It's been a rough week for democracy and genuine healthcare reform.
The Senate revealed itself to be a deeply flawed institution better suited to sausage making than democratic deliberation. The doling out of party favors has resulted in a historic but watered down bill to expand healthcare coverage to 30 million more Americans. Widely shared reform goals--a public option, Medicare expansion--have been killed off by turncoat Senators like Joe Lieberman and Ben Nelson, an anti-democratic filibuster, and a White House unwilling to lead more boldly.
But step back for a moment and look at how a few Senators have worked to leaven this flawed bill--adding some decent and humane measures.
Without fanfare, the good Senator from Vermont, Bernie Sanders, has continued to work behind the scenes to champion community health centers--something he has done for years (also here). These non-profit, community-based facilities provide primary healthcare, dental care, mental health services, and low-cost prescription drugs on a sliding scale. As amendments were added in recent days to win over the Liebermans and Nelsons of the "greatest [undemocratic] deliberative body" in the world, Sanders made sure that a $10 billion increase in funding for the health centers was included.
"This is not gonna solve all the problems of the world," Senator Sanders told me yesterday. "But expanding access to high quality primary health care, and low-cost prescription drugs, and mental health counseling, and dental care--which is a big issue--this is a very significant step forward. If you walk into a health clinic and you have no insurance at all they will treat you on a sliding scale basis. So, that's affordable healthcare."
There has also been little news coverage of Sanders' fight to allow states waivers so they can move forward with their own "health insurance concepts, including single-payer." Such language is now in the Senate bill and Sanders is still working with Senator Ron Wyden to strengthen it. That is exactly how Canada developed its healthcare system, with a successful program incubated in Saskatchewan. This provision is actually stronger in the Senate bill--it didn't make it into the House version.
"It's still in play," Sanders says.
As for the community health centers--officially named federally qualified health centers--they were spearheaded in the 1960s through legislation authored by Senator Edward Kennedy. There are now 1200 of them across the country with over 7500 satellites. 20 million Americans utilize these facilities, including 1 out of 6 Vermonters, giving the state the highest rate of participation in the nation.
Also critical, the funding would expand the National Health Service Corps which provides loan repayments and scholarships for primary care doctors, dentists, nurse practitioners, physician assistants and mental health professionals. Sanders points out that currently there is a "primary healthcare crisis" with "tens of millions of people"--even people who have insurance--unable to find a primary healthcare doctor or dentist.
The House bill provides $14 billion in funding for the federal health centers and service corps. Sanders says that indications from the White House and Democratic leadership are that there is a "good chance" the final bill will do the same. That would translate to health centers in 10,000 more communities throughout America within 5 years, and increase the number of people served by over 100 percent, to 45 million. It would also create 20,000 new primary care practitioners, dentists, nurses and other healthcare professionals. Sanders emphasizes a George Washington University study that shows the $14 billion expenditure would save money--$23 billion in Medicaid alone--"because you're keeping people out of the hospital and out of the emergency room. Now if this is not a win-win-win situation, I don't know what is," he says.
Sanders notes some other positive elements of the Senate bill.
"We can talk about the politics, and all of our disappointments," he says, "but at the end of the day you're gonna have 31 million more people who have health insurance--taking us up to some 94 percent [covered]. That's not an insignificant achievement and we shouldn't become too cynical about it."
Sanders also says the insurance reforms--banning denials based on preexisting conditions, lifetime benefit caps, and dumping people because they ran up a high healthcare bill--are significant.
Finally, he points to disease prevention which was a real focus for him and Senator Tom Harkin.
"There are billions and billions and billions of dollars going in to try to make sure we do a lot better as a nation in preventing heart disease, preventing diabetes, preventing cancer--than we have done in the past," Sanders says. "So at the end of the day it saves you money, and certainly prevents human suffering."
One thing Sanders is unhappy with is a lack of cost-containment. There are generous subsidies for people with limited income but every year healthcare costs will continue to "go up 5-8 percent and the government will pick up the tab" for those subsidies.
"I think it's fair to say that the insurance companies and the drug companies are going to laugh all the way to the bank, they're doing very well," Sanders says. "The people who are not doing particularly well are the taxpayers of this country and that is obviously an issue we are gonna have to address the day after this bill is passed."
Sanders urges progressives to continue fighting for House provisions--including the $14 billion for community health centers, progressive taxation as opposed to taxing healthcare benefits, and a strong public option.
But can we get a better bill and still get 60 votes?
"Well, that remains to be seen," Sanders says. "What is being increasingly discussed all over the country is this is extremely undemocratic. You've got a strong majority in the House who want to do something, and all of that effort is nullified by one or two people in the Senate. Does that make sense to you? I don't think it's fair. So I think we want to take a look at how we deal with a dysfunctional situation like we've seen on the Senate healthcare bill, and you know, maybe some good will come out of that."