On the status of health reform

by Andrew Coates MD

At the end of August the Republican Party took the position of “hands off Medicare.” While this would leave in place “Medicare Advantage” (which pays private insurance companies 12 to 17% more than it pays for the costs of care of traditional Medicare), and Medicare Part D (another huge giveaway to the drug and insurance industry), it was striking to see the Republican Party tie itself in knots after decades of calling for the abolition of Medicare.

Also in the name of "keeping the government out of health care" the Republican Party came out in defense of the Veterans Administration, a socialized health care system directly owned and operated by the federal government. In August the Congressional Budget Office released a study that underscored once again evidence of superior quality of care at the VA: better than Medicare, better than private practice and better than managed care.

If we were to engage a truly evidence-based debate over how to pay for health care using a “uniquely American” model, it would be a debate between single payer, the Medicare model, and socialized medicine, like the VA.

From "off the table" to "on the floor"

Single-payer national health insurance, after more than 20 years of accumulating evidence, now accumulates unprecedented popular support. Although polls have shown for decades that a majority, including physicians, favor national health insurance, the depth and passion of grassroots activism for the proposal is something new. For the first time this fall single payer may be voted on on the floor of the House of Representatives.

At the end of July, as the Energy & Commerce committee completed deliberations on HR 3200, Representative Anthony Weiner of New York, with 6 others, put forward an amendment to replace the text of HR 3200 with the text of HR 676. Committee Chair Waxman interrupted to say that House Speaker Nancy Pelosi offered to allow single payer to be voted on by the entire House of Representatives if the amendment were withdrawn from Committee. Weiner accepted.

Perhaps the prospect of defeating single payer on the floor of the House of Representatives seems, to the Democratic Party leadership, a way to at last get single payer off the table.

Single payer activists have welcomed this turn of events, for it was the direct fruit of grassroots mobilization. The proposals before Congress, with the exception of HR 676 and S 703, will simply not work. Whatever happens in Congress this fall, the system will grow more dysfunctional. And with expectations for fundamental reform now raised even higher, excellent prospects to build a movement for single-payer national health insurance will persist.

Read it all at PNHP's blog.

Dr. Coates practices medicine in Albany, NY, where he is assistant professor in the departments of medicine and psychiatry at Albany Medical College, secretary of the Capital District chapter of Physicians for a National Health Program and co-chair of Single Payer New York.