AP Photo/Paul Beaty

Crowded emergency room at Stroger Hospital in Chicago July 30. Stroger is a “safety net” hospital, providing minimal care to Medicaid and uninsured low-income patients. Such programs are targeted for cuts as part of “health-care reform” bill being hashed out by Congress.

The House version narrowly passed November 7 by a vote of 220 to 215. One Republican, Anh Cao from New Orleans, voted for it. To become law the Senate must approve a bill, and the two versions would have to be reconciled and voted on again.

The keystone of the nearly 2,000-page bill is the health-care “mandate,” which requires all U.S. citizens and legal residents to have health insurance. Those who can’t afford to buy insurance at the going rate would be eligible for government subsidies Anyone still without insurance would be forced to pay a fine.

Under the proposed law a “Health Benefits Advisory Council” would propose a minimum plan everyone must have and that large companies would have to offer. Nothing in the bill would require insurance companies to provide that minimum level at a price that working people can afford.

Supporters of the reform say that it will insure 30 million additional people, many through expanding Medicaid coverage to those earning up to 150 percent of the official federal poverty level.

As part of financing the project, proponents of the bill estimate collecting $33 billion in fines from those who don’t obtain insurance in the first 10 years of the program.

The fines would be collected by the Internal Revenue Service, which has the power to charge those who don’t pay up with a misdemeanor. Penalties could include up to a year in jail.

The Senate version of the bill steeply taxes so-called Cadillac health insurance plans, that is, plans offered by some companies, often as a result of union contract negotiations, that provide more substantial benefits and medical care.

The House and Senate bills promise to extract billions of dollars in savings from Medicare and Medicaid by cutting costs, discouraging many medical treatments and procedures, slashing fees paid to health-care providers, and making health-care workers increase “productivity,” a code word for speedup.

A November 13 report by the Centers for Medicare and Medicaid Services, an agency similar to the Congressional Budget Office, notes that if payments are reduced, some hospitals and doctors will refuse to accept Medicare patients.  
 
Obama: ‘Take painkillers’
Answering charges in June that the reform would mean some treatments would not be available, President Barack Obama said, “Maybe you’re better off not having the surgery, but taking the painkiller.”

A November 12 column in the Wall Street Journal by Andrew Heinze, who describes himself as a writer and “registered Democrat living in New York City,” said that after seeing the health-care reform bill, “I’m preparing for life without health insurance.”

He notes that he currently cannot afford even the least expensive HMO plan, about $13,000 a year for an individual. So instead he has opted for a hospitalization plan—also known as catastrophic insurance because it pays for almost nothing except a major medical emergency. Heinze’s plan covers only hospital expenses, not doctors’ fees.

Heinze argues that if he has to pay a fine for not buying the required plan, he might not even be able to afford the bare bones catastrophe insurance.  
 
What will ‘minimum’ plans cover?
Exactly what medical services the minimum required plan would include, and how large a deductible workers may have to pay before the insurance kicks in, won’t be set until after the bill becomes law. Some plans currently offered by companies large and small, exclude coverage for routine medical checkups, mammograms, physical therapy, and mental health.

The debate over a “public option,” a government-owned and run insurance, received widespread publicity after it was included at the last minute in the House bill. The text says that premiums would be set to “fully finance” the cost of medical treatment under the plan.

Under the main versions of the bills currently in Congress, insurance companies will still be allowed to charge higher fees to smokers and the elderly.

Whether some version of health-care reform is passed or not, capitalist corporations will continue to rake in profits. Already in the last year, pharmaceutical companies have jacked up the prices of brand-name prescription drugs by more than 9 percent.