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US health-insurance reform, at last

30 March 2010

Obama has proposed a more humane system for everyone, says Bill Countryman

ON 21 March, the House of Representatives passed the com­­prehensive health-insurance Bill that had already been passed by the Senate in late December. The delay conveys a sense of how difficult it was to mobilise the Democratic majority.

The party was divided by dis­agreements over several issues: the possible use of federal money to fund elective abortions; whether the nation can afford to make this move, given the present state of the economy and the size of the national debt; and, perhaps most of all, it was fragmented by fear of an angry but unfocused electorate, which the Republican Party and the insurance industry have worked hard to frighten into reaction against the Bill.

As President Obama said of the Bill: “This isn’t radical reform, but it is major reform.” It comes at a time when it is particularly needed, because high unemployment has deprived many people of health insurance. The new system is certainly more humane than the patchwork it replaces, which permitted a certain amount of ruthlessness on the part of insurers.

They were free, for example, to refuse coverage for reasons of “pre-existing conditions”, in other words, because a person was already known to need medical attention. But, despite the claims made by the opposition, it is hardly a sweeping change.

What exactly the new law will mean will be­come apparent over the next few years, as the system is phased in. For many of those who have insurance now, it should make little difference. Employer-provided insurance will probably con­tinue to be the norm. For people at the lower end of the economic spectrum, it will mean some government assistance in purchasing insurance. For everyone, it will mean closer scrutiny of the practices of insurance companies — no more refusal because of “pre-existing conditions”.

Perhaps the most interesting thing about the whole legislative process has been the vastly dif­ferent ways people portrayed the Bill. Roman Catholics were strongly divided. The bishops argued that the Bill did not hold a strong enough line against funding abortion, while nuns and hospital ad­min­istrators, equally opposed to abortion, favoured it, possibly because they feared the consequences of any further increase in uninsured hospital ad­missions, but also because they are closer to the actual practice of medicine in the US than the members of the hierarchy, and more aware of the needs.

At this point, many of us will simply breathe a sigh of relief that this particular topic is resolved for the moment. Now Congress can move on, per­haps to deal with other vital concerns. Indeed, the House made a start by also passing a Bill to rationalise loans to university students, which have long been channelled through private banks at considerable expense and without discernible advantage to the students.

Dr Bill Countryman is Emeritus Professor of New Testament at the Church Divinity School of the Pacific in Berkeley, California.

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