Beyond Preventing Blanche Lincoln, Ben Nelson & Lieberman Ruining The Bill, What Are The Battlelines In Health Care Reform Now?

Two different progressive approaches

I got a lovely personalized e-mail from MoveOn.org yesterday thanking me for having a little something to do with the health care victory Saturday night. (My congressmember, Diane Watson-- who I love for her prefect voting record and wonderful leadership role among progressives, but who has never responded to a phone call from me-- voted for the bill. If not her, who?)

Within moments of the MoveOn note, another came from Dennis Kucinich, one of only two Democrats who voted against it because it wasn't good enough-- the other being career-long single payer advocate Eric Massa. Kucinich is very clear about why he lined up in the disreputable company of corrupt and reactionary Blue Dogs like John Barrow, Bobby Bright, Parker Griffith, Jason Altmire and Mike Ross on the Republican side of the aisle. Here's Kucinich's statement:

"We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system.

"Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.

"But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies-- a bailout under a blue cross.

"By incurring only a new requirement to cover pre-existing conditions, a weakened public option, and a few other important but limited concessions, the health insurance companies are getting quite a deal. The Center for American Progress' blog, Think Progress, states, 'since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.' Similarly, healthcare stocks rallied when Senator Max Baucus introduced a bill without a public option. Bloomberg reports that Curtis Lane, a prominent health industry investor, predicted a few weeks ago that 'money will start flowing in again' to health insurance stocks after passage of the legislation. Investors.com last month reported that pharmacy benefit managers share prices are hitting all-time highs, with the only industry worry that the Administration would reverse its decision not to negotiate Medicare Part D drug prices, leaving in place a Bush Administration policy.

"During the debate, when the interests of insurance companies would have been effectively challenged, that challenge was turned back. The 'robust public option' which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million. An amendment which would have protected the rights of states to pursue single-payer health care was stripped from the bill at the request of the Administration. Looking ahead, we cringe at the prospect of even greater favors for insurance companies.

"Recent rises in unemployment indicate a widening separation between the finance economy and the real economy. The finance economy considers the health of Wall Street, rising corporate profits, and banks' hoarding of cash, much of it from taxpayers, as sign of an economic recovery. However in the real economy-- in which most Americans live - the recession is not over. Rising unemployment, business failures, bankruptcies and foreclosures are still hammering Main Street.

"This health care bill continues the redistribution of wealth to Wall Street at the expense of America's manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.

"Notwithstanding the fate of H.R. 3962, America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system, which is good for the American people and good for America's businesses, with of course the notable exceptions being insurance and pharmaceuticals."

More than a few progressives view Kucinich as the last man standing and the purest of the pure. Others take a dimmer view of the former boy wonder mayor of Cleveland. Last week though, Raul Grijalva (D-AZ), about whom there is no ambiguity, penned an OpEd for Politico laying out what the Congressional Progressive Caucus, which he leads, wants out of health care legislation. He's more hopeful than Kucinich.

Those of us who fought long and hard on its behalf are glad to see House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) still standing with us so close to the finish line, pushing together for a program that will give millions the hope and opportunity the market currently denies them.

The last and most pressing question is what kind of public option will come out of this process. I, along with other progressive members of the House, argued strongly during the past few months that a successful public option would structure its payments to doctors and hospitals around Medicare rates. Medicare saves the government money because its purchasing power nationwide is unmatched, giving it leverage to negotiate affordable prices for Americans over the age of 65. It can afford to charge consumers less because it has low overhead and is remarkably efficient at what it does.

A public option, we argued, should look very similar if it is also to save the government money and provide affordable health care to the public at large. Indeed, the Congressional Budget Office calculated that a “robust” public option paying Medicare rates plus 5 percent would save the government $110 billion over its first 10 years.

We were glad to have Pelosi’s support. Unfortunately, it seems we fell short in the House, and Democratic leadership decided we could not sustain such a proposal if it came to a vote. Like my progressive colleagues, I understand the art of the possible and have no illusions that my answers are perfect. At this point, I am considering support for a public option even if it is not the robust version for which I have so often argued.

My support for such a plan is based on the reality of the insurance market. Because tens of millions of Americans lack health insurance, we must create a plan that can help sick people get well, help struggling families get and keep good coverage and help contain the costs of medicines and procedures often out of reach even for the middle class. We must start somewhere in addressing these disparities, and progressives will continue to play the constructive role we have played throughout this process. If I believe a public option as written in any final bill can help, I will vote for it. My conscience dictates nothing less than full support of a program that can lessen the injustice of our broken health care system.

My support is not unconditional. I believe certain proposals now being advanced would be fatal to the effectiveness of any public option, and I will very strongly consider voting against any bill that includes them. Among these is the notion of waiting to create a public option until a “trigger” point has been reached. As we have seen with Medicare Part D, these sorts of triggers do not go off. They are designed to sound appealing and appear to be a useful compromise.

In fact, they are designed to let everyone take credit for supporting a good program without accepting responsibility the next day when it doesn’t go into effect. A public option must be active from Day One to give doctors and hospitals confidence when they consider whether to participate. If a public option rests in political limbo for several years, it may as well not have been in the bill.

Allowing states to opt out of a public option is a second moderate-sounding compromise that will undermine the program from the get-go. It is unfair to create a national mandate for citizens to buy health insurance, only to allow states, for ideological reasons, to deny their citizens access to the public version. My state of Arizona is only one of several-- including Texas-- likely to take that step the morning after the president signs the bill into law. “Opt out” will not work, and it will not receive my support.

We are close to enacting truly historic health care reform. This is a moment on a par with the passage of Medicare and Social Security. Twenty years from now, Americans will look back at this Congress and have a great deal to say about whether we passed a public option that worked or a fig leaf that did nothing to address the problem. With so much at stake and the final threshold so near, I urge my colleagues to consider the best policies for the nation and give voters the successful public option they want and deserve.

Watch kick-ass Texas populist Lloyd Doggett explain why Republican obstructionism has itself become one giant pre-existing condition to meaningful change:




UPDATE: And Eric Massa

I've known Eric Massa for just around four years. In all that time he's never wavered from his die-hard support for single-payer. His insistence comes from deep within and trumps politics. As long as I've known him he's been all about getting us out of senseless wars, ending unfair trade practices and pushing single-payer, universal health care. It has a lot to do with why Blue America supported him in 2006 and 2008 and its why he may wind up being the only Democrat to have voted against the health care bill with a chance to be endorsed in 2010. This morning he explained his votes, for the rule of debate, against the Stupak Amendment and against final passage of the bill to constituents in NY-29:

While this bill does contain a public option, it is far from a "robust" one and Rep. Massa pledged, in a letter months ago, to vote against anything less than that. The public option in this bill is available for only about 2% of the American population and its premium rates will match private health insurance, guaranteeing no effective competition in the marketplace.
 
Additionally, he thinks that this bill, if signed into law, will not do enough to regulate the private for-profit health insurance industry and will actually empower them further. This is a major problem with the legislation as far as he is concerned... During the closing hours of the debate, Rep. Massa voted against the Stupak Amendment which he viewed as a significant universal increase of current federal law. For the first time, if passed, the federal government would have prohibited a private citizen from using private funding to buy an insurance policy that covered elements of reproductive rights. The bill as written is clear, no federal funding for abortion procedures is allowed. Rep. Massa agrees with that but does not support an increase in federal law on this matter. This amendment passed and became part of the final legislation.
 
While there are several provisions that he did like in the bill, such as the elimination of patient rejections on the basis of pre-existing conditions, and the closing of the Medicare Part D Donut hole, members of Congress cannot vote for one part of a bill and against another.
 
"There are several reasons why I voted 'no' on H.R. 3962," said Congressman Eric Massa. "I have always said that I will vote 'no' on a bad bill to try and get a better one and that's what I did. Reforming our health care system is critical to our economy and our nation, but I had some serious concerns regarding the bill that we voted on Saturday night. If the Senate is able to move forward, I hope we can get a better bill back for a conference version."