Health care reform shorts: Who will still not get care under reform?

While Republicans in the House of Representatives grandstand against the insurance reform act passed last year, we need to remember that there are lots of us who don't like the bill because it failed to go far enough in improving access to doctors. Polls that measure attitudes to the law show that roughly 40 percent claim to approve of it and 41 to disapprove -- but some of the later just wanted something better.

"Overall, it didn't go as far as I would have liked," said Joshua Smith, 46, a sales consultant to manufacturers who lives in Herndon, Va. "In a perfect world, I'd like to see them change it to make it more encompassing, but judging by how hard it was to get it passed, they had to take whatever they could get."

CBS News, January 16, 2011

"Whatever they could get" means that in 2019 there will still be 22 million people in this country without the rudiments of access to medical care should they get sick. According to Ezra Klein,

• About one third of them will be undocumented immigrants. If we can't manage the political will to solve the injustices created by allowing employers to attract cheap workers with no rights and no way to get legalized, we'll go on having this class of absolute outsiders in our midst.

• Another set of the uninsured will be the abysmally poor who have avoided contact with the social welfare system. The new mandate that people must buy health insurance exempts people for whom this would cost more than 8 percent of monthly income. They'll be in big trouble, just like today, if they need care. But the system will have a huge incentive to try to get them on some form of Medicaid, state-level government provided health coverage subsidized by the Feds.

• Finally there will be the inevitable set, most young and feeling invincible, who just blow off the whole system, figuring they'll pay the $750 penalty for failing to carry insurance if they have to. The law with its penalty simply recognizes we are that kind of country, though the benefits of being insured ought to become more and more obvious to anyone who looks around.

The United States should have health care reform that covers everyone; most developed countries manage this through some form of single payer (we'd probably call it "Medicare for all") or very heavily regulated private insurance. But we will only get that if our powers-that-be become willing or able to take on the mess of drug companies, doctors, hospitals and medical device merchants that collude to squeeze private profit out of sick people. That's who really stands in the way health care reform. Those Republicans are just performing theater on behalf of their sponsors.