Lots of bandwidth and pixels have been spent on discussing health reform, and that's perfectly appropriate given the importance of the issue. We've been writing about health reform for some years now, but though you'll hear from the likes of mcjoan, Kos and myself, none of the Contributing Editors "own the issue"... that privilege belongs to the American people. What we have written in the past is this:
When Can We Expect Health Care Reform (Whoever Wins)? from 3/08, a follow up on Daily Kos posts here (Medical Crisis: The Shape Of Things To Come), here (Perspective on Health Care Reform), here (What's The Effect Of Recession On The Health Care Safety Net?), and here (Health Stories: HR 5449). The posts use public opinion polling from Kaiser, here with a summary tutorial, narrative supplied by Claudia Deane (formerly of the Washington Post polling unit). Further elaboration appears here in more academic form published in the January 24 New England Journal of Medicine with co-authors from the Harvard School of Public Health and John F Kennedy School of Government). The latest poll from NPR/Kaiser/HSPH is dated 2/28/08, and available here.
So where do we stand now?
Single payer is very popular at Daily Kos, somewhat popular amongst the American people, and anathema in the Senate (except for visionaries like Bernie Sanders). The likelihood of single payer passing the Senate is almost nil. For that reason, practical politics (yeah, I know, this rubs folks the wrong way) suggests lining up behind Ted Kennedy's proposal for public option instead (see diaries by slinkerwink, TomP, icebergslim, and especially Healthcare reform and political realities by Darcy Burner.)
Here's a hint as to the current battle lines, including the size of the opposition.
Kennedy, a Massachusetts Democrat, would also create a public health plan to compete with private insurers, a priority of President Barack Obama’s that is opposed by Republicans, and would bar insurers from limiting coverage.
The effort to revamp health-care would affect a sector that makes up 17 percent of the U.S. economy. The goal of Democratic supporters is to provide insurance to most of the nation’s 46 million uninsured, and lower the soaring cost of care. A key challenge is the potential impact of legislation on an already rising U.S. budget deficit that may reach $1.8 trillion this year.
The health insurance sector is responsible for over 457K jobs. Another player, the pharmaceutical industry, had trillions of dollars [sales of $629bn in 2007.]
About 62% of the 1997 total represents sales to domestic customers, with 38% of foreign sales.
Big Pharma revenues were US$ 534.8 Billion in 2005. Both AHIP and PhRMA are strong lobbies. And neither is a friend of a strong public option.
Robert Reich puts it succinctly:
You know why, of course. They don't want a public option that would compete with private insurers and use its bargaining power to negotiate better rates with drug companies. They argue that would be unfair. Unfair? Unfair to give more people better health care at lower cost? To Pharma and Insurance, "unfair" is anything that undermines their profits...
All this will be decided within days or weeks. And once those who want to kill the public option without their fingerprints on the murder weapon begin to agree on a proposal -- Snowe's "trigger" or any other -- the public option will be very hard to revive. The White House must now insist on a genuine public option. And you, dear reader, must insist as well.
This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers -- one that gives the public insurer bargaining leverage over drug companies, and pushes insurers to do what they've promised to do. Don't wait until the concrete hardens and we've lost this battle.
mcjoan will be talking about Snowe's "trigger", which smells to me like a way to kill reform. But the important thing to keep in perspective, as Reich outlines, is that there's major institutional opposition to a public option from Big Pharma and AHIP. And as Ezra outlines, the time frame is from now to October.
I was given an internal Finance Committee memo today that offers the clearest look yet on the Congress's timetable for health-care reform. Staffers in various Senate offices affirmed that the dates sync with the schedule they've been given. The document, as you might expect, has the most information on the Finance Committee's efforts, but it outlines the Senate Health, Education, Labor, and Pensions Committee's schedule, the legislation being built in the House, and Congress's overall goal: A bill on the president's desk by Oct. 1.
The more we dilute our efforts, the less likely the public option passes, at least with any teeth. My opinion is that while single payer is worth fighting for (it's my preference), since it has zero chance of passing (or maybe less), the public option should be looked at as the next best thing, and we should line up in support. This is true even if public option is not single payer and even if single payer is possibly cheaper. The strongest public option, in fact, saves the most bucks ( the latter two links are to diaries by DrSteveB.)
Now I suppose (as Matthew Holt supposes) that there are those who still hold on to fantasies about single payer being rammed through:
Now imagine that there’s a policy that polls show at least 35% and (depending who you believe) perhaps up to 60% of all Americans want, and that the same polls show that a vast majority of Democrats want it. And of course Obama’s political situation is way stronger than the Cheney Administration's was.
In that situation and if they had a different political philosophy, wouldn’t the Cheney Administration just ram through single payer?
For some, the price might be acceptable, but Obama/Biden isn't Bush/Cheney, and they simply don't govern that way, partly because Senate Democrats aren't Republicans and don't line up and salute because the WH says to. And if they did, we'd have solutions today that would elicit a host of problems tomorrow. Not wise. The price tag on all of this needs open debate and vetting. The price of not doing anything is staggering, but there's going to be sticker shock either way, and Democrats who are in power are averse to ready made campaign issues being used as a bludgeon. Better to understand that, and work around it, than to pretend it is not so.
Another thing to realize, from this 2006 poll published by Kaiser.org, is that people are nervous about giving up the imperfect system that they have (written up here), which makes passing anything all the more difficult.
2006, you say? It's been true since the Clinton Presidency. But for more current polling, see CBS/NYT (via Polling Report):
Note that "fundamental change" beats out "completely rebuild".
Meanwhile:
The 161 million Americans with employer-sponsored health insurance are facing substantial increases in out-of-pocket (OOP) costs, according to a study published June 2 on the Health Affairs Web site. The study, authored by researchers from the National Opinion Research Center (NORC) and Watson Wyatt Worldwide, finds rising rates of underinsurance and unaffordability, particularly for poorer and sicker people.
Reform is damn difficult, but can be made easier with public support. Look at what the greatest of reformers, FDR, said:
Go Ahead, Make Me
I agree with you, I want to do it, now make me do it.
Franklin D. Roosevelt
Comment to a group of reformers. His point: Until they lead the way, they shouldn't expect leaders to follow.
Obama wants to pass health reform. Like FDR, he wants us to make him have to do it. Let's act accordingly, and realistically. Pressuring him to do something that can't pass the Senate isn't realistic. Pressuring him to support the House in insuring a viable and strong public option is.
In the meantime,Sen. Sanders provides a mechanism for trying single payer out at the state level.
While some single payer advocates think the only thing worth fighting for is single payer, what I have also introduced is a five-state option. That would mean five states would have the option of running pilot programs in universal health care but one would have to be single payer.
Like Washington state's use of a medical board for public plan cost control, it's an idea worth implementing at the state level, and seeing how well it works. (Essential reading is this Atul Gawande piece about doctor over-utilization. The issue is who will be the gatekeeper - the insurance companies, as they do now, or a rational system that weighs cost and benefits?)
It all sure beats the status quo.