Showing posts with label Medicine and Social Justice: HR 3962. Show all posts
Showing posts with label Medicine and Social Justice: HR 3962. Show all posts

Thursday, November 12, 2009

HR 3962 is still a bad bill, and Stupak-Pitts is a scandal

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After the House of Representatives passed HR 3962 recently, I celebrated the defeat of the opponents of health reform. I tried to make it clear, and I will emphasize here below, that the bill is not only far from perfect, it is bad. I just think it would have been worse, a victory for those who wish to keep the status quo (for example, virtually all the Republicans). To my knowledge, Ohio congressman Dennis Kucinich is the only representative who voted against it from a progressive perspective, and I applaud him for that.

I was at a conference recently at which former Senator Tom Daschle spoke. He invited us to envision a huge stadium with the 300,000,000 Americans in it, and the President at the center asking “what should we do about health reform?”, and the huge multiplicity of opinions that would come. He then suggested that the Congress, with its 535 representatives and senators, was a microcosm of those people, expressing all their multiple beliefs. Well, maybe the multiple beliefs, but not in the same proportion. I feel quite certain that, while there would have been a lot of opponents, the 300,000,000 Americans would have been a lot more supportive of health reform, much more meaningful health reform, than the 535 representatives. This is because they don’t get huge contributions from lobbyists from the insurance industry, pharmaceutical industry, hospital industry, and other big corporations, as well as doctors and lawyers and other rich people. Congress does, and it definitely affects their way of seeing things.

HR 3962 is a bad bill that will finance insurance companies, not save money, and not cover all people. I think, I know, we can do better than that. A single-payer plan, for example, such as that proposed in the Medicare for All bill sponsored by Rep. John Conyers (D, MI), and almost voted on by the house in an amendment by Rep. Anthony Weiner (D, NY) to include single payer. This is actually quite a victory, that it came so close, given the efforts of both the Administration and the Congressional leadership to keep it “off the table” from the beginning of this debate. We can hope that, at least, the amendment sponsored by Rep. Kucinich permitting states to pilot single-payer plans, that passed out of committee with bipartisan support, will be considered. It would be a scandal to not allow those states that wished to to try to model a single-payer program.

Speaking of scandals, HR 3642 is further poisoned by the inclusion of the “Stupak-Pitts Amendment”, named after its sponsor, Michigan Democrat Bart Stupak, which not only continues the Hyde Amendment’s ban on the use of federal funds for abortions, it expands on it, by forbidding any plan that may have anyone getting a federal subsidy from offering coverage for abortion care. No “public option” can offer abortion coverage. This will mean that virtually no insurance policy will offer coverage for abortions, including the ones that do at the current time. Companies could offer two separate policies, so that portion of the population not getting subsidies (above 400% of poverty) could buy the other policy, but there is no evidence that they will do so. Under current state laws, five states offer the possibility of insurance companies offering “abortion riders”, allowed under Stupak-Pitts, but there is no evidence that any of them do. Women do not anticipate that they will need an abortion; like other medical care that may come unanticipated (such as the need for emergency surgery, or a diagnosis of cancer) it needs to be covered in the “regular” policy. See the excellent analysis by Jodi Jacobson, “The ‘Real Life’ Effects of Stupak-Pitts: An Analysis by Legal Experts at Planned Parenthood”, or at the Planned Parenthood site, http://plannedparenthoodaction.org/healthreform/668.htm.

The only exceptions allowed under Stupak-Pitts are for abortions resulting from rape, incest, or danger to the life of the mother. Note that this would not only include danger to the mental health of the mother, but would exclude terminations for fetal anomalies, even those incompatible with life. Thus, as is already the case in states such as Mississippi and Louisiana, which have such laws, women can get prenatal testing with ultrasound and amniocentesis, but have no legal access within their states for terminations if something is demonstrated to be wrong. They cannot even be referred. Luckily, at this time, they can go to other states. The Stupak amendment would make the current situation worse.

A group of at least 40 women in Congress, led by Diana DeGette of Colorado, have signed on to a letter demanding that Stupak-Pitts be removed from any final health reform bill. They deserve all the support that they can get, from other members of Congress, from their constituents, and from those who are residents in districts with representatives who voted for Stupak-Pitts. Note that this effort is led by women in Congress. This, obviously, is not a coincidence. Women are the people who get pregnant, including when it is not planned, including when the fetus has anomalies incompatible with life. There are many women, as well as men, who oppose abortion in the sense that they would not have one, that they might counsel friends and relatives not to have one, but also believe that the ultimate decision about what happens to a woman is hers, not theirs. There are also many women, as well as men, in Congress and in the public, who support the concept of Stupak-Pitts and Hyde and other restrictions on abortion, who believe it is their right to make decisions for other women. But none of the men will ever get pregnant themselves. There are many women who were strongly opposed to abortion who have had abortions because their circumstances were special. No men have had to. The role of men, including, obviously, the Catholic Bishops – who, amazingly, are all men! – in fighting for restrictions on abortion, is grossly immoral and offensive.

President Obama has indicated that he will seek some revision of Stupak-Pitts, as described in the New York Times article “Obama seeks revision of plan’s abortion limits”, but even his position would continue the Hyde Amendment restrictions. This has to stop. Women’s lives and health need to stop being the pawns of politicians.

Sunday, November 8, 2009

Celebrating the Defeat of the Opponents of Health Reform

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Last night, late on November 7, 2009, HR 3962, the health reform bill jointly worked out by 3 House committees, passed the House by the narrow margin of 220-215. All Republicans but one (Anh "Joseph" Cao of Louisiana) plus 39 Democrats voted against it. This is reason enough to be glad that it passed, despite the limitations of the bill itself. It did not come so close because of progressives concerned about those limitations voting against it; it came so close because there are so many in Congress who are opposed to any improvement in the access to health care for the American people. It is important that they were defeated, even if by a slim margin, because they are voices for an untenable and unjust status quo.

The bill that passed the House is not a good health reform plan on the face of it. It will leave millions of Americans uninsured. It will not provide a significant limit on the ability of insurance companies to profit from the health problems of our people. A wise and clear analysis of the limitations of the bill is provided by John Geyman, MD, Professor and Chair Emeritus of Family Medicine at the University of Washington and author of the official blog of Physicians for a National Health Program (PNHP). In his piece Health Care Reform 2009: No Bill is Better than a Bad Bill, he makes the case that it should not pass. PNHP’s official position before the vote was: “We have been asked how to tell members to vote on the House bill. Our response is that the bill is ‘like aspirin for breast cancer’.” I agree with their analysis of the bill, and still hope (but am not optimistic) that a better bill will eventually emerge from conference, but have to disagree that it would have been better for it to have been defeated, because that would not have been seen as a victory for progressives, but rather have been a victory for the forces of darkness.

Herb Freeman, a long-time social activist and observer (and a close relative), writes:
Because of the tenor of the health bill discussion in the House today [November 7] on C-span, and after receiving an e-mail showing what cost of living and earnings were in the US 100 years ago, I started to Google how and when other changes were made. In looking up information on other federally-mandated social modifications (or improvements), such as abolition of child labor (1938), compulsory public education (early 1900s), fair labor standards (especially the 40-hour week, 1938) and food standards and examination, I came across some surprising things:
Wikipedia mostly quotes libertarian approaches to public education as destructive to the "educable" and wasteful to the "others."
The impact of the 40-hour week is largely negated by 12-hour work days, elimination of overtime after an 8-hour day, partially because of the lack of a national health plan, which makes insurance too expensive for employers and partially from lost vacations to compensate from static wages.
I reviewed the arguments made, both at the time of passage and to this day, against 68 or more laws that protect people from gross exploitation as workers, and they are exactly what I heard today on C-Span for several hours on the health bill from these dinosaurs from Texas, Mississippi, Wisconsin and Utah, etc.”


The cruel and vicious racist and classist arguments that were made against child labor laws and a 40-hour week and fair wages, that were based in ideas that some people were “educable” and others were not, that exploitation was ok, are the same ones we heard in the health care debate. They were evil and wrong back then, and they are evil and wrong now. The laws that Mr. Freeman refers to, which offer some protection for workers, have indeed been eroded, but to the extent that they exist, and that there is a strong belief on the part of most people that they are good things, help to protect against the worst of exploitation. Many of them also passed, in their day, by narrow margins. I think that the importance of passing HR 3962 was that, by a narrow majority in the House (representing, of course, a much larger majority in the country, that of the people who are not rich or corporations to give money to congresspeople), is that it rejected the narrow-minded selfishness and toadying-to-their-wealthy-benefactors of its opponents

I am not optimistic that the Senate bill will be better (Professor Leonard Rodberg, PhD, Chair of Urban Studies at Queens College/CUNY, describes in Don McCanne’s Quote of the Day how the current plan is bad (he calls it a DOG, but I like my dogs!) or that there will be much improvement in the bill that comes out of conference. It is very unfortunate that there is not a single-payer plan, and that Rep. Anthony Weiner’s single-payer plan was not brought to a vote. I still hope that the proposal by Rep. Dennis Kucinich to allow states to pilot single-payer programs (which passed the committee with support from even some Republicans) may yet happen. Single payer got much further along in the debate than the administration and leadership, which tried to kill it at the beginning of the debate, hoped.

But the most important point is that, whatever, the content of the bill, on this one night, by a narrow margin, a bill passed that says the American people should have access to health care, whatever its limitations in actually providing for it, passed, and it passed over the opposition of those who only support legislation that benefits the privileged minority, and opposed, as they have always opposed, programs that benefit all of our people. I celebrate their defeat.