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.