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RAD:June RH 7/22/09 10:30 PM Page 10 Rose Ann DeMoro Executive Director, CNA/NNOC A Uniquely American Mess President Obama seems to understand what's wrong, but lacks the political will for genuine, single-payer healthcare reform with five Senate and House committees, multiple draft bills, and the regular appearance of healthcare industry lobbyists and neo-conservative policy wonks on Capitol Hill and the TV talk shows, it would be easy to be confused about who's calling the shots on healthcare reform in Washington. The answer is on the other end of Pennsylvania Avenue, in the White House where President Obama has clearly seized the reins on the reform process and is now giving direction for what he deems acceptable and what is not on the table in the debate. And therein lies the paradox, or if you prefer, the tragedy of the great healthcare reform battle of 2009. Seldom has there been a president as aware of the need for real reform, and with as much disdain for the insurance industry. With a personal awareness of what is wrong with the insurance based system—he talks frequently of his mother's final months fighting her insurer while struggling with cancer—and a rare ability to use his bully pulpit to move the public. Yet a president who is also unwilling to embrace and lead a campaign for the very reform that is most universal, most cost effective, and most likely to improve quality of care to end our healthcare nightmare. In a mid-June press conference, for example, Obama criticized the insurance giants in language seldom heard in the Oval Office, noting that "the American people understand that, too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about how can we make sure that insurance is there when families need it." He further cited how the insurance giants exploited a Medicare carve-out for the private insurers under the last administration. "If we're spending $177 billion over 10 years to subsidize insurance companies under 10 REGISTERED NURSE Consequently, we are faced with the Medicare Advantage, when there's no showing that people are healthier using that pro- prospect of national healthcare legislation gram than the regular Medicare program, that is likely to include: A mandate forcing everyone not presently well, that's not a good deal for taxpayers." And, he even mocked the whining of those covered to buy private insurance, even though same insurers for opposing the tepid propos- the president sharply criticized that proposal al for a public option. "If private insurers say by his primary opponent last spring. Public subsidies for lower-income indithat the marketplace provides the best quality healthcare; if they tell us that they're offer- viduals and families to buy insurance poliing a good deal, then why is it that the cies, a massive public bailout worth billions government, which they say can't run any- of dollars to the insurance industry, yet withthing, suddenly is going to drive them out of out strong mechanisms to stop insurance price gouging or debusiness? That's not nials of medical care logical." they don't want to Yet despite this pay for. obvious recognition You have a president Possibly some form of the duplicity and who has essentially of tax on employer greed of the insurance signaled he will benefits, a centerpiece system, his unequivcompromise on nearly of the McCain camocal statement last fall any principle on paign in the fall which that healthcare is a healthcare as long Obama sharply con"right," and his acas there is a bill on demned in campaign knowledgement in his desk that he can appearances and ads. town hall forums that sign this year. The mitigating factor single-payer-type syssupposedly is that the tems are working well tax may be solely on in other countries, Obama has rejected single-payer, and continues the most expensive plans; in other words, the to promote an approach that will keep the pres- most comprehensive benefit packages proent, private insurance-based system largely viding the most protection for families which are also the benefit plans frequently found in intact. In a meeting with leaders of CNA/NNOC union contracts, an obvious incentive for and the Physicians for a National Health concessionary de mands by employers or Program in May, Sen. Max Baucus, lead play- reductions in benefits. A public option, being sold as the alternaer in the Senate who has drawn plenty of well-deserved critique of his own for tive plan for those who prefer a public plan excluding single-payer and for his close like Medicare rather than buy a private industry ties, shifted the onus to the presi- insurance policy. Obama says the public alternative will dent. "The president," Baucus told us, "wants to move healthcare reform very serve to "discipline" the insurers and force them to cut their bloated administrative quickly, and he wants a big win." Thus you have a president who has essen- costs and compete with better products, with tially signaled he will compromise on nearly rules to prevent insurers from rejecting peoany principle on healthcare as long as there is ple with pre-existing conditions or cherrya bill on his desk that he can sign this year, picking the healthiest customers. But in practice, the reality is likely to be far under the premise that reform must be enacted this fall before everyone gets side- different. Insurance companies are quite tracked by the 2010 election year cycle. (continued on page 15) W W W. C A L N U R S E S . O R G JUNE 2009