Is the House's Health Bill Really Worse than Nothing?
Source Dave Anderson
Date 09/11/25/08:57
Is the House's Health Bill Really Worse than Nothing?
By Joshua Holland
Some progressive opponents of the health care bill say it's so bad, we
may as well drop it. That analysis ignores the millions of Americans
who stand to get coverage.

STEP BACK FOR a moment and marvel at the legislative contortions on
display in Washington as lawmakers try to address a deep crisis in our
health-care system without shaking up the status quo too much.

What does that look like? They池e planning to leave the employer-based
private system intact, but they値l re-regulate insurers to a modest
degree and brand it 田hange." No, they won稚 force private insurers to
compete with a public plan on a truly level playing field, but they値l
give us a small public option where insurance companies can park their
sicker, costlier patients. Perhaps states will be able to skip that
part entirely. They refuse to make other hard choices that might
really bring down costs, but they値l force you to buy a policy --
don稚 worry, if sky-high premiums are out of your reach, they値l give
you a subsidy, assuming you qualify. For those who are too poor to
afford even those subsidized premiums, they値l expand Medicaid, and
they値l pay for the whole thing in part by trimming payments to
Medicare providers. And maybe with a tax on millionaires, or maybe one
on union autoworkers and others with expensive health insurance.
They値l make employers shoulder a share of their workers health-care,
or perhaps just pay a small fine if they refuse to.

Got all that? They call Washington痴 legislative process
"sausage-making," but this time around you壇 almost think they池e
mixing up a batch of hash brownies. If we池e lucky, what comes out of
the oven will be a uniquely American "universal" health-care system
that値l only leave something in the neighborhood of 20 million people
uninsured 10 years from now.

But that痴 only half the story -- the half about how a decent,
progressive legislative proposal got watered down to such a degree by
the insurance industry and its allies in Congress that it will do
little or nothing to rein in the staggering growth of health-care
costs and ultimately prove a windfall, to some degree, for the private
insurance industry.

Unfortunately, that half is also almost the exclusive focus of a
widely discussed analysis, by one of the nation痴 most respected
single-payer advocates, of the health-care reforms wending their way
through Congress. And focusing primarily on that half, it should come
as little surprise that Marcia Angell, a lecturer at Harvard Medical
School and a passionate proponent of progressive health-care reform,
concluded the bill is "worse than nothing in an essay published on
the Huffington Post.

Her analysis of the bill痴 shortcomings is spot-on. Most of her column
slices and dices the many ways in which the House bill fails to
control costs, fails to cover every person in the country and
殿ugments the central role of the investor-owned insurance industry."

But while it痴 hard to argue with her analysis of the bill痴 flaws,
her conclusion that it's "worse than nothing" is harder to accept. To
get there, one has to all but ignore the fact that the House
legislation would do quite a bit for millions of real Americans
struggling through a very real health-care crisis.

Angell all but ignores that, rendering her analysis incomplete. There
were always multiple goals to reform: covering the uninsured, offering
access to decent care to those who are priced out of the current
system, reining in the abuses of the private market and controlling
overall health care costs. The House bill, the subject of Angell痴
column, does fail miserably at controlling overall costs and the
insurance regulations it contains are tepid (they would only stop the
worst abuses, and have loopholes, but that痴 clearly better than
nothing at all), but it would also do quite a lot to expand the access
and improve the affordability of coverage for tens of millions of
Americans, many at the lower end of the economic ladder.

Angell all but ignores that primary thrust of the legislation. She
offers only this brief indication that the proposal would bring any
relief at all to working families:

To be sure, the bill has a few good provisions (expansion of Medicaid,
for example), but they are marginal. It also provides for some
regulation of the industry (no denial of coverage because of
pre-existing conditions, for example), but since it doesn't regulate
premiums, the industry can respond to any regulation that threatens
its profits by simply raising its rates.
Marginal is in the eye of the beholder, and Angell arguably negates
her larger, "worse than nothing" thesis in the paragraph above.
According to the Congressional Budget Office, Medicaid expansion alone
would offer public insurance to more than 10 million low-income
Americans who would otherwise be without.

While Angell at least gives a passing nod to the fact that Medicaid
would be expanded to those earning up to 150 percent of the poverty
line in the House bill, she omits entirely the rather generous
subsidies for those making between 150-400 percent of the poverty line
(almost $90,000 for a family with two kids). More than nine in ten
people who lack insurance in America fall beneath 400 percent of the
poverty line, and every one of them will get some help getting
coverage. We can certainly quibble over the definitions of 電ecent
and 殿ffordable, but Angell痴 argument is that the House bill is
worse than a status quo in which decent affordable coverage -- by any
definition of those words -- eludes tens of millions.

And she doesn稚 mention the very real impact the legislation would
have on millions more who are self-employed, employed part-time or are
otherwise left to fend for themselves in the individual insurance
market -- always home to the worst rip-offs in the industry.

While her analysis of what private insurers stand to gain from the
legislation (millions of new coerced customers) is cutting, Angell
omits the fact that the House bill requires most companies to cover
their employees, or pay the equivalent of 8 percent of their payroll
into the system to cover them. (Also no mention of the fact that small
employers would also get subsidies for offering their workers

It痴 noteworthy that Angell focuses on the House痴 approach -- long
understood to be more progressive than the Senate痴 legislation. In
the House bill, a good chunk of the project is financed with a surtax
on the very millionaires who benefited so richly from the lavish
tax-breaks of the last eight years.

So, to recap: the House legislation is a watered-down bill that would
do little to contain America痴 overall health-care costs, but would
help contain the family health-care expenses of tens of millions of
real working people, while covering 36 million who would otherwise be
uninsured, and it finances much of it with the kind of upward
redistribution of wealth that痴 been exceedingly rare in recent

Flawed as it may be, the only way the legislation might be worse than
nothing is if it heads off more substantial reform in the future. As
Jon Cohn, writing in The New Republic put it, "Perhaps Angell and
those who agree with her that this would be a constructive
failure--that eventually growing frustration with our health care
system will help us elect even more progressives and pass more
ambitious reforms. Cohn, noting that progressives said the same thing
during earlier attempts at reform, suggests, "That's an awfully big
chance to take.

The studies--which I know Angell has seen--suggests tens of thousands
of people die or go bankrupt every year because they can't afford to
pay their medical bills. Countless more suffer. The House bill
wouldn't stop such hardship altogether. But it would reduce it
significantly--arguably, by as much as any single piece of domestic
legislation since the Great Society. Surely that qualifies as
something more than "a few improvements around the edges."

Angell's assumption that passing a bill now will head off future
reform just doesn't hold water. The final result of the legislative
process in this Congress, whatever it might be, would be modified by
amendment for years, perhaps decades to come. If it doesn't provide
real relief to ordinary people, if it doesn't control costs, then the
political will to continue the reform process will be there down the
road, with some of the infrastructure already in place.

All of this is more than an academic debate. We don't know what the
final legislation will look like. Both the Senate and House bills have
serious flaws, and it痴 possible that what emerges when they池e
combined will in fact be worse than nothing. The infamous Stupack
amendment (which Angell doesn't mention) would, if it were to survive
in conference, arguably make the legislation impossible for
progressives to support. But other than that, drawing the line at the
House bill is privileging ideology over getting something done in the
short-term, however imperfect it might be overall.

Since single-payer health care was 鍍aken off the table (and, no,
that didn稚 happen earlier this year when Senator Max Baucus had cops
escort advocates out of reform hearings, but back before the Dems ran
and won -- twice -- on this weird Frankenstein approach to expanding
coverage), progressive reformers have been left with a choice of
trying to push for the best package possible or leaving a disastrous
status quo in place in the hope that something will give at some point
in the future that will result in the passage of the kind of modern,
universal system that痴 eluded us since Truman first attempted the
feat in 1948.

Looking only at the meager effects the Democrats' reform bills have on
America's health-care costs -- and the corruption that made them that
way -- and ignoring what the bill would do for working families'
health-care costs makes it that much harder to come to the right

Joshua Holland is an editor and senior writer at AlterNet.

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