Health Care Reform – An Independent Assessment

The Senate on Monday resumed debate on health care reform legislation. Senator Bernie Sanders offered an independent assessment of where the legislation stands, and what he sees as its pros and cons. “It is not insignificant that this bill provides insurance to 31 million Americans who have no insurance. That is a huge step forward for our country. It is not insignificant that this legislation provides for major health insurance reform and finally outlaws some of the problems of the private insurance companies. This bill is strong on disease prevention. It says to families that young people will get coverage until they are 26 years old. All of those are very important steps forward,” Sanders said in a floor speech. 

The Sanders identified some of the bill’s weaknesses.

“Right now, we are spending almost twice as much per person on health care as any other major country on earth, despite the fact that our health care outcomes in many cases are not as good. Can I stand here with a straight face and say, we have got strong cost-containment provisions in this legislation, that if you're an ordinary person that has employer-based health care, that your premiums will not go up in the next year? I can't say that. It is just not accurate.

“At the very least, we must have a strong public option to provide competition to the private insurance companies, which are raising their rates outrageously every year. What is to prevent them from continuing to do that under this legislation? Not a whole lot, frankly. So the fight must continue for strong public options, not just to give individuals a choice about whether they have a public plan or a private plan, but also to provide competition to the private insurance companies.

Another concern that I have is that our primary health system in this country is on the verge of collapse. There are people all over this country who cannot get in to see a doctor. In fact, we have some 60 million people in medically underserved areas, most of them can't get to a doctor, and what they end up doing is going to the emergency room. They end up getting sicker than they should be and they go to the hospital. What I worry about, if we add 15 million more people into Medicaid, if we add another 16 million people into private health insurance, where are those people going to get the primary health care that they desperately need?

The good news is that in the House there is language put fought for by Congressman Jim Clyburn that would add $14 billion over a five-year period in order to see a significant expansion of community health centers and the national health service corps.

Community health centers today are providing dental care, low-cost prescription drugs, mental health counseling to some 20 million people. And what is in the House bill is language to greatly expand that program and also to expand the national health service corps, which provides debt forgiveness for medical students who are going to practice primary health care or dental care or nursing in underserved areas. We desperately need more primary health care physicians, certainly we have to change reimbursement rates. One way we can help is when medical school graduate students are graduating with $150,000 in debt, debt forgiveness service will help them. This is an absolutely essential provision that we have got to adopt. We have to do what the House did and provide at least $14 billion more for primary health care, expansion of community health centers, and the national health service corps.

Now, there's another issue. At the end of the day, we have got to understand that one of the reasons that our current health care system is so expensive, so wasteful, so bureaucratic, so inefficient is that it is heavily dominated by private health insurance companies whose only goal in life is to make as much money as they can. We have 1,300 private insurance companies administering thousands and thousands and thousands of separate plans, each one designed to make a profit. The result is, we are wasting about $400 billion a year on administrative costs, profiteering, high CEO compensation packages, and all the other stuff, which goes with the goal of private insurance companies to make as much money as we can. I will be offering on the floor of the Senate,I believe for the first time in history, a national single-payer program. And I look forward to getting a vote on that. I am not naive. I know that we will lose that vote. At the end of the day -- not this year, not next year -- but sometime in the future, this country will understand that if we're going to provide comprehensive quality care to all of our people, the only way we will do that is through a medical single-payer system.

But for now, we have language in this legislation which must be improved, which gives individual states the right, if they so choose, to go forward with a great deal of flexibility in order to provide quality care for all of their people. Many states may look at a single-payer, other states may look at other approaches, but I believe that it is absolutely imperative to give maximum flexibility to states to be able to take the money that otherwise would be coming into their state, to use that for their own innovative health care programs, designed to provide quality, universal, comprehensive health care in a cost-effective way. Some may choose to go single-payer. Some may choose to go another direction. We have language in there which must be improved, so that states can begin that process when the exchange comes into effect in 2014.

The bottom line here is this bill has a number of very important features which I think will make life easier for a lot of our fellow Americans.

There are many problems remaining, and I hope that in the coming weeks we will successfully address those problems.