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

Single-payer and public option advocates are fighting each other. We must remember that we're on the same side.
 
 
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“A ‘Public Plan’ is a sell-out, crafted to appease Big Pharma.”

“’Single Payer’ is politically impossible, and advocacy of it only weakens our one chance at real reform.” 

As our country once again tries to fix our unsustainable for-profit health care system, conflicting messages threaten to derail the whole process. Progressive advocates, progressive members of Congress, and health care providers need to provide a roadmap through the maze of conflicting perceptions.

Progressives have at least two remedies to the healthcare crisis:

1)   A “single-payer” system, which is most easily described as “Medicare for All.”  It is a publicly financed, privately delivered national healthcare system, This option makes healthcare a human right, granting universal coverage, eliminating out-of-pockets costs for consumers and slashes wasteful administration costs of our current patchwork for-profit system. As Physicians for a National Health Program reveals “The potential savings on paperwork, $350 billion per year, are enough to provide comprehensive coverage to everyone without paying more than we already do.” Rep. John Conyers (D-MI) has introduced a bill that calls for Single Payer.

2)   A “public option” system, which offers a public (government) health insurance option alongside the private, for-profit plans that make up our current system. It would compete with the for-profit plans, preserve the so-called “marketplace of competition,” but provide a guarantee of affordable, accessible high-quality healthcare to all. The Congressional Progressive Caucus has what seems to be the most progressive principles for such a public option.


One problem in progressive circles that contributes to the confusion is the perception, real or not, that single-payer and public option advocates are fighting each other, weakening support for both. Though some of that is going on, the greater problem is that people think that's what's going on, and thereby try to push each other out of the room.

There are very few healthcare advocates who will tell you that a single-payer healthcare system is not the correct remedy for the U.S. health care crisis. What they instead will say is that single-payer is dead politically, and that Obama and the Progressive Democrats' public option is the only politically viable option.

Most smart single-payer advocates, like the California Nurses Association, Physicians for a National Health Program and Progressive Democrats for America, will tell you that the proposed public option won’t solve our healthcare crisis. But often they identify the real enemy as the for-profit health industry, not the incremental proposals that seek to address the crisis.

Like both camps above, I too believe that the only real solution to our health crisis is a universal, single-payer, “Medicare for All” approach. Only through a public system that puts patient care and not corporate profits as the bottom line can we achieve the promise of health care as a human right, and effectively bring down exponentially skyrocketing healthcare costs at the same time. Even the best public option runs the risk of being the dumping ground of the nation’s sickest people while only slightly cutting overall administrative costs. A public option system does not achieve the goal of health care as a universal human right.

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.

 

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.