"While protesters have been occupying House Speaker Pelosi’s office, demanding a health care system that serves Patients not Profit, the House of Representatives is preparing to vote on the market-based health care bill introduced last week by Speaker Pelosi. It is not expected that the House leadership will allow a lengthy floor discussion, but the most recent news reports suggest that the promised vote on Rep. Anthony Weiner’s (D-NY) single payer amendment may be allowed. Meanwhile, Speaker Pelosi has presented the leadership’s additions to the bill in a so-called Manager’s Amendment, stating that this would strengthen provisions for ‘excluding insurers who put profits over patients from an affordable marketplace that will serve tens of millions of Americans.’

Does that mean the protesters demands have been met? Is this health care bill bringing us closer to realizing our human right to health care? Let’s recall that according to international legal standards, the human right to health requires that ‘health facilities, goods and services must be affordable for all. Payment for health-care services… has to be based on the principle of equity.’

The House bill aims to achieve affordability by subsidizing the purchase of an insurance policy for those earning between 150% and 400% of the federal poverty level, provided they don’t have employer-based insurance. In practice, this means someone with an income at the upper end of this scale would pay $5300 a year in premiums and up to $2000 a year in cost-sharing, amounting to around 17% of their income. At the bottom end of the scale, health care costs would be around 6-7% of a person’s income – which is still higher than a general income tax increase proposed by single payer health insurance bills.  Many immigrants would get no support at all, and anyone unable to afford such an insurance plan would be subject to a penalty payment, since everyone will be mandated to purchase insurance.  

Is this affordable? Maybe for some, but probably not for others. Is it equitable? Giving lower-income people greater subsidies seems like a reasonable starting point, yet even if those subsidies were sufficient, and even if everyone who needed them was eligible, it is not clear that this money would actually buy access to health care, as opposed to access to coverage. Each person’s subsidy would go directly to an insurance company, which would continue to control an individual’s access to care, covering certain treatments but not others, allowing the visit to one doctor but not another, or denying claims altogether. Different groups of people would get different coverage and therefore different access to care, depending on their ability to pay. People would not get health care based solely on their health needs, but based on their income or wealth, age, and immigration status."

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