Courage, schmourage on health care

I wish the new compromise health care proposal were getting more bad press. At least, notably, when the Los Angeles Times endorsed the plan, the Letters to the Editor were uniformly negative and tore it apart in all the right ways.

I'm heartened that Californians are not fooled by the Governor and state Assembly's “historic” and “courageous” plan. Well, I guess if I had to choose between “historic” and “courageous,” then I would have to side with “historic.”

Anyway, here's a bit more bad press from me, that deals with the plan's courage-free specifics more than the previous bad press I've posted here.

Here's what the plan proposes. It maintains the basic structure of the current system--if Americans’ reliance on employers and insurance companies to pay for health care can possibly be called a system--and adds a series of much-trumpeted reforms. It requires people to buy coverage and insurance companies to take all comers. It requires employers to spend a set percentage of their payroll on health care. And it subsidizes California’s poorer residents.

How much, exactly, is that going to change, since the plan offers no subsidies to the middle class or even upper-middle class, all of whom can currently be saddled with unaffordable premiums, high deductibles, and uncovered health expenses. Overall, the plan mandates universal coverage, but fails to enact reforms that will make coverage adequate, reliable, and affordable.

It fails, first, to closely regulate the cost of premiums or the extent of coverage. Rather, it continues to leave major decisions about the cost and provision of health care in the non-medical hands of insurance companies, which have a logical mandate to maximize profits—not health—and which profit only in proportion to the degree that they do not provide health care. The plan does specify that insurers have to spend 85% of premium income on health care—which sounds, at the least, like an incentive for insurers to continue to raise their premiums. And it exempts families from the mandate to buy insurance if the cost of coverage would exceed 5% of their income.

Now that’s groundbreaking health-care reform, which we should all get excited about. Here's a plan that assures Americans that they don’t have to have health insurance if they can’t afford the insurance companies’ premiums.

And subsidies to the poor? Well, that’s the plan’s sole feature that just might make a difference, by making health coverage accessible to the state’s lowest-income residents (and to middle-class Californians who become poorer trying to pay for health care). It should be noted, however, that these payouts will heavily subsidize not just poor Californians but also the not-at-all-poor insurance companies, to continue to charge the premiums that the plan assures many Americans they won’t be able to afford to buy.

No, with this plan, Californians will continue to enjoy precisely the same two routes to affordable coverage as before (aside from being poor). We can be young and healthy—which even for us Californians, alas, turns out to be impossible in the long term. Or we can find jobs in which the employers themselves provide large subsidies for health coverage. And by now requiring all businesses to pay for or contribute to employee health care, the plan legislates and perpetuates the link between employment and health coverage—an artifact of a long-ago post-World-War-II economy—that has generated so much of the anxiety in the current health care crisis.

The plan will continue to constrain smaller employers, especially. It will continue to restrict our choices—often severely—about what work we can do and where we can do it. (As a freelance writer, for example, I can no longer write full-time, for the sole reason that I couldn’t afford the $12,000-plus unsubsidized annual premium for insurance—and how would Governor Schwarzenegger respond if he could no longer work as governor for the sole reason that he couldn’t afford the premiums for health insurance?) This plan continues to tie job security to health coverage—if you get fired or want to quit, you soon lose your subsidized coverage—and to deprive people of their heavily subsidized health plans soon after they become too sick to work.

By failing to regulate the insurance companies effectively (or God forbid do away with their role), and by reinforcing the disastrous link between employment and health coverage, this historic, courageous plan will keep Californians in a mass state of anxiety and insecurity about how to get and maintain and pay for health coverage.

Though perhaps it does take some courage, at least, to call the proposal courageous.

A version of this piece was cross-posted on the Huffington Post Blog.

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