Sunday, March 28, 2010

To be continued over matzah

All right, the preparations for Passover have put my blogging behind schedule. I will get back to analyzing the health care bill next week, after the seders. In the mean time, here's a very narrow but deep problem with the health care system that the bill won't fix:

Wednesday, March 24, 2010

Also to Like, but Not about Health

I forgot to mention that the health insurance bill does some good things on an entirely unrelated subject: student loans. It increases the maximum Pell Grant and forgives the debts of more students quicker. It provides money to community colleges for career training. Most interesting: it makes families who want federally backed student loans get them from the federal government, not from banks. It cuts out the middleman and saves a ton of money.

Question: if the federal government can lend money directly, why can't it buy health care directly? If cutting out the middleman is good in education, why not in health care?

What's to Like about the New Health Insurance Bill

How should we regard the new health insurance bill that President Obama just signed into law? On Monday, I gave an overview. For the next few days, let's go into the details.

Compared with the system we have now, there's plenty to like about the new plan. Based on a summary in the Boston Globe, here are some of the good points:

More money for states to pay for poor people's health insurance. "Massachusetts would receive a $2 billion boost in Medicaid assistance over 10 years to help pay for insurance coverage for low-income residents." Medicaid plans let poor people get decent health care they couldn't afford otherwise.

More money to help moderate-income people pay for their own health insurance. "Tax credits are provided to help pay for insurance, and that aid is available for people with incomes up to four times the federal poverty level, which is $88,2oo for a family of four and $43,32o for an individual."

Fewer denials of coverage. "The measure would prohibit insurance companies from denying coverage because of a preexisting condition," within six months for children and by 2014 for adults. It also lets young adults stay on their parents' plans until they turn 26 (meaning fewer will go without health insurance), and it makes sure Medicare pays for elders' prescription drugs (eliminating the "doughnut hole" in which, if you paid more than $2,700 a year for prescriptions, you were on your own until your expenses mounted to $6,200). People with pre-existing health problems, young people, and seniors make up a large part of the population! They will all be better off because of these provisions.

Coverage for legal immigrants. Currently, the federal government provides no help at all to legal immigrants seeking health insurance. In 2014, under the new bill, the feds would send money to state governments like Massachusetts which choose to subsidize health insurance for low- and moderate- income legal immigrants the same way as they subsidize low- and moderate-income American citizens.

If your question is, "Will anybody be better off under the new bill than they were before?", then the answer is, "Yes, lots of people will." And I agree with columnist Scot Lehigh that Obama and the Democrats need to go on tour to promote it. They should use every mass marketing and social networking trick in the book to spread the word and build support for the bill.

That doesn't mean I think it's a good bill. Why? Come back tomorrow to find out.

Monday, March 22, 2010

The Blessing and the Curse of the Health Insurance Bill

Democrats will say that the health insurance bill which passed the House of Representatives last night is a historic expansion of the right to health care. Republicans will say that it's full of loopholes and sweetheart deals and that it costs too much.

They're both right.

We in Massachusetts have lived under something a lot like the new federal health insurance system. We are in a privileged position to tell the rest of the nation what to expect. Over the coming days and weeks, I will try to do just that.

Here's a hint at what you're likely to hear from me. I work in an anti-poverty agency, and the way that both the Massachusetts and the federal bill expand high-quality care to the poorest of the poor is something I can applaud. Plus, everyone can be happy that insurance companies will have to cover people regardless of pre-existing conditions--and that they have to cease and desist dropping people's coverage once they get sick. These are real gains.

For people who are not among the poorest, this bill is bait and switch. It promises health care, but only delivers on health insurance, mostly at our own expense. The kinds of health insurance that many working poor and even middle-income people will be forced to buy won't help them with the things they need most: doctor visits, preventive care, prescription drugs. Instead, they'll be required to send their hard-earned money to fatten insurance company profits for policies that only kick in when they have medical emergencies. By delivering new customers to already-wealthy insurance companies while not paying attention to the daily needs of the working and middle classes, Obama and the Democrats are creating a constituency that will blame them, think of them as out of touch, and be open to manipulators like Scott Brown.

The country would be better off if our rulers had passed the Medicare-for-all type system that most people want. It would include everybody, meet all their basic needs, and cost much less. But it was never seriously discussed. That's why we're left picking out crumbs of good news on a day when we should have been able to feast on victory.

Thursday, March 4, 2010

The Real Economy is People

Note: This entry first appeared as a column in the Somerville Journal.

They say the economy is improving. But you can’t tell it by Anne.

Anne is a graphic designer in her mid-50s. She has made her own living all her life, either in her chosen field or in general office work. She hasn’t been able to find a steady job for the past year. Anne came to the Community Action Agency of Somerville (CAAS), the anti-poverty agency where I work, to apply for the Supplemental Nutrition Assistance Program, or what most of us still call “food stamps.” She was denied. Having a little bit of savings for her retirement meant Anne was poor, but not poor enough for benefits.

They say the economy is improving. But you can’t tell it by Matt.

Matt is one year out of college with a degree in mathematics. He is working in a corporate mailroom, as a temp. Matt has the skills to do a lot more. His first temp job had him troubleshooting a web site designed to let middle school students study math at their own pace. He had hoped a few months’ temp work would put him in line to use his skills in a permanent entry-level job. No one was hiring. For now, he is sorting the mail.

They say the economy is improving. But you can’t tell it by the Blanco family.
Antonio and Maria Blanco have lived in Somerville since 1988. They have gone to church here and raised their three children here. They both commute into Boston where he works as a janitor and she as a nurse’s aide. Two full-time jobs are not enough to support a family in Somerville. So, four nights a week, Antonio comes home for dinner and a quick hello to his children. Then he heads out again to his second job as a night watchman in an office building. With two-and-a-half full-time jobs, the Blancos are still living at the poverty level.

For whom is the economy improving? Not for tenants living in buildings where the owner can’t pay his mortgage and the bank is taking over and evicting the tenants. Not for disabled people, who have a harder time finding work than average even when the economy is sound. Not for most of the people we call our neighbors. A few are fortunate to work in high-income jobs. Most are struggling to get by.

At CAAS, we are on the side of the struggling. We can help people narrow the gap between what they have and what they need, with services like job readiness training, housing and benefits advocacy, and early childhood education and daycare through our Head Start program. But human service agencies cannot do it alone. If life is really going to improve, all of us, in Somerville and across the country, have to change the way we think about “the economy.”

The real economy is not corporations, nor the stock market, nor the price of real estate. The real economy is people. How many people have jobs that pay a living wage? How many families can pay for the necessities of food, clothing, shelter, healthcare, transportation and childcare without working all day and all night? Who has a sense that they really belong, as a respected member of this community? Who can look forward to a better future?

These are the questions we must ask ourselves. These are the goals we should set for our city and our country. We will know we live in a better economy when the answer to each question is, “We are all doing better, together.”