New America Media 

President Obama, every Democratic and Republican senator and House member, the private insurers, major pharmaceuticals, liberals, progressives and many conservatives are virtually unanimous in claiming that the big reason for waging the health care reform war is to insure all, most, or many of the estimated 50 to 60 million uninsured Americans. Blacks and Hispanics have the most to gain from real reform. They make up more than half of America’s uninsured. Private insurers, pharmaceuticals and major medical practitioners fought a seven-decade battle against national health care regulation in large part out of horror at having to treat millions of uninsured, unprofitable, largely unhealthy blacks and Hispanics.

The overwhelming majority of black and Hispanic uninsured are far more likely than the one in four whites, who are uninsured, to experience problems getting treatment at a hospital or clinic. A study by the Joint Center for Political and Economic Studies found that they are far more likely than whites to suffer higher rates of catastrophic illness and disease, and are much less likely to obtain basic drugs, tests, preventive screenings and surgeries. They are more likely to recover slowly from illness, and they die much younger. The cost of treatment and care for the millions who suffer chronic and major diseases—cancer, diabetes, asthma and heart disease—is exorbitant. Blacks and Hispanics have far greater incidences of these ailments than whites. According to a Kaiser Foundation study, a family of four without insurance currently would spend an estimated 15 percent of its total income on health insurance, if it had the money.

A fully functioning and funded public option might have covered a moderate number of those totally shut out of access to affordable, quality medical coverage. Obama and top Senate Democrats snatched it off the table in backdoor talks at the White House with private insurers and the pharmaceutical industry in the first months of his administration. The House version of the public option is cautious, moderate and would not fully kick in for a decade. Even then it would cover only a small number of the uninsured.

The House public option almost certainly will be the first casualty in the second round of warfare when House-Senate conference negotiators try to reconcile their two wildly-at-odds health care reform bills. The plan to extend Medicare coverage to millions more would have made a small dent in the number of uninsured and it was lightly floated and then just as quickly tossed. But the Medicare extension had even less chance of getting Senate traction than the public option.

The still undetermined number of uninsured will have to buy health insurance at a still undetermined cost from private insurers, and they’ll have to rely on the major pharmaceuticals for their prescription drugs. The government promises to provide subsidies to those too poor to pay (which will almost certainly be virtually all of the uninsured), enforce a mandate for private insurers to provide coverage to any and all, and to keep the cost of their coverage and drugs down.

That’s the promise. How much the government can and will pay is vague and tenuous. And with public jitters rising over the trillions of government spending and dueling projections on the end cost of health reform creating even more jitters, any dollar figure put forth on the amount of government subsidies for the poor is just guess work. But even if the government has the billions promised to underwrite insurance for those too poor to buy it, even under the most generous provisions of the subsidy plan, according to a Congressional Budget Office Report more than 40 percent would still not get a nickel of help. Yet they’d still have to pay the estimated hikes in premium coverage that they’d be forced at penalty to buy.

The ban on denial of coverage due to preexisting conditions won’t go into effect until 2014. The unanswered question when it finally does take effect is just how tough the government will be in policing the private insurers to make sure they don’t wiggle out of their agreement not to deny anyone coverage on medical grounds, or to arbitrarily raise the cost of coverage. The House and Senate bills are filled with talk of commissions, panels, task forces, integrity councils, and a big role for the departments of Health and Human Services and Justice to prevent fraud and abuse. There’s absolutely no mention of enforcement procedures, or what fines and penalties will be imposed for skirting the ban.

The House bill partly addresses some of the massive problems the uninsured face in getting coverage. The Senate bill addresses almost none of them. As it now stands, health reform is still not the cure for the chronic absence of health care that ails the millions of black and Hispanic uninsured.