“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — Martin Luther King Jr. in a speech to the Medical Committee for Human Rights, 1966
With Martin Luther King’s birthday earlier this week, pundits and politicians celebrated the annual tradition of trying to guess what he would have said about current issues if he was alive today. Obviously it’s impossible to tell exactly what Martin Luther King would have thought about health care reform, but that hasn’t stopped people (including us) from guessing.
Republicans weren’t talking much about health care and King directly, but they hinted at it. For example, in a facebook post, Sarah Palin wrote that, “He fought for liberty and equality because he knew they were God-given and he knew that no government should be empowered to thwart our freedom” The implication, given that conservatives have spent the past year stoking fears of a “government takeover of health care,” is that King would have been against health care reform because it would be a blow to freedom.
Meanwhile, some progressive blogs have complained that the bills don’t go far enough towards King’s vision of equality. They point out that millions will remain uninsured, the “Cadillac tax” on expensive health plans could hurt middle class workers, and the subsidies don’t go far enough towards helping poor families. These bloggers are probably right to a certain extent- King would have pushed for a bill that did more to help poor and working families, and a bill that covered everyone.
That doesn’t mean, however, that the bill we have now isn’t worth passing. Criticisms from the left tend to gloss over the good parts, and there is plenty in both the House and Senate bills that King would have supported. A fact sheet from the nonpartisan Kaiser Foundation points out a bunch of ways health care reform will make the health system more equitable for the poor and people of color:
Expanding Health Coverage
Employer mandate – Low income jobs are generally jobs that don’t provide health benefits. Although there are exceptions, the proposed legislation would require most employers to provide coverage to their employees.
Health exchange – The House bill and Senate bill allow people to buy coverage through a health exchange. For those who can’t afford insurance, subsidies are available for people with incomes up to 400% of the Federal Poverty Level (FPL). The FPL in 2009 is $14,404 for individuals and $29,327 for a family of four.
Medicaid Expansions – The House bill would expand Medicaid to cover anyone who makes less than 150% of the FPL (in the Senate it’s 133%). That’s 25 million more low income people who would be covered and would pay no premiums.
Improving access to care
Community Health Centers – Half of the patients who receive care at a community health center are people of color. Each health reform proposal includes funding increases for community health centers, which would help them meet the needs of their patient population.
Workforce Development – There is currently a shortage of health professionals that is getting worse- mostly in low income rural and urban areas. Both bills contain provisions aimed at increasing the number of providers, particularly primary care providers, and increasing the number of providers in medically underserved areas.
Other provisions related to disparities
Indian Health Care Improvement Act – Under the House bill, the Indian Health Care Improvement Act would be reauthorized for the frst time since 2001. This Act includes provisions to improve health promotion and disease prevention services, to improve access to care for urban Indians, and to modernize facilities where American Indians and Alaska Natives receive care.
Immigrants – Legal immigrants would remain eligible for Medicaid, but would continue to be barred from enrolling during their first five years residing in the U.S. Legal immigrants would also be eligible to receive subsidies on the same basis as citizens. However, none of the proposed bills would allow undocumented immigrants to enroll in Medicaid or to receive subsidies for coverage through the health insurance exchange.
Prevention – People of color experience higher rates for many chronic conditions, as well as higher death rates from many of these conditions than whites. All of the bills contain provisions to improve access to proven preventive services.
It’s easy to say what Martin Luther King would think of these specific provisions- it’s harder to say what he would think of the bill overall. Both the House and Senate bills are far from perfect. The abandonment of the public option was a major disappointment, and there are legitimate concerns about whether or not the bills (particularly the Senate version) would do enough to make insurance affordable for low income folks. But still, Obama made a good point in his speech to Vermont Avenue Baptist Church on Sunday:
Sometimes I get a little frustrated when folks just don’t want to see that even if we don’t get everything, we’re getting something. (Applause.)
King understood that the desegregation of the Armed Forces didn’t end the civil rights movement, because black and white soldiers still couldn’t sit together at the same lunch counter when they came home. But he still insisted on the rightness of desegregating the Armed Forces. That was a good first step — even as he called for more.
He didn’t suggest that by the signing of the Civil Rights Act that somehow all discrimination would end. But he also didn’t think that we shouldn’t sign the Civil Rights Act because it hasn’t solved every problem. Let’s take a victory, he said, and then keep on marching. Forward steps, large and small, were recognized for what they were — which was progress.
