Hey Progressives, Join Forces to Fight the Health Insurance Industry!

By Karen Dolan, Institute for Policy Studies. Posted June 29, 2009.

But we remain divided.

Many progressives will point out that Conyers’ single-payer bill, H.R. 676, has only 90 cosponsors and can’t pass, while 120 Democrats have pledged not to pass any health reform bill that does not have a “robust public option.” They are buoyed by the notion that with that block holding steady, a huge leap forward from the status quo may finally be on the horizon. They are understandably nervous about anything that would threaten this possibility.

A public option may indeed be crafted in such a way to become the wedge that ultimately wins the prize, as public plans under-price costly private plans. The public option could offer public plans designed to adhere strictly to the Congressional Progressive Caucus’ laudable principles of universality, affordability, equality. They could be carefully constructed as to be so cost effective that the Republicans fear that they will crowd out private insurance due to their affordability becomes a reality.

But a public option could also be crafted in such a way to expressly prohibit that outcome by allowing private insurers to cherry-pick the healthiest patients, eventually bankrupting a public plan stuck with the nation's sickest people. If private insurers are allowed to continue the current practice of cultivating and covering the healthiest Americans, the sickest will be dumped into a public plan, thus creating a financially unsustainable situation for the public plans.

These scenarios need to be aired, debated, and dealt with. The way that Obama and progressives on and off Capitol Hill have set the debate thus far, a "robust Public Option" is, effectively, the "left flank," and thereby the very most we can hope for. It becomes the goal rather than the compromise. Had single-payer not been off the table, it might have served as the "left flank," thus making a public option, crafted to lead to single payer, a more politically feasible option, more appealing as the compromise that it is.

Maybe the horse is already out of the gate, and the chance to set the finish line at single-payer has passed. But maybe not. Let the roadmap through the maze of misperceptions tell us this: The real enemy in the healthcare debate is the for-profit healthcare system, which vastly overspends on administration, leaves almost 50 million people uninsured -- and many more underinsured -- and makes profits a higher priority than patient care. With healthcare costs rising three times as fast as U.S. incomes, the private healthcare system can’t go on without major changes.

Single-payer is the answer, and few progressives dispute this. Whether politically feasible or not, it should be on the table, in the street, and on the floor of the House and Senate.

Single-payer and public-option advocates should embrace. Single-payer advocates should see that, properly constructed, a public option could potentially hold the door open for single-payer health care. And public option proponents should see the value in having single-payer as its left flank, thereby presenting a "robust public option" as the politically feasible compromise that it is.

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Karen Dolan is a fellow at the Institute for Policy Studies in Washington D.C. and a contributor to Foreign Policy In Focus. She directs the Institute's Cities for Progress project.

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