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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:

  1. The lobbying front directed at Congress
  1. 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

  1. It's likely to be weak
  1. 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.

Originally posted to khin on Thu Aug 27, 2009 at 01:38 PM PDT.

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Comment Preferences

  •  Tip Jar (6+ / 0-)

    Join ZBlogs--an explicitly leftist blog. www.zmag.org/blog

    by khin on Thu Aug 27, 2009 at 01:38:13 PM PDT

  •  Actually, NO...... (2+ / 0-)
    Recommended by:
    leftover, rubine

    ....we DON'T need "national health insurance".

    We don't need "insurance" AT ALL.

    We need national health care.

    It's not just a matter of semantics -- the whole idea of making sure everyone has health insurance  is obviated with national health care.

    So let's get RID of the entire "health insurance" idea and debate.  In private hands it's simply a skimming operation that rips off Americans for the financial gain of the present death panels -- er, I mean health insurance companies.  
    And nationalized completely, it's at the service of the nation -- health care becomes a right (as it is in every single other industrialized country) not a gamble bought into hoping that this or that might get approved, might not get approved ....

    •  You mean socialized medicine? (0+ / 0-)

      In typical usage these can mean the same thing.

      National health care is a pretty broad term which is why I've been using more often lately - because it's not essential which kind of national health system we use as long as we pick one that works. Medicare-for-All seems to be the most credible option being advanced right now.

      •  Yes, "socialized medicine"! (0+ / 0-)

        ...that's EXACTLY what this damn backasswards country needs.
        Call it what it IS, and let's get it done. Enough of the "We just GOTTA compromise with the right-wing twits, doncha know", "But we CAN'T call it 'socialism!", and "Gee willikers, does that mean we'll hafta raise taxes on the rich?!?!?"

        YES.  Socialized medicine.  Works fine in the actually civilized countries on the planet.
        And yes, RAISE taxes on the rich.  (If we DOUBLE the highest tax bracket tax rate and it'd STILL be lower than what it was under Eisenhower....)

        What is with the rampant greed, myopia and "Me first, fuck everyone else" ethos that predominates the present Reagan-exacerbated definition of "Americanism"?

        •  Socialized medicine is not necessary (0+ / 0-)

          ...single payer systems or even non-profit organizations tightly regulated by the government can do just as good a job. In America, socialized medicine would be harder to get than any of these. Let's focus on function - not names.

          •  Only through socialized medicine (0+ / 0-)

            can we truly bring down costs by developing standards of care based on something other than the profit model.

            If wanting the country to succeed is wrong, I don't want to be right.

            by Angela Quattrano on Thu Aug 27, 2009 at 03:28:24 PM PDT

            [ Parent ]

            •  Something other than the profit model? (0+ / 0-)

              Single payer and non-profits under government regulation are not for profit in terms of insurace.

              Now if you are talking about non-profit providers, honestly there is no evidence that mandating that brings down costs. There just isn't.

              •  Truly unexplored territory in this country. (0+ / 0-)

                But it has been proven that health care costs are driven up with unnecessary tests and treatments that are profit-driven. Doctors who own diagnostic and treatment facilities have learned to work the insurance companies for the maximum payment.

                We reward doctors who overprescribe and overtreat. It is only thanks to the fact that so many of them are not in it only for the money that health care in the country does not cost half again as much per capita.

                If wanting the country to succeed is wrong, I don't want to be right.

                by Angela Quattrano on Sun Aug 30, 2009 at 03:56:45 PM PDT

                [ Parent ]

  •  Completely disagree... (0+ / 0-)

    but at this point...I don't think it matters because opponents are already essentially saying that this is a backdoor approach to NHS...

    Obama - Change I still believe in

    by dvogel001 on Thu Aug 27, 2009 at 02:02:14 PM PDT

  •  Somehow we've all been tricked... (0+ / 0-)

    into thinking that we can't talk about or even consider Universal Health Care (UHC).  This view, that UHC is impossible at this time, is promulgated by many democrats who call themselves pragmatists and realists.

    What this involves is that each of us, individually, must restrain our desire, adjust our language, and bow to the superior forces of the health care institutions.

    The truth is that if we want UHC then we must throw aside this bullshit and allow ourselves the full and passionate expression of our desire, both for UHC, but also for justice and compassion in our nasty, greedy, society.  We must behave with such dedicated sincerity, such focused intensity, that the moral and ethical truth will not be denied, regardless of how many rich suits line up against it.

    We must act with the moral certainty that would make the Abolitionists, the civil rights workers, the women suffragettes, and the Stonewall rebels, proud of us.

    It is a tradition in this country that there comes a time when sophistry, entrenched privilege, and "patience", must be broken through and real, substantive change, that truly benefits the people as a whole, must take place.

    It is time to demand, it is time to act.  Too many in this rich country are suffering, we need Universal Health Care NOW.

    The ekpyrotic theory hypothesizes that the origin of the observable universe occurred when two parallel branes collided.

    by rubine on Thu Aug 27, 2009 at 03:01:21 PM PDT

    •  Universal health care is not quite the same issue (0+ / 0-)

      Actually universal health care is (almost) what is being proposed in the House bill, except for about 9 million people.

      But the bill is very bad for efficiency reasons. To make this work properly we need a national health care system of some kind. Otherwise the current bizarre fraction of GDP spent on health care (16%) will only go up.

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