Democrats at the fore of shaping health care reform policy concede the issue from the start by failing to put forth the best possible case for reform. Instead, they have begun the discussion with compromise.
Even as Democrats fail to frame the issue, the failed U.S. multipayer health insurance industry that siphons hundreds of billions of health care dollars to profit and administrative costs is at the center of health reform discussion, defining the terms of the debate.
Inclusion of the one reform model -- single payer -- that could save $400 billion annually, restore the U.S. primary care infrastructure and provide the health care that everyone needs, has been declared off the table.
When Gov. Howard Dean appeared in Denver last week to promote a parallel public health option, he elicited audible groans from his progressive audience when he rhetorically asked, wasn't Medicare Part D a "good" reform for seniors? The 2003 reform was good for the corporate lobbies, but not so much for those trapped in the doughnut hole, or in plans with changing formularies, or forced to pay premium prices for medications because Medicare is prohibited from negotiating bulk drug rates. Nor is it a bargain for taxpayers, forced to subsidize for-profit insurances at higher cost.
Perhaps indicative of the insularity of Washington, there exists a real disconnect between many in the Capitol (whose health coverage is largely subsidized by taxpayers) and those in the hinterland. Medicare prescription drug reform should be reformed, and it doesn't deserve to be a model for reform in 2009.
Senate Finance Committee chair Sen. Max Baucus declared Single-Payer health care "the only thing that's not on the table because it cannot pass," thus perpetuating self-fulfilling prophecy and the continued suppression of full debate around the single payer model of health care reform. The adjective "politically unfeasible" speaks more to the lack of political will of legislators to frame the debate, instead conceding the issue to the monied lobbies. Doctors and others who protested the exclusion of single payer model from the dialogue have been brought up on charges by Sen. Baucus.
Even a parallel public plan option is marginalized by some Democrats, including Sen. Baucus, as a "fallback option." Baucus has indicated that a public option might merely serve as a bargaining chip to nudge the health insurance industry into "less disruptive" market-based reforms. Still on the table, he has said the public plan "might be a bit on the side of the table."
Sen. Schumer proposes a watered down public plan, reducing it to just one more private insurance. Sen. Ted Kennedy has made the strongest statement for a public plan: "Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit." If Democrats seriously want to end up with a true parallel public plan -- vs. a publicly subsidized private plan -- it is a simple rule of negotiation that you don't start with your compromise position.
If ever there was a time for systemic reform, now is the time for our leaders to make the most compelling case for comprehensive health care access with huge dollar savings in the face of devastating economic crisis and its ripple effects -- rampant job layoffs with lost health coverage, escalating mortgage foreclosures, and failing auto and other U.S. industries.
Republican think tanks and cultural warriors understand the principle of negotiation -- over four decades they have advanced the most extreme right-wing positions in every area in order to push every political outcome far to the right.
Reminiscent of "Harry and Louise" fearmongering in the '90s, the corporate lobby invokes the single payer bogeyman and short circuits debate with corrupted language around "choice," "competition" and "rationing," even though rationing is the norm within the current multi-payer health insurance bureacracy.
This year's poster child for beleaguered health insurance CEOs is disgraced former Colombia/HCA hospital CEO and multimillionaire Rick Scott, who in the name of "Conservatives for Patient Rights" is promoting "free market" notions of "choice" and "competition." Ironically, only the single payer health care model offers full choice of providers and competition based on quality of care.
U.S. primary care infrastructure has been decimated by the burden of insurance paperwork. Wrote a family physician of 47 years, "Health care insurers are more bureaucratic than any government agency. They often deny choice of doctor, and refuse to pay for care." Furthermore, the bureaucracy is exponentially multiplied as each insurer has a different set of rules.
The shortage of primary care providers is pushing not only the uninsured, but also the insured, into ERs. Sen. Patrick Leahy (D-VT) recently noted that too many insured Vermonters go to the emergency room for everyday health care needs, due to a lack of primary care physicians to handle demand for services.
Massachusetts reform has also crashed upon the shoals of reality. Even as more are insured, growing numbers of insured report they cannot afford needed treatment. In Massachusetts also, the shortage of primary care physicians drives the insured into emergency rooms for non-emergency care. Authors of an annual Massachusetts health care survey cite a lack of cost controls that have significantly compromised health care. A Massachusetts commission is reportedly drafting a system of global payments to networks of doctors, hospitals and other providers -- operating as a single payer model would. The goal is to incentivize keeping patients healthy, instead of paying by numbers of procedures, thus incentivizing unnecessary treatment.
Thus far Democratic leaders have conceded the framing of health care reform debate to Republican corporate interests seeking to maintain their profit advantage. For-profit primary health insurances are forbidden in most industrialized nations because they compromise health care access, primary care infrastructure and quality of care.
If Democrats want to end up with a true public plan option or any meaningful reform, they should lead with the best model, making the best case for reform. The question has to be asked: "What are we insuring -- health care access or the bottom line?"