Yes, This Health Care Bill Really is Worse Than Nothing

If you join a fight for social justice you many win or lose, but just by being part of the struggle, you win, and your life will be better for it.

– – Howard Zinn

Already defenders and apologists for the Democrat’s health care legislation are busy at work. In the next few weeks they will be working overtime to persuade, cajole, shame and ruthlessly attack if necessary, anyone opposing health care legislation. They’ll reserve special hysteria, invective and contempt for those of us who continue to support a single-payer, national health care system.  And because it is the holiday season, we will be called heartless health care Grinches and silly, single payer, Bernie Sanders Scrooges. There will be accusations: “If you don’t support health care reform legislation, you support the status quo.” Implicit in the indictment is single-payer advocates, with their pie-in-the-sky idea that health care is a human right for all, will be responsible for the continued impoverishment and immiseration of the American people if a bill doesn’t pass.

Joshua Holland, an editor and senior writer for AlterNet and Uwe E. Reinhardt, an economics professor at Princeton, have begun the onslaught.
In a piece posted on AlterNet November, 24th titled, “Is the House’s Health Bill Really Worse than Nothing?” Holland attacks Dr. Marcia Angell, author, former editor of the New England Journal of Medicine and a leader of Physicians for a National Health Program (PNHP.) Dr. Angell opposes the House bill and believes it’s “worse than nothing.” For that she earns the disdain of Joshua who just can’t accept there isn’t something in the bill worth supporting, even though he agrees with her trenchant criticism of the bill’s gaping defects. He claims she ignores the “primary thrust of the legislation” which for Holland is “the fact that the House legislation would do quite a bit for millions of real Americans struggling through a very real health care crisis.” “Real” Americans, a “real” health care crisis? The insinuation is Angell, and by affiliation PNHP, isn’t operating in the real world of real suffering if they don’t support whatever bill Congress delivers to the Oval Office for a signature. That’s interesting. An organization of 16,000 doctors that conducts research on major aspects of the health care crisis and have been on the frontlines for real reform for decades doesn’t understand what’s real?

Holland argues Angell negates her original thesis when she writes, “The bill has a few good provisions (expansion of Medicaid, for example) but they are marginal.” It doesn’t. Her central contention is even with an expansion of Medicaid and a few other “good” provisions, the bill is a bomb because on balance, it entrenches the power and profits of the private insurance industry – the source of the health care crisis.

This isn’t the first time an expansion of Medicaid has been offered as a partial panacea for the health care crisis. And it has to be said: It isn’t necessary to create a huge, complex and expensive piece of national legislation in order to expand the Medicaid Program. Any state can decide at any time to change eligibility rules and insure more residents (Massachusetts did in 2006.) But the overall trend has been the opposite.

According to a study published in the Annals of Family Medicine, “Medicaid programs in all 50 states implemented cost-savings strategies, including benefit reductions, cost sharing and tightened administrative rules during the recent economic downturn.” Medicaid operates within the dysfunctional, multi-payer health care system and has suffered from an expand-contract cycle since its inception. It’s a favorite target for blame-the-victim politicians who want to get poor people off welfare (and health care) and into the workforce with no health care. Under the Clinton Administration’s “welfare reform,” hundreds-of-thousands of mostly women and children lost Medicaid coverage. The Medicaid program is not an entitlement or a right. An onerous redetermination is done every year in most states. And in fact, losing Medicaid coverage for a variety of reasons is the norm.

It’s true – the expansion of Medicaid would help millions of low-income Americans, but for how long? Expansion of Medicaid is a short-term, incremental fix, not a permanent one. And that should be the goal of legislation – a permanent fix to the health care crisis so there is no longer a health care crisis.

Holland thinks the subsidies are “rather generous.” It’s curious he isn’t asking these questions: If the government were truly reforming health care, why would millions of people need subsidies? Shouldn’t the cost of coverage come down so much its affordable without government assistance?

Here’s the conundrum – if you support subsidies to help people buy insurance and the expansion of Medicaid, you are forced to support the transfer of billions of taxpayer dollars into the coffers of the investor-owned insurance industry and a mandate that criminalizes and punishes people. You also have to accept the Stupak Amendment and the denial of health care to millions of undocumented workers.

There are more poison pills to swallow. Holland thinks it’s fine insurance will still be linked to employment – tell that to the millions who are unemployed and being laid off by the thousands every day. In the House bill, if employers offer insurance, they must pay at least 72.5 percent of the premium for individuals and 65 percent for families. That’s too low and gives companies who pay a higher percentage an incentive to shift costs onto employees until they hit the government-mandated limit. Workers will then be dumped into the insurance exchange because it will be cheaper for employers and once there, because of the mandate, forced to buy stripped down plans with no limits on premiums.

Currently, there are over twenty-five million people underinsured. The majority of people who declared medical bankruptcy started out with insurance. That is the wave of the future. The government will claim more people are insured and technically they will be, but are you really insured if you have a $5000 deductible, high co-pays and less than one-hundred percent coverage for hospitalizations, expensive medication and diagnostic tests?

And what about the much ballyhooed public option which was supposed to keep the rapacious insurers honest and give millions quality, inexpensive health care that Joshua argued for at the expense of advocating for single-payer which he is a supporter of? Eviscerated, not robust at all, and what Paul Krugman now calls “medium-strength.” It’s not even that. The “progressive” Democrats abandoned Holland and his ilk and voted in favor of the bill after they swore not to if it didn’t contain a robust public option with rates tied to Medicare. These are the same “regressive” Democrats that voted in favor of the Stupak Amendment. Holland argues if the final legislation contains Stupak it can’t be supported. But if “Progressive-Regressive” Democrats voted for it the first time, they will vote for it a second time because they don’t have the spines to stand up to President Obama, or for abortion rights.

Toward the end of his assault on Dr. Angell’s position, Holland writes, “…drawing the line at the House bill is privileging ideology over getting something done in the short-term, however imperfect it might be overall.” But that is precisely the problem. For decades short-term, imperfect reforms are offered that inexorably lead right back to the crisis. Then more short-term, imperfect reforms are offered and the cycle continues. Instead of attacking the privileged ideology of for-profit, corporate controlled health care, Joshua attacks single-payer ideology and argues to abandon it in order to get something, anything done.

Single-payer supporters also reject his false choice of “trying to push for the best package possible or leaving a disastrous status quo in place…” The not so subtle message is if a bill doesn’t pass we will be responsible for the disastrous status quo that is the state of health care in this country. Sorry Joshua, but that responsibility will rest with the Obama Administration that at every turn placated the profit hungry, parasitic insurance and pharmaceutical industries.

And if a bill does pass this year, we can hurry up and wait 4 years because that’s when it will be enacted! So, disastrous status quo for 4 more years, then in 2013 implementation of a disastrous bill that will continue to leave 20 million uninsured. I can hardly wait.

Uwe E. Reinhardt dismisses and disrespects Dr. Don McCanne, another leader of PNHP, for arguing current health care legislation can’t be supported and instead the fight for a single-payer health care system must continue.

Reinhardt wrote in response to Dr. McCanne’s comments on the letter he and 22 other prominent economists sent to President Obama: “Don is a mensch, but a dreamer. Let’s face it, this very limited bill, should it pass into law, is the very best Americans can hope for. This country will never have a sensible, efficient health care system, and perhaps not even a totally humane one. For better or worse, we must get used to it.”

Reinhardt’s work is full of contradictions. He writes extensively on health care and understands that a government-run, single-payer system is the best way to control the cost of health care and insure everyone. Like in Taiwan. But Reinhardt is thoroughly pessimistic the political movement that is necessary to bring about that kind of system can be built and can win. So he tells us we have to get used to 45 thousand people dying every year for lack of health care. We have to get used to millions of families being bankrupted from medical bills. It’s the very best Americans can hope for and if you don’t hope for that you are a stupid dreamer. I couldn’t disagree with Dr. Reinhardt more. We cannot and will not get used to that barbarism.
Obviously Reinhardt hasn’t been paying attention to the movement for single-payer and what we have accomplished during this round in the health care debate.

Reinhardt needs to come down from his Ivy Tower and join the movement for single-payer. It’s really not so bad down here at the grassroots level, Uwe. There is PNHP with 16,000 members. The California Nurses Association (CNA) supports single-payer and has thousands of members, too. Sections of the labor movement support single-payer. There are grassroots, single-payer organizations in almost every state with committed members who got arrested in acts of civil disobedience at insurance company headquarters. And poll after poll consistently shows the majority of Americans want government-run, guaranteed and financed health care.

If Reinhardt came over strongly and unequivocally to the side of single-payer, he could help the movement take a giant step closer to winning a humane, efficient health care system. He could use his prodigious talents of number crunching and economic analysis to demonstrate the superiority of single-payer and to demoralize and defeat The Powers That Be who listen to his economic prognostications on health care reform. Reinhardt could be a founding member of an organization of economists for single-payer and name it Economists for Single-Payer Network (ESPN.) He could be a proud member of a social movement struggling to make health care a human right in the richest capitalist country in the world.

HELEN REDMOND, LCSW, is a medical social worker in Chicago. She can be reached at She blogs at

Helen Redmond is an independent journalist and writes about the war on drugs and health care. She can be reached at