Keep Health Options Open

Congressional leaders are working on health-care overhaul, with an eye to getting a bill that will provide “universal coverage,” or something like it, to the president’s desk by Oct. 1. Meanwhile, health industry lobbyists see conservative Democrats in the Senate as their best hope for preventing real reform that threatens billions in corporate profits.

The best reform, in our view, would be adoption of a single-payer health plan, which could be accomplished by expanding Medicare to cover everybody in the US. That would threaten hundreds of thousands of jobs in the insurance bureaucracy, which makes it a tough sell in a recession. But the $167.6 million spent by the health industry on federal candidates in the last election cycle would really be missed by Congress members.

In May, Sen. Max Baucus (D-Mont.) shut single-payer advocates out of Finance Committee hearings and ordered 13 protesters arrested. Since then, Baucus has met with Sen. Bernie Sanders (I-Vt.) and some single-payer advocates. He reportedly said he’d try to get the charges dropped. It looks like single payer will get a hearing in Sen. Ted Kennedy’s Health, Education, Labor and Pensions Committee June 11 as well as the House Health, Employment, Labor and Pensions subcommittee chaired by Rep. George Miller (D-Calif.) on June 10. But single payer is still the longest of shots. The real battle is shaping up over whether the health reform includes a government-run “public option.”

[Update: Hearings on single payer were held in House Health, Employment, Labor and Pensions Subcommittee, where four of the five witnesses favored single payer, and in the Senate Committee on Health, Education, Labor and Pensions, where one of 24 witnesses favored single payer. David Swanson reports on the single-payer hearings in Truthout.]

Baucus, who accepted $1.1 million from the health industry in the last two years, took the lead on drafting the health bill while Kennedy battled brain cancer. But Kennedy (D-Mass.) circulated his own draft of the “American Health Choices Act,” on Capitol Hill in early June. Kennedy aims to regulate insurers, expand Medicaid and the State Children’s Health Insurance Program (SCHIP) and build state-sponsored insurance exchanges to help Americans find affordable coverage. Most important, it includes a strong government-run health plan to compete with private insurers. But his illness may keep him from pushing the bill through intact.

The goal for both Senate committees is to have a bill ready for Senate debate in July. The House, where three committees are working on bills, expects to get a unified bill to the House floor in late July.

The major sticking point appears to be whether the reform includes that “public option” to compete with private insurance companies to provide affordable health coverage for small businesses and individuals. The Commonwealth Fund estimates that a government-run insurance program that wasn’t looking for a profit but was able to lower administrative costs and bargain down the price of services, much as Medicare does, would result in a savings of 20% to 30% over traditional private insurance.

Private insurance companies complain that the public plan would have an unfair pricing advantage. Of course, they don’t want any competition to interfere with their profits.

Sen. Charles Grassley (R-Iowa), the Finance Committee’s ranking Republican who is leading the fight against a strong public option, wrote in a column for Politico.com, “As many as 119 million Americans would shift from private coverage to the government plan and put America on the path toward a completely government-run health care system.”

We’re willing to risk it.

Sen. Olympia Snowe (R-Maine), who is considered the moderate Republican on Finance, has joined some conservative Dems in proposing a public option that would only be triggered into existence in regions or states where there was not enough competition among private insurers and health providers. But it would take years for the public option to kick in and, as Robert Reich noted, “As Pharma and Insurance well know, ‘years from now,’ in legislative terms means never.” Among those who are said to support Snowe’s plan are Sen. Ron Wyden (D-Ore.) and Thomas Carper (D-Del.) while others watch to see how the wind blows.

Another proposal is a weak public plan—also known as the “level playing field,” which would limit how much the government plan could undercut private insurers. This is another compromise that only postpones reform. A strong public health option, such as the one proposed by Kennedy, which would be in a position to negotiate deep discounts with health-care providers, is the minimum acceptable reform that Democrats should insist on.

(To find out how your senators and House member stand on the public health option, see standwithdrdean.org. As of June 9, 37 senators supported it, 7 opposed and 55 were unknown. In the House, 192 supported it, 4 opposed and 244 were unknown.)

Small business groups also are lobbying to be exempted from the requirement that employers supply health insurance or contribute to the cost of a plan. Some Democrats are proposing that revenue come from taxing employer-provided benefits on higher incomes or limiting deductions on higher incomes. The White House has demanded that deductions be limited to taxpayers earning under $250,000 a year, but organized labor dislikes the precedent of taxing any employer-provided health benefits.

Some single-payer advocates are pursuing an “all or nothing” strategy, but it appears increasingly likely that strategy will produce nothing—which would suit the insurance executives just fine.

Sanders seems to have come around to the view that adopting a strong public option to compete with private insurers is a way to move toward a single-payer system.

In March he filed the “American Health Security Act (S 703), which would provide every citizen with health care through state-administered single-payer programs. His bill has failed to get a co-sponsor. A similar House bill, HR 1200 by Rep. Jim McDermott (D-Wash.) has seven co-sponsors. In the House, Rep. John Conyers (D-Mich.) has refiled his “National Health Insurance Act” (HR 676), which would expand Medicare to cover everybody. It has 78 co-sponsors.

Sanders also filed a bill (S 898) to help five states create pilot programs in universal health care, including at least one single-payer program. That could become part of the reform bill.

As long as Baucus has ruled out expansion of single-payer—and there is no groundswell of support in Congress for such a comprehensive approach—those advocates might be better off organizing at the state level. That’s how Canada’s single-payer health care got started. Tommy Douglas, a Baptist minister and progressive premier of Saskatchewan, established Canada’s first publicly funded hospital insurance plan in 1947. Its success prompted four other provinces to adopt similar plans by 1957, when the Canadian Parliament adopted a bill sharing the costs of covering hospital services. By 1961, all the provinces had universal coverage for hospital care. Douglas then moved to cover physician costs, against the bitter opposition of the province’s doctors, who went on a brief strike in 1962. After some adjustments, a 1965 survey found that most doctors favored continuing the plan, according to the Canadian Encyclopedia. The Canadian Parliament adopted the Saskatchewan plan for universal health coverage in 1966. It provides all legal residents of Canada to receive physician and hospital services without charge. Douglas was voted “Greatest Canadian” of all time in a contest organized by the Canadian Broadcasting Corp. in 2004.

Baucus has said he wants a bipartisan compromise on the “public option” that can attract support of Republicans such as Grassley, but he shouldn’t water down the bill in a vain attempt to gain GOP approval. They have made it clear that they will oppose any reform that threatens corporate profits. A simple majority is all that’s needed under budget reconciliation rules, and there will be 60 Democrats in the Senate when Al Franken is seated from Minnesota. Baucus can lose 10 mossback Dems and still pass the health-care reform with Joe Biden’s tie-breaker, if he wants to. If he doesn’t pass a health care reform bill with a strong public option, it won’t be because the Republicans stopped him. — JMC

From The Progressive Populist, July 1-15, 2009

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