Like many people who hoped the stars had finally aligned for a fundamental overhaul of our health care system, I have been going through all of Elisabeth Kubler-Ross’ stages of grief and loss — denial, anger, bargaining, depression and acceptance — as I’ve watched what has been happening in the Senate. I moved toward acceptance this morning as I watched the Senate pass its bill, but — being an incurable optimist — I’m still hopeful that the legislation can be improved when Senate and House conferees meet to determine what the final bill will look like.
But even if all the problems of the Senate bill can’t be fixed in conference, Congress must send the president a bill to sign — and soon. My position on this puts me at odds with many of the wonderful reform advocates I have met in the six months that have passed since I switched sides in this national debate — going from being a spokesman for the health insurance industry to being a vocal critic of it — in testimony before Senator Jay Rockefeller’s Commerce, Science and Transportation Committee last June.
Over the past few days, some organizations that have worked so hard for many years for comprehensive reform, especially those that have advocated for a single payer system like Canada’s, have joined groups on the opposite end of the political and philosophical spectrum in calling for defeat of the legislation. “Kill the Bill” is in the subject line of many emails I’ve been getting lately.
I understand their frustration, but I believe that when they stop and think about the real consequences of what they demanding, they will realize that for all its disappointing compromises and flaws, even the Senate-passed bill should be viewed as a foundation that can be built upon in years to come. Ted Kennedy, who advocated for a “Medicare for All” type system before many of today’s activists were born, would truly have been proud of this beginning. He would not have liked everything about the bill, that’s for sure, but he understood what it means to live in a political world and that compromises — even big ones — almost always have to be made on the journey toward an ultimate destination.
We will not be arriving at that final destination with the bill that reaches the president, but we have started the journey. Progressives must keep in mind that even leaving the station has not been a possibility for 15 years. We must not forget what happened in 1994 — the last time we thought the stars had aligned — when opponents of reform prevailed. We must also not forget that many of the reforms in the Senate and House bills are critically important. Yes, insurance companies likely will try to game the system in their relentless quests to meet Wall Street’s expectations, but many of the practices they have used for decades to do that will become illegal. We also must not forget the importance to lawmakers of the future of having a foundation to build upon. They will not have to start from scratch as current and past lawmakers have always had to do. And future lawmakers will be able to fix problems not addressed by this legislation as well as the unintended consequences that inevitably will arise.
Among the other wonderful people I have met over the past six months are people who were denied coverage — or lost it — because insurance companies had decided they had disqualifying “pre-existing conditions.” Others, many with chronic conditions, lost coverage when they lost their jobs and have no idea how they will be able to eat, pay the mortgage and buy the medications necessary to stay alive. They are scared, and they are desperate. The stories I have heard have been heartbreaking. I just wish my former corporate colleagues, the tea baggers who tried to shut down even consideration of reform, and the “Kill the Bill” liberals could have been my traveling companions. I’m sure many of them, even the liberals who think we can wait until we can get more perfect reform, would have been stunned to hear the compelling evidence that the country they love, the country many opponents of reform continue to insist has the best health care system in the world, lets this happen to their fellow citizens. Looking people in the eyes as they tell their stories makes you understand in ways you couldn’t before just how crucial it is to act now.
After speaking in Omaha and Des Moines at the end of last week, and hearing more heartbreaking and maddening stories, I flew to Tennessee to visit my parents. They had to move to an assisted living home over the summer after Dad fell and broke his arm, so I try to get down there to check on them as often as I can. I nearly panicked when I couldn’t find them when I got there. Their bedroom was cold. I eventually discovered them, covered in blankets, in the common living room. Dad was sitting in the big recliner he had brought from home, so big it takes a lot of effort to get from one place to another.
I learned that the building had lost heat during the snowstorm the night before — and that Eddie the maintenance man had gone to the considerable trouble of hauling Dad’s chair to the living room so that Dad would be more comfortable.
When Eddie took me aside and whispered that he wanted to talk with me about something, I was afraid he was going to give me some bad news about Mom or Dad. Instead, he told me that he had recently lost his health insurance when his employer at his second job laid him off. He had been able to get coverage for himself since then, but not for his wife. He asked me if I could help.
For the first time I had an idea of what it must be like for a doctor to tell a patient with a terminal illness that there is nothing he can do. I wish I could have given Eddie some encouraging news and some suggestions of where to look for insurance, but the reality is that his wife probably will not be able to get coverage in the United States of America unless she gets lucky and is hired by a company that offers benefits.
If Congress doesn’t pass reform legislation, Eddie’s wife might never again have health insurance. It is probably more likely, in fact, that she will be among the 45,000 Americans who die every year — 123 every day — because they don’t have insurance. So even though the Senate bill is far from being the bill of our dreams, it will help people like Eddie’s wife. It might even save her life.
It is tempting to join the “Kill the bill” folks, but it would amount to cutting off our noses to spite our faces. Big Insurance and Big Pharma will not be running out of money anytime soon to spend on manipulating public opinion and influencing votes on Capitol Hill. Part of every premium dollar we send to our insurance companies, and part of every dollar we pay when we pick up our prescriptions, end up in corporate piggy banks that overpaid executives tap to hire armies of lobbyists and PR firms whenever their profits are being threatened. These giant corporations and their trade associations have been saving up and preparing for this debate for years. I know because I used to be part of it.
Reform advocates do not have such an endless supply of money. After this long fight, their resources are already dwindling. Over the past several weeks, opponents of reform have been able to spend twice as much as reform advocates on advertising. And the opponents’ ads are part of a campaign carefully and disingenuously crafted by the best PR and advertising people money can buy to scare people away from the very reform that would benefit them most. So it is little wonder that polls show Americans are having second thoughts about reform.
Although the effort to achieve health care reform has been arduous and ugly, progressives can’t merely brush off their hands, move on to other issues and hope the stars will align again for “real” reform. When you stop and think about the bottomless pot of money that health insurance companies constantly replenish by diverting part of our premium dollars away from paying for medical care, it is in some ways remarkable that we have accomplished as much as we have with this legislation.
So instead of sending more “Kill the Bill” emails, we need to turn our attention now to leaders in the House, insisting they stick to their guns on important elements of their bill and improve on what the Senate has passed. It will not be easy to merge the two bills to the satisfaction of reform advocates, but at the very least the House should add language to strengthen the regulation of insurance companies and close the loopholes that would allow them to circumvent the intent of the legislation.
There will be plenty to do later — including paying close attention to how this legislation is implemented, changing the way the Senate conducts its business and getting real campaign finance and lobbying reform enacted — but let’s get this part done now. Millions of people are counting on it. Many of them won’t live to see the next debate if we do exactly what the opponents of reform hope we will do, and that is to join them in trying to “Kill the Bill.”