Jonathan Gruber (sorry FDL, I guess I couldn't leave Prof. Gruber out completely)and Jonathan Cohn regarding what the bill is expected to do for average working to middle class people:
You can see from the chart that many of the families who need help the most will save a lot of money under the Senate plan. You might say that health insurance is still too expensive for families and I would agree with you, especially if this chart told the whole story, but it doesn't.
The whole story is even better for the uninsured than the chart would lead you to believe. It starts with the fact that the insurance you buy under the Senate bill is much better than the insurance you can buy on the open market now and the insurance exchanges will provide a better mechanism for purchasing the insurance.
Prof. Starr again:
Here is our current reality: In most states, insurers can deny coverage to people they deem too great a risk, exclude pre-existing conditions for others, and charge however much they want based on health, age, or other characteristics. Routinely, subscribers whose health deteriorates have their coverage cancelled. Under existing law, insurers have an incentive to design every aspect of their business so as to avoid individuals with high health costs. People who obtain coverage individually or through small employers get an especially bad deal because they lack the purchasing leverage of large employee groups.
And here is how the legislation would change that reality: It would expand coverage, first, by extending eligibility for Medicaid to people with incomes under or near the federal poverty line and, second, by subsidizing private insurance for people earning up to four times the poverty level. More than 30 million people would gain coverage as a result (the more generous the subsidies, the higher that number). The basic rules of the insurance market would change. Insurers could no longer exclude pre-existing conditions or charge according to an individual's health; they would be required to issue a policy and renew it for any legal applicant; and while they could vary premiums by age, they could do so only within limits, unlike current practice.
The law's central organizational innovation would be to create insurance exchanges offering multiple insurance plans, initially for those in the individual and small-group market, to give them the buying leverage and benefits of choice enjoyed by workers at larger firms. (An earlier name for the exchanges, "health insurance purchasing cooperatives," better conveys their function as a group purchaser.) The exchanges would play a critical role in restructuring and policing the market. To discourage insurers from cherry-picking the healthy, the law would require them to pay into a risk-adjustment fund if they enrolled a healthy, low-cost population; conversely, the fund would compensate insurers if they signed up a more costly group of subscribers.
Now, a lot of progressives have objected to the Senate bill as a giveaway to the insurance companies based on: 1. the presence of an individual mandate; and 2. the absence of a public option.
Professor Starr's got an answer for that too:
But, critics ask, isn't the entire program a gift to the insurance industry because of the mandate -- the requirement that individuals purchase coverage? The mandate or its equivalent would be necessary in a reformed system regardless of whether health insurance were public or private. If there were no mandate, but people could, whenever they wanted, get coverage with no pre-existing-condition exclusions, the rational choice for the healthy would be not to buy insurance until they got sick. But because insurance works only if the healthy as well as the sick pay for it, the system would break down. It would be like saying people needed to pay for the protection of the local fire department or for fire insurance only when a fire broke out in their home. As a practical matter, without a mandate, health-insurance premiums would have to be significantly higher -- and government subsidies would rise along with them, making the program more costly.
The insurers, I am confident, would be happy to keep the present system, which has been highly profitable for them. From their standpoint, reform presents both economic and political risks. Although the mandate would bring them new customers, many of those customers are people whom no insurer has been willing to cover in the past because of their poor health. Moreover, if the federal government is on the hook for subsidies for private insurance, it will develop a direct interest in keeping down insurance rates. Under the reform plan proposed by Bill Clinton in 1993, the government would have imposed a cap on increases in the average premium in the insurance exchanges. The current legislation does not include such a budget cap, but the insurers must be concerned that it could be enacted after the exchanges are established.
As the debate began in 2009, the public option took the place of the budget cap as a way to limit the industry's control over premiums. In its original "robust" form, the public option would have paid doctors and hospitals at Medicare rates, which are now 20 percent to 30 percent below what private insurers pay. If such a plan had been offered to everyone below age 65, it would have had a significant price advantage over private insurers, who predictably opposed it for fear of being driven out of business. But a Medicare-like plan would have also reduced the revenue of hospitals and other providers so sharply as to plunge them into a crisis, so they opposed it too. There was never any chance that Congress would approve that version of the public option, even within the exchanges. After all, the proposal threatened to reduce providers' revenues below their existing levels, which not even the Clinton plan's budget cap would have done.
By the time the public option died, however, the version under discussion was no longer much of a threat to insurers or providers, who would have been paid negotiated rates, just as they are under private plans. And because the public plan would likely have attracted more of the chronically ill (and the risk-adjustment system would not have corrected 100 percent for their costs), the Congressional Budget Office estimated that the public option would have had higher premiums than those of private insurers and would have enrolled only about 2 percent of the population.
Still, the public option might have provided some protection against exorbitant premiums in states where there is little competition among insurers. And it polled well in public-opinion surveys, though if things had worked out as the CBO projected, the public option would have been a big letdown -- and a conservative talking point against future government action.
Last year I suggested that the public option would likely serve as a sacrificial lamb in the effort to pass a bill, and that is what happened. Democrats sacrificed it to propitiate the lords of the Senate -- Ben Nelson and Joe Lieberman. But that may not be the end of the story. If costs prove to be higher than projected, the public option will have been spared any of the responsibility and may, like the budget cap, yet have its day. The current legislation includes a variety of provisions to control costs, but it has no hammer to ensure that they are controlled, and we may ultimately need one.
A claim that I've seen made over and over again is that the Senate bill forces you to buy insurance from a private insurance company. It does not. What it does is force you to buy insurance or pay a $750 annual penalty starting in 2014.
To get a little bit personal, this portion of the bill interests me very much. I currently do not have health insurance. I am an unmarried, childless, self-employed professional with a modest income that is probably too high for any subsidies.
I think that you would agree, based upon the foregoing information that I have more than a sporting or purely altruistic interest in what the Senate bill does for and requires from the uninsured. And I am convinced that this is a great deal for me!
Why? Because, as Ezra Klein once pointed out on his blog: the option of going without insurance and paying a $750 annual penalty is probably the best deal in the bill.
[I]t's simply not true ... that the people paying the $750 individual mandate penalty get nothing in return. Far from it, in fact. For one thing, they get access to emergency care, as happens now. For another, they get the chance to come back into the system when they actually need insurance. Someone who puts off purchasing coverage and then tries to buy Aetna's plan the first time they collapse unexpectedly will not be sold a plan. Having chosen not to buy insurance when they didn't need care, they can't buy it now that they do need care. They become the priced out or, in some cases, locked out.
Under reform, these people get the chance to come back into the system when they need coverage. They can't be discriminated against. Indeed, you can argue that these folks, the ones willing to game the system, are the most advantaged of all the groups. It's why the individual mandate should be stronger, not weaker, than it is now. This isn't the biggest deal at the outset of the plan, as there's fair evidence showing that people overvalue insurance and will buy it even though paying the penalty is a better deal. If that turns out to be wrong, you can strengthen the mandate down the road. But the economics of the situation favor the people who decide to pay the penalty rather than purchase insurance, not the other way around.
So, if, once the new insurance exchanges have opened and I go on and can't find a policy that is affordable and to my liking, I can opt to pay $62.50 per month for the security of knowing that if I ever become seriously injured or ill, I can go back to the exchange and purchase (a suddenly more affordable looking!) insurance policy that suits my needs and cannot be denied or charged anymore for a policy than any other person in my age group. Have I died and gone to heaven?!
So, if you've ever seen me getting testy with someone who wants to hold up the bill to try to squeeze a weak public option back in or to make sure that no insurance company has to pay an excise tax on high-end health insurance plans.
Before I conclude, I just want to rattle off a few more of the benefits conferred upon the public by the Senate bill that weren't really mentioned elsewhere in this diary:
Expands Medicaid to cover an additional 14 million low-income people.
Reduces projected budget deficits by $132 billion.
Provides $10 billion for community health centers.
Creates pilot programs that experiment with ways to bend the long term cost curve.
Here's my bottom line: even without a fix, the Senate Healthcare reform bill would represent a historic victory for progressives and for American families. When progressive activists who should be celebrating this triumph, instead accuse the Senate of having sold the American people out, they are being grossly unjust to our Democratic senators.
I'm not just upset by this because of my general aversion to injustice, but also because by unjustly criticizing our Democratic Senators and the Senate Healthcare reform bill, progressives are helping to ensure that bold action on progressive priorities is never taken again.
That is what is known as shooting yourself in the foot or cutting off your nose to spite your face. Whichever metaphor you choose, I beg progressives to stop injuring our own body parts! Now!
So, I urge you to call your Senators and Representatives and ask them to finish the job now and do whatever they can to make the Senate bill even better. And, while you're at it, thank them for all the hard work they've done to bring us right to the verge of a historic progressive victory! (Unless, of course, your representative and/or Senator voted against healthcare reform or is named Joe Lieberman or Ben Nelson, in which case I urge you to call them and give them holy hell!)