Froozan Parwana is one of more than 400,000 New Mexicans without health insurance.
Her trip to the emergency room last summer was a harsh introduction to what awaits patients without medical coverage. Parwana's bladder was pressing against her appendix, causing her white blood cell count to surge. After a few tests and a five-hour stint in the waiting room, doctors told Parwana she wouldn't need surgery unless her condition got worse. The visit cost more than $300. The hospital bill forced Parwana to take fewer classes last fall at CNM, where she studies engineering. "There is always that risk of something serious happening," Parwana says.
President Obama has made no secret of his desire to see a reform bill on his desk this year. Speaker Nancy Pelosi promised such legislation will pass the House by late summer, but that seems unlikely. Obama gave a frustrated speech on Monday, July 13, in which he said, “We are going to make this thing happen.”
Several plans have bubbled to the surface. Most proposals would cost around $1 trillion over the course of 10 years. The sticker price is steep, but proponents of the legislation say acting now is crucial because the system must be fixed. "We have an unsustainable situation," state Sen. Dede Feldman says. She spent part of June in Washington with other legislators from around the country meeting with the president’s staff. They wanted to impress upon Obama what real reform would look like, including a government plan that would compete with private insurance and incentives for doctors to work in rural areas. "We have a better chance of getting health care reform passed than ever before," she says.
“The public option could become the de facto plan for the country.”
Jeff Dye, president of the New Mexico Hospital Association
There are powerful forces shoving against reform, according to Dr. Jason Cohen, who works at UNM Hospital. He says insurers, pharmaceutical companies and private hospitals would like to keep the status quo intact. Plus, old-school doctors who have been working within the privatized model for a long time are resistant to change, he adds. Cohen’s views are as a private citizen, not speaking on behalf of UNM Hospital.
The medical industry's voice in Washington is loud. According to the nonpartisan website OpenSecrets.org, the industry spent more than $166 million lobbying the federal government in 2008. More than $95 million in campaign contributions came pouring in from health care stakeholders during that year as well. "The sheer amount of money that comes in to legislators really creates a conflict of interest," Cohen says.
Paying for the expensive legislation is another tall task. The government could tax wealthy Americans or spend less on Medicare. Figuring out how to fund the bill is the biggest hurdle Congress faces, according to Sen. Jeff Bingaman’s spokesperson Jude McCartin.
Dr. Cohen asserts that taxpayers are already picking up the tab for people without insurance. He says people without coverage tend to wait until their illnesses have gotten more serious before they go to an emergency room for treatment. Hospitals that see patients without insurance have to pay for uninsured people's visits somehow. Cohen says they do it in one of two ways: They either dip into funds provided by the state and federal government (tax dollars) or they increase the amount of money they charge people who have insurance. "We're already paying for it," Cohen says. "We're just doing so in a grossly inefficient and irrational way."
Rep. Martin Heinrich says the toughest part of enacting reform will be convincing Americans that altering health care coverage won't hurt them. "Change is scary for so many people," Heinrich says. "People are so afraid of losing their coverage today that they're afraid of anything different, even if it might turn out to be better."
A mammoth point of contention in Congressional health care discussions is whether legislation should include a public plan. The plan would be government-run, or at least overseen by the feds. Congress has created different versions of public health care options. Under many models, it would be subsidized by taxpayer dollars but wouldn't necessarily be free for patients. It would provide care to Americans without health insurance or other coverage. More expansive versions of the plan would allow people to drop existing insurance and choose the public option.
The objective is to create competition. Medical insurers and private health care providers would go toe-to-toe with a government-run program. The medical industry would have to charge a fair price for their services or risk losing business.
Jeff Dye, president of the New Mexico Hospital Association, says he'd rather not see a government-funded public system passed. He says if the plan is buoyed by tax dollars, it will have an unfair advantage because many private hospitals don't have the luxury of relying on federal cash. "The public option could become the de facto plan for the country," Dye says, and that would mean the private medical industry would suffer.
For some, a government-run program competing with private industry doesn't go far enough. Kelley Burns says a single-payer health care system is the best option, making the government the sole provider of medical services. Burns couldn't get her insurance plan to approve gastric bypass surgery that would have cost her $26,000 out of pocket. She says not having the procedure put her life at risk. Burns eventually switched coverage plans and got the surgery partially paid for by insurance. "You need to take the health care industry out of the equation and put it in the hands of government," Burns says. "It's working in Canada, France and other European countries."
Politicians have largely avoided discussing a single-payer program option. However, public option proponents have an ally in New Mexico Sen. Jeff Bingaman. The senator sits on two key committees where health care bills are born. Committee members can also kill legislation before it reaches the full Senate floor for a vote. Bingaman spokesperson McCartin says the senator supports a bill that was crafted in the Health, Education, Labor and Pensions Committee, on which Bingaman serves. "Sen. Bingaman is very hopeful that a public option remains in the bill as it moves ahead," McCartin writes in an e-mail.
Republican opposition to a public plan is unanimous in Congress. Some Democratic legislators in right-leaning states say they are hesitant to vote for a health care bill with no Republican support.
Despite roadblocks, Dr. Cohen says a public plan is too important to dismiss. "It's not acceptable to me as a physician, or an American, that any of my fellow citizens can't afford to get care for their medical problems," Cohen says. "Whatever plan we have has to cover everyone."