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Healthcare and the Residual Effects of Race

By: Rev. Graylan Scott Hagler     Senior Minister of Plymouth Congregational United Church of Christ, Washington, D.C.,

         The healthcare debate raged for over a year and a half.  In the midst of that time we did not experience a credible discussion of the healthcare proposal because of the vitriolic accusations forwarded by conservative talk show hosts that motivated an emotional and largely demagogic constituency. This has been unfortunate because the merits of the healthcare bill have not been understood well by the general population because of the irrational statements that had to be defended against.  Think about the various unfounded claims that were made: "They want to establish a death panel!"  "This is socialism!"  "This is simply a plan to get abortion on demand!"  The irrational claims have continued to proliferate as the healthcare debate wore on. 

Shear racism easily reared its ugly and unwanted head.  It has been absolutely embarrassing for the nation to see people wearing monkey masks with Obama written across the forehead of those masks.  Or the spitting and "N" word name calling that happened in the halls of congress against Black lawmakers.  It has been an ugly time. 

This kind of despicable behavior has not only been an embarrassment to the United States in the world arena, but I believe that it is endemic of where we are as a country.  People of differing races still do not live in the same neighborhoods; attend the same schools; have the same opportunities; attend the same churches; have the same outlook on life; or expectations in regards to life.  Issues of race and racism have continued to be an issue within the United States of America.  People had hoped that the election of a President that is Black would be the last hurdle in racism.  But instead we find this virulent strain of virus continuing to plague the American people and the nation. 

It is clear to me that we are well within the "Third Reconstruction" in the history of race and the nation. 

The first reconstruction occurred directly after the Civil War when "one person-one vote" was enforced.  This meant that Blacks were elected all across the south and some to the halls of congress.  Then the cry went out from the proponents of the confederacy that "We need to take our country and government back!"  These cries resulted in a coup d'etat in places like Wilmington, North Carolina where the newly elected town council was simply murdered and replaced.  It was a message that went through out the land and then poll and literacy taxes were imposed and the end result was that Blacks who had tasted some small modicum of participating in the so-called democratic process were silenced and nullified.

Then the Civil Rights movement of the 1960s marked the "Second Reconstruction."  In this movement issues were addressed like voting rights, public accommodations, fair housing and the eventual institutionalization of policies like affirmative action as a way of bringing people who had been historically denied economic opportunity into the stream of career and financial advancement.  Then the cry from the political right again was raised, "We need to take our country and government back!"  Then forces galvanized under a grandfatherly type white man, Ronald Reagan, and proceeded to dismantle the changes that were made and effectively turn back the clock!

 Now we are in this moment with a President who is Black and finally we are discussing the things that are vitally important to people of color and the poor and yet the same refrain is heard, "We need to take our government and country back!"  It is the Third Reconstruction and the question is:  will we allow the clock to be turned back again? 

It is clear that what is being stated is that Black people and other people of-color are not considered an integral part of the United States by powerful forces within the nation.  Racism and racist attitudes are alive and well!  It clearly points out the moral and ethical disease that is at the core of the American fabric.  Some, a few short months ago, after the election of President Obama, declared that we had entered a post-racial era.  It is sad how quickly the hope declared a few months ago is revealed as delusive so quickly and without apology.  We have now come to a new time and new place where old themes are declared, a line is drawn in the sand, and we shall see if we shall go on as a nation or fight a new civil war.  What occurred during this healthcare debate was not pretty, but on the other hand, it was historic America!     

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The Dimensions of the Struggle: New Poll Shows The Level of Fascistic Thought Prevalent in Segments of the U.S. Population

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[Editor's Note: But can we challenge the growth of uiltra-right-wing ideas if the programs identified with the liberal and progressive forces are in fact deeply flawed and destructive to the interests of working people in the U.S. ?  Is it appropriate to label their reaction "fascistic" if they are responding to programs that seem likely to hurt them? These questions are raised in the minds of anyone who reads the article below that makes a prima facie case that the health care bill just passed is not just flawed but actually damaging to the well-being of many Americans. It is written by physicians who have dedicated their lives in the past forty years to seeking universal health care--and these are respected medical voices whose commitment to social justice cannot be questioned.]

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Statement of NOW President Terry O'Neill
March 21, 2010

As a longtime proponent of health care reform, I truly wish that the National Organization for Women could join in celebrating the historic passage of the Patient Protection and Affordable Care Act. It pains me to have to stand against what many see as a major achievement. But feminist, progressive principles are in direct conflict with many of the compromises built into and tacked onto this legislation.

The health care reform bill passed by Congress today offers a number of good solutions to our nation's critical health care problems, but it also fails in many important respects. After a full year of controversy and compromise, the result is a highly flawed, diminished piece of legislation that continues reliance on a failing, profit-driven private insurance system and rewards those who have been abusive of their customers. With more than 45,000 unnecessary deaths annually and hundreds of thousands of bankruptcies each year due to medical bills, this bill is only a timid first step toward meaningful reform.

Fact: The bill contains a sweeping anti-abortion provision. Contrary to the talking points circulated by congressional leaders, the bill passed today ultimately achieves the same outcome as the infamous Stupak-Pitts Amendment, namely the likely elimination of all private as well as public insurance coverage for abortion. It imposes a bizarre requirement on insurance plan enrollees who buy coverage through the health insurance exchanges to write two monthly checks (one for an abortion care rider and one for all other health care). Even employers will have to write two separate checks for each of their employees requesting the abortion rider.

This burdensome, elaborate system must be eliminated. It is there because the Catholic bishops and extremist abortion rights opponents know that it will result in greatly restricting access to abortion care, currently one of the most common medical procedures for women.

Fact: President Obama made an eleventh-hour agreement to issue an executive order lending the weight of his office to the anti-abortion measures included in the bill. This move was designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women's access to abortion. This executive order helps to cement the misconception that the Hyde Amendment is settled law rather than what it really is -- an illegitimate tack-on to an annual must-pass appropriations bill. It also sends the outrageous message that it is acceptable to negotiate health care reform on the backs of women.

Fact: The bill permits age-rating, the practice of imposing higher premiums on older people. This practice has a disproportionate impact on women, whose incomes and savings are lower due to a lifetime of systematic wage discrimination.

Fact: The bill also permits gender-rating, the practice of charging women higher premiums simply because they are women. Some are under the mistaken impression that gender-rating has been prohibited, but that is only true in the individual and small-group markets. Larger group plans (more than 100 employees) sold through the exchanges will be permitted to discriminate against women -- having an especially harmful impact in workplaces where women predominate.

We know why those gender- and age-rating provisions are in the bill: because insurers insisted on them, as they will generate billions of dollars in profits for the companies. Such discriminatory rating must be completely eliminated.

Fact: The bill imposes harsh restrictions on the ability of immigrants to access health care, imposing a 5-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibiting undocumented workers even to use their own money to purchase health insurance through an exchange. These provisions are counterproductive in terms of controlling health care costs; they are there because of ugly anti-immigrant sentiment, and must be eliminated.

Fact: The bill covers only 32 million of the 47 million uninsured in this country, does not contain a meaningful public option and provides no pathway to a single payer system like Medicare for all. Democratic negotiators crumpled before powerful business interests and right-wing extremists, and until they get a spine there will be no true competition to help rein in costs.

The bottom line is that everyone -- citizen and non-citizen, undocumented immigrant and visitor -- has a fundamental human right to health care. This right has been denied in the U.S. for far too long, while the rest of the industrialized world moved ahead to assure universal and affordable care for their people.

We call upon President Obama and elected officials in both houses to commit to a process of steady improvement of our health care system that will result in true reform with universal coverage, realistically affordable rates and no discrimination. We still have a lot of work to do before we can genuinely celebrate.

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By Rose Ann DeMoro
California Nurses Association
California Progress Report, March 24, 2010

Passage of President Obama's healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent rightwing opposition. Now that we have an insurance bill, can we move on to healthcare reform?

As an organization of registered nurses, we have an obligation to provide an honest assessment, as nurses must do every hour of every day. The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth.

When all the boasts fade, comparing the bill to Social Security and Medicare, probably intended to mollify liberal supporters following repeated concessions to the healthcare industry and conservative Democrats, a sobering reality will probably set in.

What the bill does provide

-Expansion of government-funded Medicaid to cover 16 million additional low income people, though the program remains significantly under funded. This limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance, with the result some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target to budget cutting governors and legislatures.

-Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders, that will open their doors to nearly double their current patient volume.

-Reducing but not eliminating the infamous "donut hole" gap in prescription drug coverage for which Medicare enrollees have to pay the costs fully out of pocket.

-Insurance regulations covering members' dependent children until age 26, and new restrictions on limits on annual and lifetime on lifetime insurance coverage, and exclusion of policies for children with pre-existing conditions.

-Permission for individual states -- though weakened from the version sponsored by Rep. Dennis Kucinich -- to waive some federal regulations to adopt innovative state programs like an expanded Medicare.

All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them.

Where the bill falls short

-The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for other moderate income working people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gouging, care denials, and other abuses.

-Inadequate healthcare cost controls for individuals and families.

1. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, an idea also dropped from the bill.
2. There is no standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer provided plans.
3. An illusory limit on out-of-pocket medical expenses. But even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.

-No meaningful restrictions on claims denials insurers don't want to pay for. Proponents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.

-Significant loopholes in the much touted insurance reforms:

1. Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
2. Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will likely set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
4. Insurers may continue to rescind policies, drop coverage, for "fraud or intentional misrepresentation" -- the main pretext insurance companies now use.

-Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.

-Erosion of women's reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.

-A windfall for pharmaceutical giants. Through a deal with the White House, the administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.

Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.

As former Labor Secretary Robert Reich wrote after the vote "don't believe anyone who says Obama's healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama's health bill is a very conservative piece of legislation, building on a Republican (a private market approach) rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option."

Unlike Social Security and Medicare which expanded a public safety net, this bill requires people -- in the midst of the mass unemployment and the worse economic downturn since the Great Depression -- to pay thousands of dollars out of pocket to big private companies for a product that may or may not provide health coverage in return.

Too many people will remain uninsured, individual and family healthcare costs will continue to rise largely unabated and private insurers will still be able to deny claims with little recourse for patients.

If, as the President and his supporters insist, the bill is just a start, let's hold them to that promise. Let's see the same resolve and mobilization from legislators and constituency groups who pushed through this bill to go farther, and achieve a permanent, lasting solution to our healthcare crisis with universal, guaranteed healthcare by expanding and improving Medicare to cover everyone.

Leaders of the National Nurses United have raised many of these concerns about the legislation for months. But, sadly, as the healthcare bill moved closer to final passage, the space for genuine debate and critique of the bill's very real limitations was largely squeezed out.

Much of the fault lies with the far right, from the streets to the airwaves to some legislators that steadily escalated from deliberate misrepresentations to fear mongering to racial epithets to hints of threatened violence against bill supporters.

For its part, the administration and its major supporters shut out advocates of more far reaching reform, while vilifying critics on the left.

Both trends are troubling for democracy, as is the pervasive corruption of corporate lobbying that so clearly influenced the language of the bill. Insurers, drug companies, and other corporate lobbyists shattered all records for federal influence peddling and were rewarded with a bill that largely protected their interests, along with a Supreme Court ruling that will allow corporations, including the health care industry, to spend unlimited sums in federal elections.

Rightwing opponents fought as hard to block this legislation as they would have against a Medicare for all plan. As more Americans recognize the bill does not resemble the distortions peddled by the right, and become disappointed by their rising medical bills and ongoing fights with insurers for needed care, there will be new opportunity to press the case for real reform. Next time, let's get it done right.

Rose Ann DeMoro is the Executive Director of the California Nurses Association/National Nurses Organizing Committee, representing over 85,000 staff nurses throughout the nation.

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A Defining Moment for Obama by Robert Kuttner

We have just witnessed what could be a turning point in the Obama presidency. In many respects we can thank Scott Brown. For it took the humiliating loss of Ted Kennedy's senate seat, and the even deeper incipient humiliation of lost health reform, for Obama to be reborn as a fighter. It remains to be seen whether he will match the resolve that he finally summoned on health reform with comparable leadership on all of the other challenges he yet faces.

But even those of us who were lukewarm on this bill should savor the moment and honor Obama's odyssey. His Saturday speech was simply the greatest of his presidency. It reminded us of the inspirational figure in whom so many of us invested such hopes last summer and fall. If you have been on Jupiter and somehow missed the speech, you owe it to yourself to watch it.

At long last, we saw this president leading, as only a president can. And we saw him leading as a progressive Democrat, finally admitting that no common ground with today's Republicans is possible, narrating stories we all can recognize about the human tragedy that is our current health care system.

We saw him reminding Democratic congressmen and women why progress on health reform is good politics. We saw him using gentle ridicule on the Republicans, who have suddenly become oddly solicitous of the Democrats' congressional majority.

But it may also be possible that they realize after health reform passes and I sign that legislation into law, that it's going to be a little harder to mischaracterize what this effort has been all about.

We watched Obama master the mechanics of legislative politics, cobbling together a majority one vote at a time. And we observed the Republican right reduced to sputtering frustration.

What a splendid shift from the Obama who less than a month ago went imploringly to reason with the House Republican Caucus.

Until very recently, the press treated this battle as a symmetrical stand-off. Now, with the president at last regaining control of the narrative, the Republicans are revealed as pure obstructionists. As the bill takes effect and citizens actually experience benefits (and as Obama said, "Lo and behold, nobody is pulling the plug on Grandma,") the Republicans will lose both as the party of No, and as a party that tried and failed to block a beneficial reform that citizens will come to value.

It has taken more than fourteen months for Obama to vindicate as president the leadership potential that we saw on the campaign trail; fourteen months to give up on the fantasy of bipartisanship; fourteen months to start truly inspiring ordinary people as he did as a candidate.

House Speaker Nancy Pelosi deserves to share this moment. She never gave up on this legislation, and she kept after Obama and his aides to be tougher, smarter, and unapologetically partisan. She as much as Obama did the hard work of pulling together a majority, and kept Obama from caving in to Rahm Emanuel's advice to seek a puny bill that the Republicans might support.

The media is notorious for exaggerating the ups and downs of a president. A few weeks ago, Obama and health reform were doomed and Obama was not up to the job. In the coming days, we will see a jubilant Obama on the cover of newsmagazines. He will be lionized as a giant-killer. His approval ratings will rise, both because more Americans are paying attention to the beneficial features of the bill as opposed to the Republican caricatures and because Americans love a winner.

Whether he continues to earn these accolades depends on what he does next, now that the long distraction of health reform is finally behind us. For this come-from behind victory is only the first step in a long road back to the presidency we thought we were getting when we voted for Barack Obama.

The financial system is setting itself up for a second collapse, as new speculative maneuvers make insiders rich and add risks to the rest of the system. The bill working its way through the Senate is far too weak to fix what is broken. We are inviting new scandals, even before we get to the bottom of what really happened at Lehman Brothers and at AIG.

Mortgage foreclosures continue to increase far faster than the Administration's feeble program of subsidizing the banks can provide relief to homeowners. Credit is still very tight because of the administration's strategy of putting Wall Street bank balance sheets ahead of recovery on Main Street.

Last week's signing ceremony in the Rose Garden for a pitifully small jobs bill was enough to wilt the roses. It was a relic of what we get when we strive for bipartisanship. With the economy short at least eleven million jobs, Obama himself has appointed a bipartisan deficit-reduction commission stacked with members who are almost certain to call for massive cuts in social investment that America needs.

And the health bill itself only begins the long task of wresting control of the health care system from callous insurance and drug companies. We still have to fight for a real public option that is the first step towards national health insurance.

But in the springtime of March 2010, we have seen a president who evidently has learned how to lead, who relishes winning, and who is primed to become a more effective progressive. For that we should be grateful. It should whet his appetite as a fighter -- and ours.

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