Health-care bill wouldn't bring real reform
By Howard Dean
IF I WERE A senator, I would not vote for the current health-care
bill. Any measure that expands private insurers' monopoly over health
care and transfers millions of taxpayer dollars to private
corporations is not real health-care reform. Real reform would insert
competition into insurance markets, force insurers to cut unnecessary
administrative expenses and spend health-care dollars caring for
people. Real reform would significantly lower costs, improve the
delivery of health care and give all Americans a meaningful choice of
coverage. The current Senate bill accomplishes none of these.
Real health-care reform is supposed to eliminate discrimination based
on preexisting conditions. But the legislation allows insurance
companies to charge older Americans up to three times as much as
younger Americans, pricing them out of coverage. The bill was supposed
to give Americans choices about what kind of system they wanted to
enroll in. Instead, it fines Americans if they do not sign up with an
insurance company, which may take up to 30 percent of your premium
dollars and spend it on CEO salaries -- in the range of $20 million a
year -- and on return on equity for the company's shareholders. Few
Americans will see any benefit until 2014, by which time premiums are
likely to have doubled. In short, the winners in this bill are
insurance companies; the American taxpayer is about to be fleeced with
a bailout in a situation that dwarfs even what happened at AIG.
>From the very beginning of this debate, progressives have argued that
a public option or a Medicare buy-in would restore competition and
hold the private health insurance industry accountable. Progressives
understood that a public plan would give Americans real choices about
what kind of system they wanted to be in and how they wanted to spend
their money. Yet Washington has decided, once again, that the American
people cannot be trusted to choose for themselves. Your money goes to
insurers, whether or not you want it to.
To be clear, I'm not giving up on health-care reform. The legislation
does have some good points, such as expanding Medicaid and permanently
increasing the federal government's contribution to it. It invests
critical dollars in public health, wellness and prevention programs;
extends the life of the Medicare trust fund; and allows young
Americans to stay on their parents' health-care plans until they turn
27. Small businesses struggling with rising health-care costs will
receive a tax credit, and primary-care physicians will see increases
in their Medicare and Medicaid reimbursement rates.
Improvements can still be made in the Senate, and I hope that Senate
Democrats will work on this bill as it moves to conference. If
lawmakers are interested in ensuring that government affordability
credits are spent on health-care benefits rather than insurers'
salaries, they need to require state-based exchanges, which act as
prudent purchasers and select only the most efficient insurers. Sen.
John Kerry (D-Mass.) offered this amendment during the Finance
Committee markup, and Democrats should include it in the final
legislation. A stripped-down version of the current bill that included
these provisions would be worth passing.
In Washington, when major bills near final passage, an
inside-the-Beltway mentality takes hold. Any bill becomes a victory.
Clear thinking is thrown out the window for political calculus. In the
heat of battle, decisions are being made that set an irreversible
course for how future health reform is done. The result is legislation
that has been crafted to get votes, not to reform health care.
I have worked for health-care reform all my political life. In my home
state of Vermont, we have accomplished universal health care for
children younger than 18 and real insurance reform -- which not only
bans discrimination against preexisting conditions but also prevents
insurers from charging outrageous sums for policies as a way of
keeping out high-risk people. I know health reform when I see it, and
there isn't much left in the Senate bill. I reluctantly conclude that,
as it stands, this bill would do more harm than good to the future of
The writer is a former chairman of the Democratic National Committee
and was governor of Vermont from 1991 to 2002.