5 Key Fights We Face Against the Insurance Industry in the Push for Better Health Care

Last week, after almost a year of tumult, the final act of the health care reform drama began as House Democrats unveiled their final legislative package, and Senate Majority leader Harry Reid, D-Nev., challenged conservative Democrats in the upper house to fall in line by promising to bring a bill with a public health insurance option to the Senate floor.

In the House, the ball's rolling. Speaker Nancy Pelosi, D-Calif., is confident the bill worked out by her caucus will pass now that she has made some steep concessions to conservative Blue Dog Democrats (irking progressive lawmakers and health reform activists). Final touches are being put on the legislation, and it may come up for a vote as early as this week.

Although it's far from certain that Reid has the votes to pass his bill, which is yet to be finalized, the announcement moves us closer to getting a plan with a public option out of both the Senate and the House.

There's rare momentum to finally bring some sanity to our fractured health care finance system. That offers an opportunity to create a real shift in the balance between public and for-profit health care in this country, something that has largely eluded progressive health care activists since the 1960s.

But within the Democrats' "Big Tent," an incredibly significant game of chicken is being played.

While the corporate media pays rapt attention to those "moderate" Dems who have threatened to join Republicans in blocking the creation of some kind of public insurance option (in spite of the fact that a majority of Americans and most Democratic voters support it), they represent just one side of the divide that congressional leaders have to bridge.

Their opponents, rushing toward them head-on, are a bloc of House progressives who have vowed to vote down any bill that doesn't contain a "robust" public option.

Whether both sides will stay the course and blow up the Democrats' majorities in a spectacular collision, and if not which side will swerve first, will depend to some degree on the pressure put on lawmakers.

In the final push, it will be the energy of activists -- or lack thereof -- that helps determine the shape of reform.

Yet, most progressive reformers have long favored a national single-payer health care system. Throughout the legislative process, they have faced a choice: either jump on a moment of rare opportunity and support a proposal that while compromised, and perhaps deeply so, would bring significant new regulation to the out-of-control health insurance market and, more importantly, extend affordable coverage to millions who now lack it, or they could hope for a better day for reform in the future and oppose the final product, leaving a disastrous status quo to stand untouched.

So as the legislation is completed, the question is: How much should champions of substantive reform concede to the Blue Dogs -- or the odd moderate Republican like Maine's Olympia Snowe -- to get a bill passed that does some real-world good in the midst of a serious crisis?

For most reform activists, it's not an easy question to answer, in large part because the devil is in the often-mind-numbing policy details. There are many, and how they all get hammered out will determine if this reform effort is worth supporting -- whether it's a crucial incremental step on a path toward a less-perverse health care delivery system, or merely a bailout for an employer-based insurance industry with a business model looking increasingly shaky over the long term.

Keeping the Reform in "Reform"

The reform package Reid will try to bring to the Senate floor -- a "compromise" approach that takes elements from the more progressive legislation passed out of the Health Education Labor and Pensions committee and the industry-friendly, and markedly flawed, approach adopted by the Finance Committee -- is still being cobbled together. He sent a number of alternative measures to the Congressional Budget Office for cost estimates.

But we know what was in the bills passed by the two Senate committees with jurisdiction and in the House bill released last week. With leaks about what approach Reid favors filtering through the press, the broad shape of the Democrats' final approach is coming into sharper focus.

All of the proposals before Congress expand the number of insured by creating regional insurance "gateways" through which people who currently lack access to decent and relatively affordable health insurance on the job will be able to purchase a plan, and those plans will offer a standard set of relatively comprehensive minimal benefits.

They all require most individuals to carry insurance and provide subsidies for those who couldn't otherwise afford it to buy insurance through the "gateways." All require employers who don't contribute to their workers' health costs to help pick up the burden.