A Bird in the Hand Is Worth Two in the Bush

The health care reform plan passed the US House of Representatives on March 21 with 219 votes in favor and 212 votes against. In this contest, not a single Republican Party member voted for the legislation, and for ideological reasons even some conservative Southern Democrats voted against the bill.

In the US, the struggle to persuade the upper classes and the government that in modern times society as a whole is responsible for the health care and well-being of its citizens has taken one hundred years. When, 65 years ago, Harry Truman proposed a government funding to increase the number of doctors and nurses and build hospitals, the American Medical Association attacked the plan as “socialized medicine” and accused Truman’s team of toeing “the Moscow party line.” Truman’s idea that the “health of American children, like their education, should be recognized as a definite public responsibility” was buried under piles of insurance company propaganda. Since then, if by chance any US administration was sympathetic to the idea of public health care, it became a target of attacks by not only giant insurance corporations and the pharmaceutical industry, but also by their defense lawyers and lobbyists posturing as the people’s congressmen.

The health plan drew fire from both the right and the left forces. The criticisms of right-wing forces, mainly Republicans, were that society cannot afford the cost and the government principally must not be in the business of providing health-care services. Like all other industries, they add, the private sector is better qualified to serve the health care needs of the population than the government. They did not admit that profit being at the center of the business motivation has resulted in poor allocation of resources, high medical costs, large numbers of uninsured Americans and even the deaths of tens of thousands of people annually.

On the other hand, the objection of the far left to this plan was that either it does not go far enough, in one case calling it the “brain child of the monopoly corporations” and claiming that the reforms are worse than what people have had under the status quo. The sad part to this sloganeering is that they did not feel indebted to their readers to cite concrete provisions of the plan, concluding that without the public option, it is not worth passing. This group ignored the fact that “Perfectionism is the enemy of objectivity”.

There is no doubt that the health care plan signed into law is not a socialized health program, but it is much better than no plan for at least the next decade, knowing that it has taken 16 years since Clinton introduced a reform plan that was defeated and taken off the agenda all these years.

Given the fact that in the US health care costs embrace more than 16 percent of the Gross Domestic Product (GDP) and the industry interwoven with medical colleges, hundreds of thousands of doctors and nurses, insurance companies and pharmaceutical industries and medical equipment industries, not to mention the advertising companies and investors in the financial institutions and public in general, any major changes that impact the interests of these strata negatively will meet with seismic social resistance that only a social revolution can overcome. It is not impossible that the current world capitalist crisis may prepare the ground for such upheaval. The difficulty still remains that the revolutionary forces are extremely in disarray and feeble at best. In the absence of the necessary revolutionary conditions, those who advocate that the present legislation should be discarded in the hopes that the present or future Congresses and administrations would introduce and pass a public single-payer reform sometime in the next decade are playing into the hands of the far right and the insurance companies who dominate an unregulated industry. The well-known American idiom – A bird in the hand is worth two in the bush – is applicable here.

A group of people are of the opinion that passage of this plan would only make it harder in the future to adopt a better plan with a strong public component. Let’s examine this premise. If this plan is actually worse than what people had in the past and have under the current realities, then after experiencing the negative effects of this new legislation, the job of challenging it and calling for a robust public option should be easier. However, if there are positive structural improvements and features of this plan that would be considered by millions of Americans as an improvement of their health care needs in comparison to what they had previously, such as parents being able to keep their children on their insurance plan until age 26 instead of age 23 (a category of over 1,600,000 individuals), and portability of health care in the workplace, then it would be harder to convince people to abandon the new legislation for something that is hypothetically better in the future. There is no doubt that this plan opens the gate of expectations for future improvements, and as it is rightfully said, “It’s a major step in the right direction.”

The present plan, known as the “Patient Protection and Affordable Care Act” and the “Health Care and Education Affordability Reconciliation Act of 2010,” includes health insurance market reforms that will bring immediate benefits to millions of Americans. The following benefits are only a partial list of provisions that will be available to the public in the first year after passage of the two bills by the Senate:

  • Access to affordable coverage for the uninsured with pre-existing conditions.
  • No pre-existing coverage exclusion for children.
  • Closing the coverage gap in the Medicare (Part D) drug benefit.
  • Small business tax credits.
  • Patient protections’ choice of doctors by allowing plan members to pick any participating primary care provider.
  • Creates immediate access to reinsurance for employer health plans providing coverage for early retirees, while reducing premiums for employers and retirees.
  • Extension of coverage for young adults. It permits children to stay on family policies until age 26.
  • Free prevention benefits. It requires coverage of prevention and wellness benefits from deductibles and other cost-sharing requirements.
  • Access to quality care for vulnerable population. Establishing community health centers in neighborhoods where it is needed most.

There are additional provisions, such as no pre-existing coverage exclusion for adults that will not come into play until 2014, but the list above is effective fiscal year 2010.

One last point to all those sincerely progressive activists who honestly are longing to see the day when all hard-working residents of the United States, especially the poor and working class, enjoy their rights to decent health care services, is that a scientific and rational discussion and analysis of the concrete conditions contained in the plan is the order of the day. To do so, every effort must be made to avoid unfounded claims and assumptions and generalizations that draw unreasonable conclusions. Under all conditions, the progressives must refrain from positions that would place them alongside the conservatives, Republicans and anti-labor forces that are against health care reform altogether.