LAST TIME I POINTED OUT THAT health care reform is really about freedom and democracy, in two ways:

1. The value of any health care reform package to the average citizen should be measured, in part, by how successfully restores our power over our own health care.
   
   As things stand now, that power is vested in large insurance corporations, and generally denied to patients.
2. If health care reform succeeds in making citizens and families more secure, it will also strengthen our democracy.
   
   Anxiety and worry makes citizens less grounded and easier to manipulate—security makes it easier for them to fend for their own interests, and those of their country.

I promised that today I would begin looking at the Democratic (capital D) proposal, to see just how democratic (small d) it really is.

The power, in our present situation, is divided between government, wealth (both personal and corporate), and the people (us).

At the moment, most of the power in the area of health care is in the hands of large insurance companies, which means that the primary direction any helpful policy change should take, at the moment is down and to the left.

It's generally agreed, and generally overstated, that the Democratic plan will move the X to the left, but how far down will the plan move it?

Given how far to the right the current health care system is, we should expect that any movement downward will include some movement to the left as well, since some government control is going to be necessary to wrest control from the insurance companies.

Using the house bill, which has actually been passed, let's rate it, one provision at a time:

1. The bill creates an insurance exchange, which will allow both small businesses and individuals to comparison shop between the various private companies and the public option.
   
   Since one of the current problems with access to health care is the inability of individuals to afford it—both because of lack of competition and lack of access—this provision is definitely a step away from corporate power toward individual choice and security.
   
   Also, this provision works to help small businesses compete with large corporations in terms of the health insurance they can offer their employees, another move downward.
   
   

   Provision	Moves Us Toward	Direction
   The Insurance Exchange	Democracy, Freedom

2. The much-maligned public option is a piece of the same effort. A government-run insurance company—self-supported, much like the post office—it would provide an additional choice to consumers and additional competition to the insurance corporations.
   
   The point is to make sure that the free market works properly, given the stacked deck where health-care is concerned.
   
   

   Provision	Moves Us Toward	Direction
   The Public Option	Democracy, Freedom

3. The government would take a more active role in supervising the industry. This would include multiple measures, such as:
4. • Raising penalties on insurers who lie to the government.
   • A Health Choices Administration in the White House to oversee the health insurance exchange.
   • Publishing ratings and other information about Medicare Advantage plans, to help consumers make better informed decisions.
   • A commission of drug companies, health care companies, patients, and others would be set up to supervise a new center that would compare the effectiveness of different treatments and pass the information on to consumers and the industry.
   • Drug companies would have to give rebates to Medicare and Medicaid patients
   • Insurance companies would be barred from refusing to cover people with pre-existing conditions.

5. Each of these measures is aimed at providing more accurate information or more choice to the consumer.

   
   

   Provision	Moves Us Toward	Direction
   Greater Supervision	Democracy, Freedom

Next: Subsidies, Taxes, and Fees...