The Patient Protection and Affordable Care Act signed by President Obama is, we hope, a first step on the way to a Medicare-for-all type program, which would offer better coverage at a lower cost by cutting out private insurers. Under the new healthcare system, however, private insurance companies are guaranteed millions of new customers, and regulations on the industry aren’t as tough as they should be. Big Pharma and HMOs were also able to secure lavish subsidies and concessions in the bill. Drs. David U. Himmelstein and Steffie Woolhandler, longtime advocates for single payer with Physicians for a National Health Program, have sifted through the mounds of information and misinformation to bring you ten things you need to know about the new law and a few actions to bring true reform to the healthcare industry.

 1 The act risks ensconcing skimpy coverage as the norm. Participating plans are required to cover only 60 percent of expected healthcare costs, leaving families responsible for huge out-of-pocket expenses. The law will also tax "Cadillac plans," hitting millions of working families. Work with union activists to repeal the tax, maintain comprehensive healthcare benefits and fight for Medicare for all.

 2 The law reduces Medicare’s out-of-pocket costs for drugs by closing the infamous "donut hole," covering 75 percent of these costs by 2020. But the deal is even better for drug firms, who’ll be getting paid full price for their products. Push to replace the privatized Medicare drug-coverage program with a fully public plan that would use its bargaining power to force down drug prices by about 40 percent.

 3 HMOs were allowed into Medicare on the promise that they would save money, but over time they successfully lobbied Congress to increase their Medicare payments to 14 percent above costs. The new healthcare law cuts about $136 billion from these overpayments. Advocate for eliminating them entirely and phasing out investor-owned health providers that deliver inferior care at inflated prices.

 4 The law will reduce federal subsidies to public and other safety-net hospitals. Yet 23 million Americans will remain uninsured and tens of millions more will continue to rely on safety-net providers because hospitals often shun insured patients with unprofitable illnesses. Unless the assault on public hospitals is stopped, millions of sick Americans may find they have nowhere to go. Advocate on behalf of Safety Net Hospitals. 

 5 Insurance and Big Pharma lobbyists’ fingerprints are all over the new law. It’s time to curb their influence. Join efforts for public funding of political campaigns. Support the Fair Elections Now Act. Ask your elected officials to stop taking funds from the health insurance lobby and push for tougher regulation of Big Pharma.

 6 Expose and agitate against insurance firms’ abuse of their customers and the outrageous incomes paid to their executives. Share your story at the excellent site maintained by the California Nurses Association.

 7 The law excludes undocumented immigrants from buying insurance in the new exchanges, even if they can pay full price, and bars green-card holders from receiving any publicly subsidized insurance for five years. Defend the right to healthcare for everyone. Sign the petition at The Center for Immigrant Healthcare Justice.

 8 Keep up to date on reform at PNHP or Trudy Lieberman’s blog. Show Michael Moore’s Sicko in your community, and start a dialogue about what true reform should look like.

 9 Work with state-based single-payer groups. Vermont passed a law that mandates the design of new healthcare models, including the possibility of single payer. Similar bills have been introduced in California, Maryland and Minnesota.

10 Exercise, eat right and advocate for public policies that facilitate healthier lives. Learn how to get active as a physician, a medical student, a citizen or labor advocate. The fight for real national health insurance will carry on into the 2010 election cycle and beyond. We need you around for the long haul.

CONCEIVED BY Walter Mosley with research by Rae Gomes

"Ten Things" is a monthly feature. Readers who wish to propose ideas for it should e-mail [email protected].