Another small window of opportunity for a congressional debate and vote on the single payer bill (HR 676) will open next month. In response to Rep. Anthony Wiener's (D-NY) proposed amendment for HR 676 in the House Energy & Commerce Committee, Speaker Pelosi agreed to have a debate and a vote on the single payer bill on the House floor after Congress reconvenes in the Fall. Please urge your representatives to support the single payer proposal - more suggested talking points below. The "public option" has been diluted from its original intent - see piece below.

Fearmongering around "government-controlled" health care has been used to distract from our Wall-St. controlled health care. See The Tyranny of Wall St.-Run Health Care: No CEO Left Behind. 

Genesis of the Public Option & Its Dilution
The "public option" has been diluted – testament to the influence of the monied lobbies. It is a rule of negotiation not to start with compromise, and, instead to make the best case for reform upfront. The best case for comprehensive coverage and cost containment is a single public payer model with full free choice of private providers -- from that position, compromise would at least be a stronger "public option."

The Public Option feature of health care reform was conceived by political science professor Jacob Hacker, whose most recent iteration in 2007 is named the "Health Care for America Plan." Hacker envisioned it as a "Medicare-like" program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today.

Kip Sullivan, member of Minnesota Physicians for a National Health Program, recently evaluated the "public option" features of House and Senate Democratic proposals, and concluded that they are faint shadows of Hacker’s original proposal. Read the full piece about the genesis of the public option & its dilution.

The 5 original criteria that Hacker and the Lewin Group (which evaluated it) said are critical to the success of the "public option":

•• The Public Option had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
•• Subsidies to individuals to buy insurance would be substantial, and only Public Option enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
•• The Public Option and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
•• The Public Option had to be given authority to use Medicare’s provider reimbursement rates; and
•• The insurance industry had to be required to offer the same minimum level of benefits the Public Option had to offer.

Concluded Sullivan, of Hacker’s five criteria, only one is met by the Democrats’ proposed bills – i.e., both proposals require the insurance industry to cover the same benefits the "public option" must cover. None of the other four criteria are met.

As Robert Kuttner writes (Faint Praise): "...the likelihood is that whatever finally makes it through this session of Congress will reinforce and further bloat the current disaster of a health insurance system rather than fundamentally changing it. And if the decent elements of the plan are blocked, Obama should have the courage to pull the bill and take his case to the people....The satisfaction of a Rose Garden signing ceremony is not worth it, if the plan is more thorn than rose."

Talking Points to take to Legislators

Legislators need to hear from constituents in order to counter the $1.4 million/day spent by insurance, PHRMA & other special interests steering the health care reform debate to benefit their bottom lines.

Some things we might tell our senators/represenatives:

Eliminate For-Profit Insurances – The U.S. is the only country that continues to build its health insurance system around for-profit insurances. Most other industrialized nations prohibit for-profit insurance for primary health care; private insurance is reserved for supplemental coverage (e.g., private hospital room with TV, cosmetic surgeries, etc.). Underwriting should be eliminated, and true universal coverage provided.

Extend Medicare to All – As Dr. Marcia Angel says, the simplest way to expand health coverage to all (even in stages) is to expand Medicare coverage to all. It can be expanded by decade - lower the qualifying age to 50, then 40, etc. The infrastructure for Medicare billing, etc. is in place; it only needs to be improved, e.g., to permit negotiation of bulk drug and medical equipment costs; and the more costly privatized Medicare plans eliminated.

Support the amendment offered by Rep. Anthony Weiner (D-NY), which would effectively replace the entire existing health plan with the text of H.R. 676, Rep. John Conyers' single-payer legislation. Speaker Pelosi has agreed to permit debate and a vote on Weiner's Single Payer Amendment sometime after the House reconvenes in September.

A True Public Option – must include the 5 main criteria listed by Hacker above. The "Public Option" won’t save much money, but it may provide the competition to keep private insurances "more honest."

CBO Report of Single Payer Savings – The Congressional Budget Office should report the cost savings of the single-payer proposals (HR676 & SB703) side-by-side with the cost analysis of every other proposal. Over 20 federal and state studies since 1990 show considerable cost savings with the single-payer model. If the Blue Dog Democrats are serious about cost containment, they should demand the full CBO Report – see Blue Dogs Should Demand CBO Report of Single Payer Savings

Means-testing for subsidies adds a high "non-benefit" cost. It is less costly to simply cover everyone (like Medicare) instead of making folks jump through hoops to prove eligibility (for subsidies, etc). Read the comments of Merton C. Bernstein, leading health insurance expert and law professor emeritus at Washington University, who notes that private health insurance non-benefit costs range from about 12% to as much as 30% of outlays – compared to Medicare overhead of 3%.

Kucinich Amendment in Support of State Single Payer – Urge our senators and representatives to assure that the Kucinich Amendment is part of any health bill that passes, to help states pass single payer reform without federal ERISA challenges. At least 10 states have written single payer proposals thus far.