Obama's Strategy for Health Care Reform

Thus far the Obama administration has been letting Congress take the lead in framing legislation to bring about fundamental change in the way Americans get their health care paid for. The bills being developed in Congress currently feature a "public option" that would create a government run and financed health insurance fund that would compete with the big private health insurers, like Blue Cross/Blue Shield, Aetna, Kaiser Permanente, and the other for profit health insurance companies. These companies, as well as the for profit hospitals, the manufacturers of medical equipment and supplies, the big pharmaceutical companies are now launching a massively funded public relations campaign designed to get rid of the public option idea and go on with "business as usual" for another few decades.

At the same time, the Obama plan has ticked off progressives because he and his democratic allies in Congress have decided at the outset to take a "single-payer" option off the table. There was a good discussion of this on Amy Goodman's Democracy Now show the other day with Bernie Sanders and the President of the California Nurses Union, Rose Ann DeMoro in which they both expressed frustration and anger about Congress not taking the single-payer option seriously. The single-payer option is the only possible plan that offers significant cost savings while also ensuring universal coverage. It has been empirically tested and refined in Canada and other countries that have long ago accepted the proposition that health care is a human right, to another opportunity to make a killing in the market. There is a well-developed proposal for a system of national health insurance (see PNHP)

There is no good reason for Congress not to even consider a single-payer option. But perhaps this is a calculated political strategy. The insurance industry and their Republican allies in the Congress are already lining up to oppose the "public option" that they claim will eventually threaten the private insurance business. The public option plan does not have the advantages of the single-payer system in terms of cost saving and administratiive simplicity nor in terms of universality. But it does allow the private health insurance business to stay in existence to compete with a government financed insurance program. But the private insurers and their allies are already whining that by offerring the public a lower cost option for health insurance, the public option will eventually take over the market and price private companies out of the competition.

I believe that this argument is total bullshit -- did all private schools and colleges go out of business when state governments started funding schools? But in any case, what Obama ought to say to this argument is: "OK, if you guys won't let us have the public option which may eventually drive some of your insurance companies out of business, then we are putting the single-payer option back on the table and that is what we will be pushing through Congress this year." Your choice is between accepting a proposal that may put some of insurance companies out of business eventually, or one in which they will all be put out of business immediately. Your choice."

It is likely that if the Democrats in Congress and the President play this particular brand of political hard ball the Republicans will walk and refuse to vote for any plan. But once Al Franken gets seated, the Democrats have enough votes to pass it anyway, without any Republican support. If they avoid the 60 vote threshold by means of reconciliation they will need only 50 votes to pass it in the Senate, and they should be able to do that even if convervative Democrats such as Arlen Spector and Ben Nelson vote with the Republicans.

If the Republicans start screaming bloody murder about employing this tactic to get a long overdue national health insurance bill passed, I suggest that President Obama dispatch Rahm Emanuel to Capitol Hill to convey to them the immortal words that Vice President Dick Cheney said to Senator Patrick Leahy --- "You can go fuck yourselves".