The health-care bill that looks likely to clear the Senate this week is not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.
This claim, I feel, is just not based in reality. The following is a list of all the promises broken:
Promise:
Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.
The CBO has concluded that premiums for employer-provided insurance will not drop by anything close to $2,500 per year. Without reforms like drug re-importation, direct government drug price negotiations, a robust public option, or a central provider reimbursement negotiator, I see no way this reduction can happen with the Senate bill.
The Senate bill also breaks the key promise that “you can keep the insurance you have.” The excise tax in the Senate bill is designed to make your health insurance worse. It will force your employer to select plans with less coverage and higher co-pays. If you are one of the roughly 30 million Americans in 2016 who's insurance will be lessened because of the excise tax, your current health insurance will definitely change for the worse. Obama attacked John McCain throughout the campaign because his plan would tax your health insurance benefits. Now Obama is going back on his key distinction from John McCain by promoting a bill that does in fact tax your health insurance benefits.
Promise:
Barack Obama and Joe Biden’s new National Health Insurance Exchange will also help increase competition by insurers.
The Senate bill will use state-based exchanges. This is not some minor technical distinction. By using state-based exchanges, it relies on state insurance commissioners to enforce the new regulations. State insurance commissioners do not have a good track record policing the insurance companies. They often lack the power, funding, or will to hold them accountable. Regulation without strong enforcement is meaningless.
Promise:
Allow consumers to import safe drugs from other countries. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies should profit when their research and development results in a groundbreaking new drug. But some companies are exploiting Americans by dramatically overcharging U.S. consumers. These companies are selling the exact same drugs in Europe and Canada but charging Americans a 67 percent premium. Barack Obama and Joe Biden will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S.
This is a pure broken promise. Obama traded it away to PhRMA as part of a secret backroom deal (which itself breaks another promise: to make all negotiations public on C-SPAN). He actively worked to kill drug re-importation when it had a real chance of being added to the bill.
Promise:
Allow Medicare to negotiate for cheaper drug prices. The 2003 Medicare Prescription Drug Improvement and Modernization Act bans the government from negotiating down the prices of prescription drugs, even though the Department of Veterans Affairs’ negotiation of prescription drug prices with drug companies has garnered significant savings for taxpayers. Barack Obama and Joe Biden will repeal the ban on direct negotiation with drug companies and use the resulting savings, which could be as high as $30 billion, to further invest in improving health care coverage and quality.
Again, this is another broken promise that was part of Obama’s secret sweetheart deal with PhRMA.
Promise:
Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan... The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.
There is no public option in the Senate bill. In the health care system that Obama promise the public option was not just some “small sliver.” It was going to be the benchmark against which all private plans would need to be measured.
Promise:
Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
I do not believe the subsidized premiums are affordable and the subsidies are only for the 70% actuarial plans. Plans with this low of an actuarial will likely have high co-pays and deductibles.
Promise:
EMPLOYER CONTRIBUTION. Large employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement.
The Senate bill does not have a real employer mandate based on payroll. It only has a small “free rider” provision. Because of the lack of a real employer mandate, the amount of employer-provided coverage will drop by $5 million.
Other promises not part of the official campaign plan document:
During the 2008 primary campaign, Obama really pushed that a key distinction between Hillary Clinton and himself was that he promised not to include an individual mandate in his reform package. This bill has an individual mandate.
Obama attacked John McCain for planning to tax health insurance benefits. This bill taxes employer provide benefits.
Candidate Obama promised to make the negotiations public, and, clearly, that did not happen.
To recap: the Senate bill taxes benefits and will result in millions of Americans’ insurance plans changing for the worse. It is not expected to bring down premiums by $2,500 a year. There is an individual mandate forcing you to buy private health insurance, but no real employer mandate. The subsidies will be insufficient to truly make insurance affordable. It does not create a national exchange or a public option. It does not allow for drug re-importation or direct drug price negotiations by Medicare. All the negotiations were conducted in secret, and clearly to the detriment of the American consumer. It is a massive rollback of women's reproductive rights, something Obama promised to defend vigorously. These are not minor changes. These are core promises of the Obama campaign.
This Senate health care reform bill is nothing like what Obama campaigned on. Obama's two biggest campaign promises about health care reform--that he repeated over and over again (no individual mandate and no taxes on employer-provided heath insurance)--were both completely broken. If Ezra Klein wants to argue this is still a good bill, he has that right, but he should not try to re-write history. I studied Obama's campaign promises closely during the campaign, and this is nothing like the health care reform he promised. He did almost everything he promised he would not do, and he kept almost nothing of his most progressive promises to stand up to the powerful industry lobbies.
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