As we move into the final make-or-break months of the health care debate, every progressive should, in the James Carville tradition, put a simple warning on the wall: Do not snatch defeat from the jaws of victory. While many are fighting passionately for one particular policy proposal, such as a public plan, it would be tragic to allow the inclusion or exclusion of any single element to derail reform.
The reforms already agreed upon are by themselves historic — a fact obscured by the currently overheated debate. If Congress and the White House succeed in passing the reforms around which there is already strong consensus, the impacts would be as sweeping on American society as the passage of Social Security in 1936 or Medicare in 1965. To diminish this potential achievement as “half a loaf” or “Plan B” is shortsighted and wrong.
Despite the antiseptic labels — “guaranteed issue,” “individual mandates,” “community rating,” “purchasing subsidies,” “caps on out-of-pocket expenses” and “exchanges” — these consensus reforms would profoundly alter Americans’ health experiences and bring health insurance stability and security to working-age people for the first time in our nation’s history.
Health insurance is meant to be both a guarantee that you’ll get the treatment you need and a hedge against the financial risks that you or a loved one could face because of a serious illness or injury. Yet today, even when insurance works at its best, the consequences of a random act of ill health can be dire. Insurance may only cover part of your treatment, and it could be difficult to get coverage in the future. What you pay for future coverage will almost certainly skyrocket, and if you work at a small business, the cost of your co-workers’ coverage is also likely to rise.
But even with its imperfections, insurance is a must-have for all of us. While only some of us will absolutely have to depend upon it in the face of a catastrophic illness, none of us can predict who and when such an emergency will occur. A lump may show up on your breast; a growth on your brain; a drunk driver in the next lane. Because of this arbitrariness of fate, many Americans make deeply personal and professional decisions simply to ensure they keep their coverage — staying in the wrong job just for the benefits or giving up the dream of starting a business.
The insurance industry reforms that President Barack Obama and many in Congress have already agreed upon would change all of that, replacing individual risk and unpredictability with security and stability. “Caps on expenses” means the threat of financial devastation because of illness or injury will disappear. “Community rating” means people will no longer pay an economic penalty simply because God gave them a weak heart or a bad gene. “Guaranteed issue” means you can’t be denied coverage because you’ve suffered a heart attack, have high blood pressure or have another pre-existing condition. And if you fall ill between jobs, you’ll get help to pay for insurance until you’re back on your feet.
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