Healthcare for the Ages

March 23, 2010

David Coates is a political science professor at Wake Forest University and author of the new book, “Answering Back: Liberal Responses to Conservative Arguments.”  Here he shares his perspective on the passage of the healthcare reform bill. If you are a journalist who would like to interview Coates, email Carol Cirulli Lanham at or call 972-818-0895.

By David Coates

Sunday was a good day. The House vote for health care reform was a good vote. It started us on a journey towards universal health care. It threw up a road block against some of the most egregious practices of the insurance industry. It established the principle that when you’re healthy you pay in so that when you’re sick you can take out; and that if you don’t earn enough to make that paying easy, tax dollars provided by the better paid should be used to ease that burden. Good principles – the healthy looking after the sick, the affluent helping out the near poor – a kinder and more compassionate social settlement than the one in place the day before: the one in which if you couldn’t afford to buy health care, you didn’t get it; the one in which if you became very sick, you ran a real risk of losing the very health cover you needed.

 So yes, a good day – one that will be long remembered – a good day, but sadly not a perfect one.

 The Senate bill was significantly weaker in its reforming zeal than the House bill, and it remains an open question how much of that weakness will be corrected through reconciliation. The answer is likely to be less rather than more.

  • We are likely to remain stuck with 50 state-level exchanges, not the one national one that the House bill initially contained.
  • We are likely not to find in those state exchanges any public option worthy of the name, so that the exchanges will be a site for competition only between private insurers, private insurers whose coffers will be overflowing with tax payer dollars paid over to them through the subsidies given to their low paid customers.
  •  We will have to live with the Hyde amendment enshrined into law, and extra hurdles created within the exchanges for women wishing to obtain health insurance that will give them the right to choose.
  • And even if it is a better week in the Senate than I fear, we will still remain wedded to a health care system based on profit-taking private insurance companies, one in which the main drivers of rising costs remain uncontrolled.

 So Sunday was both an ending and a beginning. It was an ending. It marked the moment when the US health care system was at last reset to give access to affordable health care to virtually all Americans. But it also was also a beginning. It set the stage for the next struggle: on how to keep that health care genuinely affordable, by addressing the inflationary forces still at work deep inside the system.


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