Leave it to lawmakers on Capitol Hill to wait until the year’s end to take up a major package pushed by congressional Democrats and the Biden Administration and that could potentially improve Americans’ health — big time.
The machinations by which the proponents hope to pass the “Build Back Better” program have, sadly and significantly, prevented too many people from knowing until this legislative endgame the exact content and effects of this initiative.
This occurred because Congress is so riven, including within the Democratic Party, that ambitious plans and money for them went in and out of the law like children in a hot house on a summer vacation. Media reports have zeroed in on the politics surrounding the measure and its possible financing — and less so on what it contains.
The New York Times’ fine “Upshot” feature, which focuses on evidence and public policy, has offered a helpful summary of key components now under consideration by the U.S. Senate — with a ticking clock and lots of other legislation to consider, too.
The Senate may make big changes still to Build Back Better, which rings up a tab just under $2 trillion over a decade of spending. But as reporters Reed Abelson, Sarah Kliff, Margot Sanger-Katz, and Sheryly Gay Stolberg have found:
“An estimated 3.4 million Americans would gain health insurance as a result of the legislation, which passed the House last month but faces a tough road in the 50-50 Senate. Senator Chuck Schumer of New York, the majority leader, said … that his goal is to have it pass before Christmas. The bill would expand health care access for children, make insurance more affordable for working-age adults and improve Medicare benefits for the disabled and older Americans.
“Separately, its health provisions are a ‘piecemeal of incremental changes,’ said Caroline Pearson, a senior vice president for health care at NORC at the University of Chicago, a nonpartisan research organization. But taken together, these policies represent the biggest step toward universal coverage since the passage of the Affordable Care Act in 2010. ‘This is a moment of extraordinary opportunity for improving health policy and improving the health coverage that people get,’ said Stan Dorn, director of the National Center for Coverage Innovation at the advocacy group Families USA.”
The newspaper team also reported:
“Medicare will add hearing coverage, but not a vision or dental benefit. The government will not gain the ability to bargain down the prices of hundreds of prescription drugs, though it will be able to lower the prices for 20 each year in the Medicare program.”
The piece carries subheads, highlighting key and advantageous health aspects of the broad Build Back Better, including how it could be:
- Providing Medicaid to New Mothers for a Year
- Erasing the ‘Coverage Gap’ for Poor Adults
- Providing Premium Subsidies to Middle-Class Americans
- Expanding Home Care, and Raising Wages for Those Who Provide It
- Capping How Much Medicare Recipients Spend on Drugs
These benefits come at a cost and the article also offers a pithy summary of complex finances, thusly:
“As a group, the health care provisions will cost $330 billion over the next decade and come with compensating health savings of $325 billion, according to an analysis of Congressional Budget Office data by the Committee for a Responsible Federal Budget. But that balance is slightly misleading: The parts that save money are designed as permanent, while several new coverage provisions would expire after 2025. Even with the changes, the Congressional Budget Office estimates that more than 27 million people would remain uninsured, including many undocumented immigrants, whom the bill does not assist. Many of the remaining uninsured would be eligible for expanded Obamacare subsidies or Medicaid, but are not expected to sign up.”
For those who are eager to see more information and analysis about Build Back Better, other organizations have offered their expert takes, including dissections by: the nonprofit, independent Kaiser Family Foundation, or work by the Center on Budget and Policy Priorities, or how about the thoughts of George Washington University faculty writing on the respected Health Affairs blog?
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to afford and access safe, efficient, and excellent health care. This has become an ordeal due to the complexity, uncertainty, and soaring cost of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Americans spend more than $3.5 trillion annually on health care, while receiving some of the poorest outcomes among their peers in advanced, industrialized nations. Too many patients in this country forego care that would change or save their lives due to skyrocketing medical costs, which persist as a leading cause of bankruptcy. This is all unacceptable. In the wealthiest nation in the world, health care must be a right and not a privilege.
One party — the Republicans — have failed to offer their alternatives to improving U.S. health care, partly because of a theological opposition to a federal role in any part of medicine. That makes no sense when citizens’ needs are so great. Critics have assailed the cost of the Biden-Democratic package — which by the way also deals in major ways with the inarguable and vital concern of climate change. But politicians on both sides of the aisle seem all too willing to wave by far greater defense spending.
We have much work to do to make so many lives in this country healthier, longer, and better, and if spending for that isn’t a priority, what’s wrong with us?