There are good things in there. Expanding Medicaid to cover 12-14 million more people is a positive development. Medicaid is a public program with low administrative costs (no exorbitant shareholder profits and executive salaries) that will keep costs down and guarantee coverage for those people. Moreover, thanks to the work of independent socialist Sen. Bernie Sanders of Vermont, the bill also increases funding for primary care health centers that serve under-resourced areas. These two provisions amount to a real expansion of the social safety net in our country. Contrary to the sanctimonious proclamations of the Democratic leadership, the rest of the bill does not.
The FDL analysis outlines the major structural problem with the bill: it requires individuals that don't qualify for Medicaid to purchase health insurance from private insurance companies or pay a penalty. The very same private companies that have been exposed for so callously putting profit above health. The very same companies that skim off the top so many of your premium dollars to pay for marketing, underwriting, lobbying, executive salaries, and huge profits for Wall Street. Yes, the very same companies the Democratic leadership has been railing against.
The mandate does come with subsidies for lower middle class families and some regulations, but they are inadequate, as the FDL analysis explains. A public option or a Medicare buy-in (a better public option in my opinion) would have protected some of those people from the profit-seeking chicanery of the insurance companies and held them partly in check through competition (I wrote on this here). Yet that public option was watered down and then finally flushed down the toilet to satisfy corporate Democrats. Indeed, the meek protest of the Obama administration, despite a strong public option being a part of his campaign platform, suggest that he was satisfied with the loss of the PO.
The result, in addition to forcing working families to pay too much for insurance, is that the bill doesn't get us even close to universal coverage. According to Congress's own budget office, the CBO, the legislation will only cover 56% of the uninsured by 2019. Remember that the next time someone compares this bill to the passage of Social Security and Medicare.
Until our leaders understand that expanding public health insurance programs is the way to go, Americans will continue to go bankrupt and even die from uninsurance and underinsurance and already exorbitant health care costs will continue to rise. As William Hsiao, architect of Taiwan's extremely successful health care reform, puts it:
You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.