What now on health care reform?

With the new balance of forces in Washington, a path has opened for us to achieve a first, true step towards turning around our nation’s health care crisis and achieving quality, affordable health care for everyone.

Many of us are well aware of the ballooning number of uninsured, of how even insured people are having more and more difficulty affording health care, of how for-profit insurance companies, hospitals and others are reaping windfalls off the back of society’s most vulnerable, of how employers are tottering under the cost of employee health care and are making us pay larger and larger portions of our health benefits, and the list continues.

Every 15 years or so, Washington takes on the health care crisis. The last round, in 1994, resulted in a defeat of Clinton’s proposal and ushered in the Gingrich era of far-right majorities in Congress. Today, we have a new opportunity to win health care for all and to consolidate the resounding defeat of the far-right achieved last November.

The American public is committed to reform. According to a Kaiser Family Foundation/Harvard School of Public Health poll, 59 percent believe that health care reform is more important than ever, despite the economic meltdown. While fixing the economy and the job situation remains the #1 priority for Americans, when you break down this priority, people feel health care costs are a major contributor to individuals’ economic woes.

Americans want something done to fix the mess

There are several proposals before Congress and most of them enjoy wide public support. The public is not differentiating between policy proposals — Americans just want something done to fix the health care mess. For example, reform that would lead to a single-payer “Medicare for all” type health care system has 48 percent support according to this poll. At the same time, tax credits for individuals to purchase health insurance has 67 percent support in the poll. Expansion of public safety net programs has the most backing: 79 support lowering the age of Medicare eligibility to 55 years, and 77 percent support expanding public safety net programs for low-income people.

The best solution is a single-payer program where everyone gets automatically enrolled in a public insurance program that covers all our medical, dental and mental health needs. This guaranteed health system would dramatically reduced administrative costs and greatly reduce disparities in access to care, and has the potential to reduce the overall cost of health care by allowing rational planning of how we spend our health care resources. Single-payer activists, including this writer, have passionately fought for the creation of this system, mostly under the banner of Michigan Rep. John Conyers’ HR676.

New opportunity to win

The Republican defeat in last November’s elections has created a path for us to actually win a single-payer victory that was impossible under a far-right White House and Congress.

Health care reform is on the fast track through Congress.

* Three House committees and two Senate committees have jurisdiction over it, and by the end of May each committee will likely be finished drafting their health care reform bills.

* June is the time for intense political action because the committees will be debating, amending and voting on their respective bills.

* In July, the work of each of the committees will be introduced into the full House and Senate and there will be more time for debating, amending and ultimately passing health care reform legislation. July also presents many opportunities for activists to influence the debate and make sure the bills move in the direction we want them to move.

* In August, once the House and Senate pass their versions of the legislation, the measures will go to a conference committee composed of members of each chamber where differences will be ironed out and a single “conference report” bill will emerge.

* In September, each chamber will vote on the conference report bill and ultimately pass health care reform for the president to sign.

This is a fast timeline, but there are many opportunities for us to work with our communities and organizations to pressure our representatives in Washington to pass legislation that reflects the needs of everyday Americans.

Among the many proposals before Congress, we cannot forget about the Republican proposals that aim to further deregulate insurance companies, tax employee health benefits, and strengthen the inefficient and inequitable for-profit private insurance system. These proposals present the most threat to working people.

Another proposal resembles the reform in Massachusetts. This reform includes expansion of public safety-net programs (for example, Medicaid), creation of an “insurance exchange” that has the potential to pool individuals’ risk and more efficiently impose regulation on private insurance, and an assortment of employer and individual mandates to purchase insurance. Despite expanding public programs, this proposal is highly problematic because it leaves in place the private insurance system and may force people to purchase insurance that does not actually cover their needs. In Massachusetts, many people have been forced to purchase insurance but still cannot afford care because of high co-pays and deductibles. This is unjust and harmful.

A significant improvement over the Massachusetts-style reform plan results if the insurance exchange includes a public insurance option similar to Medicare. Individuals seeking to buy insurance would be able to pick this plan instead of private insurance plans. This plan would have a standard benefit package and would be affordable, and its goal would be to help people get the services they need, not deny them care in order to save costs. If private plans were forced to compete with a public option, they would have to be cheaper and provide better benefit packages. The other reason to support this public option is that in a new health care reform cycle, this plan and Medicare could eventually be expanded into a de facto single-payer system.

Given the current balance of forces in Washington, especially considering the power of the for-profit health care special interests, we do not have the mass movement support to outright win a single payer system this year. However, if we fight hard, we can win a strong public option within the health care reform proposal that can ultimately be a stepping stone for single-payer. This is the political task now.

Part of bigger fight vs. far-right

This current fight for health care reform has a dual nature. Yes, it is a fight to win changes in our health care system that will expand access to care and reduce health disparities, but also, it is a political fight against the far right. The victory of last November is still not consolidated and the fight against the far right continues. In fact, the heath care fight is integral to the 2010 midterm congressional elections.

The Republicans have chosen the health care fight as the issue to break the Obama presidency. They already spend millions to oppose every single measure introduced by the president or Democrats in Congress — even the non-controversial ones such as research into the effectiveness of medical treatments. If they are successful in defeating Obama’s health care reform initiative, it will be much harder for progressives to push other important policy initiatives, such as worker rights and card-check neutrality, immigration reform, banking and finance regulation, and so on. The last time we were defeated on the health care fight, the Republicans won the “Gingrich revolution” that fostered a terrible period where we were constantly on the defensive.

So, the political task is to work throughout the summer to make sure we get the best public option we can into the health care reform proposal, and then rally behind the president to make sure we help consolidated the defeat of the far-right.

This will not be easy. The Republicans and their supporters will use every trick in the book to make sure insurance companies keep making profits off of us. Also, there are fiscally-conservative “blue dog” Democrats who will also try to block the public option. We have to take on these right-wing forces, work to build broad unity among our organizations, and understand that winning a strong public option is a right step in the direction of the health care system we need. A defeat in 2010 or a new Republican president in the White House two years later will close this opening we have to win real health care reform.

Flávio Casoy is a young doctor beginning his medical residency this summer.