The health care reform debate right now is stunted.
The best proposal in Congress is the House bill that includes only a small public option. The Senate looks eager to kill even that.
What's our best bet?
There are two fronts that I think are very separate and should be sharply distinguished:
- The lobbying front directed at Congress
- The education front directed at the public
National health insurance should be the stated goal on both.
This is essential to building a mass movement for health reform. I'll let Ezra Klein explain why. Although he is arguing in favor of the Wyden-Bennett bill here, the same idea applies to outright national health care. In fact it's even more relevant.
[The current House bill] does not offer obvious benefits to an insured worker. You can argue that it changes the system around them: There are subsidies if they lose their job and regulations to protect them from the excesses of private insurers. But though the health-care system might be different, it will not, for most people, feel different. And that has made it hard to explain to people why this is something they should pay for. You can tell the insured worker what he gets if his circumstances change. You cannot tell him what he gets if his circumstances do not change.
This is crucial and seemingly lost on those ripping the idea of advocating national health insurance (like say the Daily Kos editors). It's probably the single most important point in this diary.
Klein's other point in this article is also important. But this one is not only an appeal to self-interest--it's also an appeal to the national interest. He says that a small change like the House's public option will not bring down costs much:
[The proposals now in Congress] do not do enough to cut costs, because they do not do enough to change the fundamental nature of the employer-based health-care system. Earlier this morning, Congressional Budget Office Director Doug Elmendorf told the Senate Finance Committee that health-care reform will not save us money. If the problem is that our health-care system is too expensive, and reform does not change the structure of our health-care system, then it is unlikely to mitigate the expense. The flip side of trying to avoid changing what people have is that you don't change what's not working.
We can't use the argument that all other rich countries have lower costs, even while they also have national health care systems, if we aren't even advocating national health care. There would be no logical connection. The facts dictate arguing directly for it.
The wasting of public support is a last point. By concentrating only on the public option or on some other piece of the puzzle, one ignores that there has been solid public support for Medicare-for-All for years. Why throw out this huge advantage by ignoring the issue? And also, how can we possibly claim to be "liberal" if we're too scared to advocate what half to 60% of the public already does? Calling oneself liberal compared with the public on health care while ignoring national health insurance isn't just a bad strategy: it's simply false.
Then there's the strategy for Congress. It's different because Congress has a far lower level of support for national health care. To be clear I'll resurrect this old graph.
Obviously in Congress we face a much steeper climb. Tolerating compromise will be necessary. We should still state national health care as the goal since this will help push what debate does exist further left. Tell them to endorse HR 676 and vote yes later this year.
On the proposals that may be passed this session, we should avoid saying "Keep the public option in HR 3200 until it gets through the Senate and nothing else matters." That would be stupid because
- It's likely to be weak
- There are other valuable parts of HR 3200
Since the option now is probably very weak, we should be asking for a stronger one. It should insure more than the 10 million people it is now projected to. That is completely ridiculous and we should make clear that it is. If we are prepared to vote down a proposal with no public option there is a good chance that we're also prepared to kill one that only insures 10 million people. (I'm not saying either action is necessarily called for. But if one is then the other probably is too.)
The second point is that there are other valuable parts of the bill. Remember the surtax and the Medicaid expansions? These are good provisions and they can help a lot of people. The Medicaid expansions seem safe at this point--but the surtax is at death's door despite its popularity. The US has been first in inequality among rich nations since the 1980s. We should tell Congress not to remove the surtax but to rely on it more to help fund truly widespread health reform.
And when elections finally come, members of Congress who are not representing their constituents on health care need to be tossed out like the shills they are. Right now we have to wade through this swamp but we should absolutely try to drain it in 2010. If a Congressperson's constituents support Medicare for All and they don't, then let's get somebody in the 2010 primary who does!
Note: I posted this late a few nights ago when traffic was very low. It got 2 comments neither of which of was on the actual material, so I'm re-posting it. I've edited and retitled it since it was too boring.