The Weiner amendment [PDF] --will be submitted for a floor vote in the House, in the coming days, - This will be a historic vote - the fist time ever Single-Payer has gotten a floor vote.
The Kucinich amendment, [PDF] which will more easily allow states to implement single-payer plans, is already within the bill and must be retained.
Passing these amendments will be difficult, but the votes on them will help set the benchmarks for the next debates on health care so they really do matter. Win or lose, we’ll know who our friends in Congress are...
Sen. Bernie Sanders is sponsoring a Medicare for All bill in the Senate, S. 703. Tell your Senators to support it; find contact info here. He has said that he will be introducing amendments to the Senate Health Care bill, so keep your eyes and ears open for them.
Why it is important to keep fighting for real Health Care Reform:
The New York Times reported on Saturday, October 17, that Sen. Ron Wyden (D-OR) is warning his constituents that the “public option” is not going to be available to the great majority of Americans. No one who has actually read the Senate health committee’s “reform” bill or the House “reform” bill (HR 3200) disputes this. According to the Congressional Budget Office, the “option” will be available only to about 30 million people, or about one American in ten. As the Times put it (slightly inaccurately), the “option” in the Democrats’ legislation “would be out of bounds to the approximately 160 million people already covered through employers.”
Does the public understand this? According to Wyden, they don’t. Wyden says his constituents are shocked when they are told the "option" will not be available to the vast majority of Americans. When he began informing his constituents about this truth last summer, "They nearly fell out of the bleachers," he said.
Once a bill is passed and signed by President Obama, voters will start to learn just how little help the current reform policies will provide. While it is probable that the reforms will continue to funnel money to the Health Insurance companies to fund their lobbying machines, the relief for citizens maybe too little and/or too complicated and I don't believe anything currently being offered will be sustainable in the long term. So we will come back to this table. And that is why good support for the current Single Payer amendments to H.R. 3200 in the House are critically important.
Kucinich Amendment Grants ERISA Waiver for Single Payer States.
Sanders Senate Amendment Would Expand Support for Single Payer States
The Center for Policy Analysis worked closely with Congressional staff to craft the two amendments to health reform legislation that offer the greatest prospects for single payer supporters.
Summary
Some state and local governments that have attempted to expand health care coverage have been successfully challenged in court under the terms of the Employee Retirement Income Security Act of 1974 (ERISA). ERISA pre-empts states from enacting legislation if it is "related to" employee benefit plans. It reserves that right to the federal government. Section 514 of ERISA states that Title V (Administration and Enforcement) and Title IV (Fiduciary Responsibility) of ERISA “shall supercede any and all State laws insofar as they may… relate to any employee benefit plan.” There is no provision for an administrative waiver of these rules.
The Kucinich amendment to HR 3200, approved by a recorded vote of the House Education and Labor Committee, would remove this barrier for states that have enacted and signed into law a single payer system.
What the Amendment Does
The Secretary of Labor, in consultation with the Secretary of Health and Human Services, would be authorized and required to waive the ERISA pre-emption (Sec. 514) for states that have enacted a state single payer system. In this case, the Secretary could decline to grant the waiver only under extraordinary circumstances. The system would have to meet requirements, and the Secretary could revoke the waiver if it fails to do so.
The state single payer system is defined as a non-profit program of the state for providing health care to all residents. A single state agency would finance and administer the provision of comprehensive benefits that meet or exceed the standards for coverage and quality described in HR 3200, and assure free choice of health care providers. Private insurance that duplicates this coverage would be prohibited. Health maintenance organizations could operate on a non-profit basis if they also own their facilities and provide services directly. The system would not result in greater costs to the federal government. At the same time, the federal government would maintain the equivalent level of support as provided to other states, accounting for variations such as population and demographics. States could seek planning and start-up funds.
What the Amendment Does Not Do
A state single payer amendment was proposed by Senator Sanders. It is more detailed than the Kucinich amendment because it would cover matters beyond the jurisdiction of the House Education and Labor Committee. These include:
Dedicated funding for planning and implementation grants;
Specific allocations of funds from existing federal health programs, and waivers to permit coordination with those programs;
Quality assurance and health professional training programs associated with other federal programs.
Leaders of the campaign for a "public option" have circled their wagons around two sentences in HR 3200 (the House health "reform" bill). These sentences, which are not in the bill passed by the Senate health committee, appear in Section 223 of HR 3200:
Health care providers participating under Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary.
[T]he Secretary shall base the payment rates [for providers] on the payment rates for similar services and providers under parts A [the hospital services part] and B [the physician services part] of Medicare.
"Option" advocates are claiming these two sentences are "crucial" and “critical” to the success of the "option" and absolutely must be in any final "reform" bill. The Congressional Progressive Caucus has even warned President Obama that if these two sentences are not in the final bill, they will vote against it.
In this paper, I demonstrate why these two sentences accomplish nothing.
All of us desperately need real reform of our sick health care system. The present system ruins human lives daily through preventable deaths, devastating bankruptcies, hideous disparities and gross injustice and indignity. We cannot afford to experiment with “reforms” like the “options” in HR 3200 and the HELP bill which, coupled with the enormous insurance industry bailouts called for by those bills, will merely perpetuate the current system.
It’s time for the “option” movement to insist that its representatives start speaking truthfully about the “option” provisions in HR 3200 and the HELP bill. They might start by admitting that the Two Sentences in HR 3200 are, by themselves, incapable of giving the “option” the tools it needs to survive, much less thrive.
The Weiner amendment would replace Division A of HR 3200 with the text of HR 676, the "U.S. National Health Care Act," sponsored by Rep. John Conyers. This would effectively transform HR 3200 into single-payer legislation. Single-payer is a superior reform to HR 3200 in many ways:
Single payer would provide universal and comprehensive coverage for all medically necessary services. Unamended, HR 3200 would leave millions uninsured or with skimpy coverage.
Single payer allows patients free choice of doctor and hospital. Under HR 3200, insurance companies would continue to deny care and restrict access to services.
Single payer pays for itself by eliminating $400 billion in insurance company administrative waste and redirecting it to care. HR 3200 requires $1 trillion in new revenue in the next decade.
Single payer establishes proven and effective cost-containing mechanisms to ensure that benefits are sustainable over the long run. HR 3200 lacks effective cost controls.
The Weiner amendment presents an historic opportunity for Members to register their support for single-payer national health insurance as the best way to solve the U.S. healthcare crisis. It additionally will provide a vote that Members can stand by when approached by constituents.
Since health insurance lobbyists have effectively squelched discussion of single payer bill HR 676 as an option for health care reform in Congress at this time, Rep. Anthony Weiner, a single payer supporter, has filed an amendment to the health reform legislation recently created in the House, HR 3200. Weiner’s amendment would effectively change HR 3200 into a single payer bill.
On the same day President Barack Obama held a teleconference with Congressional members comprised of the Progressive, Black, Asian Pacific American and Hispanic Caucuses, a long time influential Democrat in Congress, John Conyers of Detroit, said he will not back the current House health care bill that passed the House Energy and Commerce Committee in July, by a narrow 26 – 22 vote, unless the public option component is strengthened.
“I don’t see anything to brag about,” he told me in an interview that will air on Pacifica Radio’s national show Letters to Washington on September 8th.
The Committee has prepared, for each member, a district-level analysis of the impact of the legislation. This analysis includes information on the impact of the legislation on small businesses, seniors in Medicare, health care providers, and the uninsured. It also includes an estimate of the impacts of the surtax that is used to pay for the legislation.
The original, "Bait and switch: How the “public option” was sold" by Kip Sullivan is linked here.
From Kip's Reply to those who wrote in response to that article:
How many times must universal coverage advocates rush onto the battle field to promote a multiple-payer solution and get slaughtered before they realize they can’t get to universal coverage that way? How many defeats will it take till they know that universal coverage without cost containment is not politically feasible? How many times can they be fooled into thinking that there are ways to cut costs other single-payer?
There are several reasons why the lessons of previous defeats don’t sink in with many universal coverage advocates. I’ll discuss two here: (1) insufficient knowledge of how social change happens; and (2) insufficient knowledge about the role that promoters of market-based solutions to the health care crisis played in marginalizing single-payer legislation in Congress.
This view of social change is often expressed in the mantra quoted above, “Single payer is not within the realm of possibility this term.” The implication is that if single-payer advocates cannot demonstrate that they have at least 51 percent of the votes lined up, they should retreat to the sidelines and watch the “political yes buts” do their thing. It implies that social change must occur within a single session of Congress rather than over the course of many sessions. It implies that movements for social change should, in the event that they do not have a majority vote locked up at the beginning of any given session of Congress, put their campaign in moth balls and forgo the opportunity to educate the public and build their movement through lobbying, testimony, rallies and all the other tools associated with campaigns to move bills in Congress.
In short, it implies an absurd Catch-22. To get the “political yes buts” to join them, single-payer advocates must show proof of having a majority of Congress on their side; but to get a majority of Congress on their side, the single-payer movement must build and wage a campaign relentlessly over many years in the face of active discouragement from the “yes buts” – and without pestering Congress with ideas unfairly characterized as utopian.
These demands, when they are spelled out, are obviously irrational. Universal coverage under a single-payer system is going to be difficult to achieve. The difficulty may be on the order of the difficulty of ensuring voting rights for women and civil rights for black people, to name just two examples of movements that took decades to accomplish their goals. If the leaders and supporters of these movements had accepted the Alice-in-Wonderland rules recommended by the “yes buts,” the women’s suffrage and civil rights movements would never have happened.
There have been three cycles of health care reform in the last half century – 1970-73, 1992-1994, and 2007 to date. At the dawn of each cycle, single-payer legislation had already been introduced. But early in the cycle, single-payer legislation was “taken off the table” (to quote a statement Sen. Max Baucus now wishes he had never made). Each time the Democratic leadership chose instead market-based proposals that had no track record and no evidence to support them. Each time they favored reform deemed more “politically feasible” than single-payer because it left the insurance industry in place. In all three cycles, the alternative, market-based proposal was promoted by one or two policy entrepreneurs (that is to say, it wasn’t an idea that bubbled up from the grassroots).
I am not going to quote all of the history of those first two cycles detailed in this article, but it would be well worth your time to read. On to the thrid one - now...
The cycle we’re in now bears many similarities with the last two cycles. When this cycle began (2007 is as good a year to pick as the first year of this cycle, although that is somewhat arbitrary), single-payer legislation was better positioned than ever before to be taken seriously by Democrats. Single-payer bills had been introduced in several states as well as the US House (Sen. Bernie Sanders would introduce a single-payer bill in the Senate in 2008). Polls were showing that two-thirds of Americans and 60 percent of doctors support single-payer (or “Medicare for all”) legislation.
But once again an articulate policy entrepreneur appeared on the scene to sell a market-based alternative to single-payer that would leave the insurance industry at the top of the health care food chain, and once again the Democratic leadership fell for it. This time the entrepreneur was not Paul Ellwood. This time the policy entrepreneur was Jacob Hacker, a professor of political science at Berkeley. Just as Ellwood and the Jackson Hole Group had before him, Hacker said enhanced “competition” among insurance companies was the solution to the health care crisis. (The name of Hacker’s latest paper is “Healthy competition.”) This time enhanced competition would not come from “managing” competition, but from the creation of a “public option.” This time the coalition that promoted the alternative to single-payer was not the Jackson Hole Group, but HCAN, assisted by a sister coalition called the Herndon Alliance.
The Herndon Alliance was founded in 2005 by many of the same groups that would create HCAN in 2008. The Herndon Alliance paved the way for HCAN’s promotion of the “public option” with some laughable “research” claiming to find that Americans want a “public-private-plan choice” approach and don’t want a single-payer system. I have written elsewhere about the bogus “research” conducted by the Herndon Alliance. Suffice it to say here the Herndon Alliance cooked up a new and more insidious version of the “political feasibility” argument.
Until about 2007, when the Herndon Alliance first began publishing its “research,” there was only one variant of the “political feasibility” argument, the one that said the insurance industry is too powerful to beat. The Herndon Alliance variant claimed single-payer is not feasible because Americans don’t want it. According to this variant, American “values,” not the insurance industry, are actually the greatest impediment to single-payer. According to the Herndon Alliance, Americans “value choice of insurance company” and “they like the insurance they have and want to keep it.” HCAN and Hacker picked up these refrains and promoted them vigorously to the public and to members of Congress. This inexcusable attack on single-payer no doubt helped key committee chairs in Congress (Kennedy, Baucus, Waxman, Rangel and Miller) feel more comfortable taking single-payer off the table and concentrating on the “public option.”
By early 2009, it was clear the Hacker-HCAN-Herndon Alliance propaganda for the “public option” and against single-payer had worked with the Democratic leadership, and that the Democratic leadership would fall once again for a market-based alternative and remove single-payer from the table. The removal of single-payer legislation took place without the firing of a single shot in public by the insurance industry and the right wing. It took place at the request of the “yes but” wing.
In the House, single-payer legislation, HR-676, has been rammed back onto the table, thanks to hell-raising by the single-payer movement, including the arrests of some brave doctors and nurses who disrupted hearings in the Senate Finance Committee last May. Last Friday night, Speaker Nancy Pelosi agreed to allow a floor vote on whether to substitute HR 676 for HR 3200, the Democratic leadership’s “public option” bill. This is a significant victory for the single-payer movement, but it should not have come so late in the 2009 session. If Pelosi and the three committee chairmen who wrote HR 3200 had permitted HR 676 to go through the normal committee hearing process, single-payer advocates would have had more time to educate Congress and the public about why a single-payer system is superior to all other alternatives.
It appears almost certain that the reform cycle we’re in now will end the way the last two did – with the Democrats’ competition-based alternative to single-payer going down in flames. It is extremely important that progressives, especially progressives in the “yes but” camp, understand why this happened. Yes, the ultimate villain in these dramas was the insurance industry and their conservative allies. But universal coverage advocates must understand the role of the “yes buts,” and the policy entrepreneurs they listened to, in splitting the universal coverage movement and in seducing Democrats to support legislation that was no more likely to pass than single-payer legislation and wouldn’t have cut costs if it had passed. If they don’t see this – if they persist in believing the insurance industry is the only force single-payer advocates have to contend with – they will, wittingly or unwittingly, help perpetuate the pattern we have seen in the last three reform cycles. They will, in short, perpetuate the insanity of doing the same thing over and over, seeing it fail, and not learning from failure.
The argument that any “public option” is better than none has rarely been articulated, but I suspect we will hear it more often as the reality sinks in that the “public option” in the Democrats’ bill is a joke. “Public option” advocates who learn for the first time that the “option” in the Democrats’ bill will insure few or zero people have only two choices: to abandon the “public option” movement, which is no doubt emotionally difficult to do for those who have invested heavily in the movement, or to continue to work for the Democrats’ version of the “public option” and rationalize that choice with the argument that a tiny “public option” can always be improved once it is established.
The problem with this argument is that the “public option” is not your typical government program. The “public option” is not like the space program or the various college loan programs, to take a few examples, all of which can be expanded or contracted as the years go by without seriously threatening the very existence of the program. The “public option” will be a business. And this particular government-run business may never get very big; it may not even survive. If it doesn’t get big, or doesn’t survive, it won’t develop the huge public fan base that protects popular programs like Social Security and Medicare. In fact, the reverse could happen. A miserable early performance may cause Americans to turn against the idea of a Medicare-like program for the non-elderly. Unlike public programs, businesses don’t have an indefinite time period to develop a supportive public. Businesses don’t automatically take root and go on living forever. The “public option” must prove its ability to survive and undersell the insurance industry quickly. Moreover, the “public option” will be attempting to break into a business that has been consolidating over the last few years. The insurance industry is extraordinarily difficult to crack.
“Public option” proponents who urge us to support even a token “public option” must remember how much is at stake here. At stake is not only the willingness of the public to believe that government health insurance programs can outperform the insurance industry. At stake as well is whether Congress will give the insurance industry a trillion dollars per decade of taxpayer money.
A well-fed insurance industry is bad news for both single-payer and “public option” advocates. An insurance industry strengthened by a trillion dollars per decade of new tax dollars will not only be in a better position to oppose single-payer legislation, it will also be in a stronger position to lobby Congress and the regulators to ensure the “public option” remains stunted.
“Public option” advocates should start talking about the “public option” as if it were inextricably tied to an insurance industry bailout. They should write the phrase “public-option-insurance-industry-bailout” on a Post-it note and paste it to their bathroom mirror to remind them to be honest with themselves and the public about this fact.
To sum up: “Public option” proponents who claim that any “public option” is better than no “public option” because even a skinny little program can be beefed up later are sadly mistaken. A weak “public option” may not survive to be beefed up later, and whether it survives or not, it will serve as fig leaf that will let Congress justify an insurance industry bailout. A strengthened insurance industry is the last thing either the “public option” or the single-payer wing of the universal coverage movement needs. Please say after me: A weak public option is far worse than none at all.
I am under no illusion that a single-payer bill would have passed Congress in 2009 given the world as it was in December 2008. I do believe, though, that if the “yes but” wing of the universal coverage movement had thrown their considerable weight behind single-payer prior to 2009, say, in 1992 when the last reform cycle began, we would either have a Medicare-for-all style system by now, or we’d be on the verge of enacting one now.
Will HCAN and Hacker put out a call to their followers to do all they can to win the floor vote on HR 676 this fall? Or will they give lip service to HR 676 and sit on their hands? When the 2009 session of Congress ends, will HCAN et al. offer their usual misinterpretations of why reform failed?
How quickly America enacts a single-payer system will depend in part on whether progressives learn the real lessons of the failure of the “public option” movement in 2009. If the “yes but” wing draws the same lessons it drew from the failure of the Clinton bill – that the “base” was not well enough organized, or that the Clintons didn’t “sell” their plan skillfully – unity within the universal coverage movement seems unlikely, and the day we get to a single-payer system will be postponed.
I believe the “yes buts” must confront some inconvenient truths immediately. The “political feasibility” rationale for doing nothing to assist the single-payer movement was never a good one or, at minimum, after two decades of constant use, has become an embarrassment and must be discarded. It is foolish to argue that even the tiniest “public option” will constitute a victory that can be built on later. If the “yes buts” see these truths, then unity within the universal coverage movement should be possible. And if unity comes to the universal coverage movement for the first time in 40 years, single-payer can’t be far behind.
Please read it all here at PNHP's Official Blog and share with your progressive friends. More people will die if we fail. Our Grandchildren will be fighting the same battle in another 20 years.
Republican obstructionists to Obama's agenda have developed a new tactic. Seemingly forgetful of how Republican majorties jammed through huge bills without letting Dems actually read them, they now insist that every Dem has to read every bit of every bill and more specifically the Health Care Bill. Well in reality that is not that much of a challenge.
When people make the claim that no one can really understand a 1018 page bill realize that mostly you don't need to deeply engage with more than maybe seventy or eighty double spaced, highly indented pages to get a pretty solid grasp of what the bill proposes.
The congressional health care reform bill, H.R. 3200, now contains the Kucinich amendment thus keeping hope alive for a single-payer system.
Two weeks ago, Dennis Kucinich proposed an amendment to the healthcare reform bill that keeps the single-payer option alive. Kucinich's amendment will permit states the power to introduce single-payer health care systems.
Importantly, Kucinich's amendment drew bipartisan support by uniting proponents of single-payer health care with states rights advocates, and it is now the crucial part of the landmark bill that is due to be voted on by the end of this month.
For years, Dennis Kucinich has been a leading advocate of single-payer health care. John Conyers and Dennis Kucinch co-authored the single-payer bill, H.R. 676, a landmark piece of legislation that has 85 co-sponsors.
America is the sole western democracy that does not have a single-payer system. Some nations in the Middle East, Asia and Latin America have single-payer health care systems.
Federally sponsored single-payer health care might be off the table as Congress debates its health reform strategy this summer, but if some House lawmakers get their way, there would be nothing to prevent states from offering that model.
The House Education & Labor Committee voted today in favor of an amendment, sponsored by Rep. Dennis Kucinich (D-Ohio), eliminating legal barriers that might prevent states from adopting a Medicare-style system of health coverage.
The vote was 25 to 19, with support coming from an odd mix of liberal Democrats who support single-payer on its merits and conservative Republicans who want to preserve the rights of states to regulate themselves.
The vote is largely symbolic. Cash-strapped states likely won’t be able to rustle up the funding to cover all their residents without federal help, even if they did support the concept politically. Still, some health care groups are cheering the House vote nonetheless. The California Nurses Association, for example, issued a statement calling the vote “a historic moment for patients.”
If the provision were to become law, CNA argues, single-payer supporters could move their lobbying battle from Washington to state capitals.
Kucinich offered his own take on the significance of the push.
“By getting rid of the for-profit insurance companies,” the Ohio liberal said in a statement, “we can save $400 billion per year and provide coverage for all medically necessary services for everyone in the U.S.”
The amendment propels the growing single payer health care movement at the state level. There are at least ten states which have active single payer efforts in their legislatures. They are California, Colorado, Illinois, Minnesota, Montana, New Mexico, New York, Ohio, Pennsylvania and Washington. The amendment mandates a single payer state will receive the right to waive the application of the Employee Retirement Income Security Act (ERISA), which has in the past been used to nullify efforts to exjavascript:void(0)pand state or local government health care.
Under the Kucinich Amendment a state's application for a waiver from ERISA is granted automatically if the state has signed into law a single payer plan. With the amendment, for the first time, the state single payer health care option is shielded from an ERISA-based legal attack. Now that the underlying bill has been passed, as amended, by the full committee, we must make sure that Congress knows that we want the provision kept in the bill at final passage!
The state single payer option was one of five major amendments which I obtained support to get included in HR3200. One amendment brings into standard coverage for the first time complementary and alternative medicine, (integrative medicine). Another amendment drives down the cost of prescription drugs by ending pharmaceutical industry's sharp practices manipulating physician prescribing habits. An amendment stops the insurance industry from increasing premiums at the time when people are not permitted to change health plans; and finally an amendment imposing a requirement on insurance companies that they disclose the cost of advertising, marketing and executive compensation expenses (which generally divert money from patient care).
Please make sure you post this message on your social networking sites, ask all your friends to get involved and encourage everyone you know to sign up at www.Kucinich.us so we can build full momentum behind this movement for real health care.
