National Nurses United

Rose Ann DeMoro Executive Director, CNA/NNOC The Real Motivations Behind Mandates How financiers are escalating the debt crisis and threatening your healthcare benefits behind the battle over healthcare mandates that has caused such sparks in the Democratic presidential contest is a significant policy battle that not only cuts across healthcare reform but poses a serious threat to coverage for everyone who receives employer-sponsored benefits. And they also have a direct correlation to the home mortgage crisis and bond market catastrophe. Take a closer look, starting with the millions of Americans staring at the loss of their homes due to the subprime loan debacle. It's not a loan crisis for those families; it's a debt disaster being forced upon them by the banks, hedge funds, and insurers who are desperate to shift their own mammoth debt onto someone else. It's also created a massive problem for state and local governments, which face the very real threat of insolvency as increasing numbers of investors abandon municipal bonds. Banking, other financial institutions, insurance, and real estate, which together make up the finance sector, now account for about half of U.S. corporate profits. With more than $2.5 trillion in outstanding consumer credit, $800 billion of that in credit card debt, and another $10.1 trillion in domestic mortgage debt, they have a gigantic problem. In looking around for help, the financial planners have identified two lucrative pots of cash. One is trading carbon credits for industries and employers that want to brand themselves as green while continuing to pollute. The other is healthcare, now 16 percent of our national economic pie and rapidly growing. The banks are already into healthcare in a big way, serving as a repository for health savings accounts and other tax credit MARCH 2008 schemes so beloved by the Bush administration and Sen. John McCain. But the financiers would like more. Enter the think tanks and policy wonks with plans to find new revenues for the financial markets in healthcare. Central to that approach is shotgun insurance, forcing everyone not currently covered to buy health insurance policies. Compelling people to buy insurance, however, is not the easiest sell. Big insurers and HMOs have a well-deserved bad reputation for heartless denials of care—that's how they make money. And, it's pricey. Premiums over the past decade have gone up 87 percent, not to mention the ever-climbing bills for deductibles, co-pays, and a host of other transaction fees. The finance industry is over the moon with services offered through the subsidized plans or cut payments to doctors and hospitals. To shroud the real story of who actually makes out like bandits, the proponents have dressed it up with misleading rhetoric that mandatory insurance is "universal healthcare." But "having" insurance is not the same as being able to use it. You're only being mandated to purchase the premiums; they're not mandating the insurance companies to make sure you get the care you need. Nor does "having" insurance protect you from financial ruin. Individual mandates accelerate the dismantling of group insurance plans with individuals forced to go it alone in the individual market—a major threat for those, like RNs, who mostly have employer-sponsored health coverage. The "Having" insurance is not the same as being able to use it. You're only being mandated to purchase the premiums; they're not mandating the insurance companies to make sure you get the care you need. this scheme. For insurers, it means millions of new customers marched into their offices with the force of law. With no controls on costs, many consumers will just add on more debt. That's a boon for the credit card companies and other financial institutions, but a heavy new burden on many of the same people now losing their homes or struggling with other financial hardship. Moreover, it doesn't work. The carrot is public subsidies for those least able to pay. However, that approach has noticeable flaws, best evidenced in Massachusetts, the individual mandate pioneer. As a result of that state's failure to control premium hikes, costs of the subsidized program in Massachusetts are projected to double over the next three years to $1.35 billion, and the state is debating whether to slash the health W W W. C A L N U R S E S . O R G mandates institutionalize risk and cost-shifting onto the backs of individuals and families. And they also distort the role of government, which should be to protect people, not act as an insurance agent. The debt fiasco should be tackled by regulating an out-of-control finance industry and jobs creation, not by putting more people in thrall to the insurance industry. And our health should not be a commodity, traded on the market like pork bellies or sold off to some hedge fund overseas to collect on medical bills we cannot pay. We needgenuine universal healthcare reform, the approach taken by every other industrialized country with a national healthcare or single-payer system. I Rose Ann DeMoro is executive director of CNA/NNOC. REGISTERED NURSE 11

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