3-120-09, 9:57 am

The Obama administration made a campaign promise that national health legislation would pass early in his administration. The promise has not been derailed by the Daschle fumble. In fact, the outline of an official proposal just might be put forward within a month.

Clearly on the minds of the administration is the disastrous mistakes of the Clinton administration in not enacting some kind of national health care legislation before the 1994 congressional elections. That will not happen again, according to every source and leak.

The administration has held to summits one on “fiscal responsibility” (which the right-wing tried to turn into a summit on 'entitlements') and “health care reform.” In addition other forums have been held in the past month. The administration has also collected tens of thousands comments from people via emails and local actions on health care reform. But, with all of those policy discussions, external political considerations were and are looming.

The administration, and indeed the country as a whole, cannot afford a repeat of a Gingrich ultra-right win Congress – not in this era of national and global financial crisis.

Lay of the land

What healthcare reform will look like is the question on everyone’s mind.

Single payer advocates, riding high with massive grassroots and labor support, are pressing their case. Moderate elements of the health movement are also in the fray. Conservative Democrats in the Senate, especially the Senate Finance Committee, Chaired by Nebraskan Max Baucus, have been pushing a mixed approach. Others like Rep. Pete Stark (D-CA), who chairs the important health care subcommittee under Rep. Charles Rangel’s (D-NY) House Ways and Means Committee is advocating a “Medicare for All” proposal.

And, of course, the medical and health industry is lobbying hard and pulling out every favor to push their private sector position, opposing all avenues to the “public option.” The corporate, for-profiteers will be pushing policy proposals that keep them in the driver’s seat on the health care reform debate and in the system itself.

What will the Specific Proposal Be?

There is every reason to believe that in conjunction with Democratic Senate and House leaders, the administration will back a a health program that will:

1. Allow everyone who is satisfied with their current health benefits program will be allowed to keep it (an Obama campaign promise);

2. Expand Medicare by lowering the eligibility age 55 years old; but most observers expect that there will be a buy-in requirement (part of the Baucus proposal);

3. Expand Medicaid by changing the eligibility requirement to enable millions more low-income workers to qualify (also a Baucus proposal);

4. View the newly reauthorized and expanded Childrens’ Health Insurance Program (CHIP) as a key component of national reform;

5. Give federal support to unemployed workers for continuation of benefits (COBRA); and, workers on unemployment insurance will be deemed qualified for Medicaid. Both of these provisions were included in the president's economic recovery package and went into effect on March 1st.

Policy experts believe that taking these steps by themselves could cover well over half of the 47 million currently uninsured people.

To fulfill the Obama campaign promise of insuring all Americans, the other half of the uninsured will likely be offered coverage under a health insurance plan that carries the principles of the Federal Employee Health Benefits Program (FEHB), which covers members of Congress and most federal employees.

Paying For the Health Program

Paying for these health policy programs is a central issue. The Obama administration has proposed the following to raise revenue to pay for its reforms:

1. Allowing the bush tax cuts for the wealthiest Americans to expire, contributing more than $300 billion to reform;

2. Eliminating overpayments to insurance companies under the Medicare Advantage program, saving at least $15 billion each year;

3. Controlling prescription drug prices in Medicare;

(These two actions will eliminate the worst privatization efforts of Medicare implemented under the Bush administration.)

Taxing benefits: How NOT to pay for reform

The right-wing suggestion that workers’ health benefits should be considered as income and taxed must be totally rejected. This proposal is framed as taxing employers, but in reality, it is taxing workers for health benefits which they already take smaller wages to pay for. That would constitute a double tax on workers. Unfortunately, White House budget director Peter Orszag hinted support for this idea recently, though he added that any new tax would be aimed at the highest income earners.

Worth Supporting?

Is this kind of national health program worth supporting? Does the sum of its parts make the whole a program something that moves the country in a better health direction?

If we viewed these possible proposals for health care reform in a vacuum, separate from the political situation, the answer is probably, no we couldn't support it.

We don’t live in a vacuum or in a perfect world. That said, these various health policy proposals would move the country in the right direction. This mix of programs, if enacted, has room to be moved to a better position. Each component has a “public option” worth supporting and pushing forward.

These are incremental moves that meet the progressive standard for support.

If implemented, Medicare would be made available or people over 55 years old, and Medicaid if expanded. Once more and more people experience the benefits and affordability of these programs, they will likely favor them as solutions for the whole country.

The FEHB principles are certainly good and would bring health services to everyone not covered by the other programs.

And, most importantly, labor unions that want to keep what they have won at the bargaining table would be able to do so. The fears of union members that they might come out of the reform process with less than what they went in with, a fear that is not unwarranted, can be put to rest. This reality is important not withstanding the difficult period that employer-based, negotiated health plans are going through.

Down the road, if they wish to join the new public program, that option would be kept open.

Key words: “public option”

In all of these sets of proposals there is a swing between a public (government responsibility) to a private (insurance company) option. The struggle for the public option is where this current epic struggle will be fought.

The failure of the Kennedy National Health Insurance Plan in the 1970s helped lead to the 1980 Reagan election win. The failure of the Clinton national health plan led to the Gingrich ultra-right wing Congress in 1994-2000. These are two experiences that must not be repeated in the 2010 congressional election.

(The great success of Medicare and Medicaid in the mid-1960s would have yielded a Hubert Humphrey/Democratic Party victory over Nixon in 1968 had not the same party and Lyndon Johnson pushed the unpopular Vietnam War.)

This is the lesson that the newly created right of center, Blue Dog Democrats, must be taught and taught soon by their constituents. The newly created moderate Senate Democratic group has targeted health care. They haven’t learned the lessons of 1980 and 1994. Their constituents must visit them during congressional recesses to convince them that a strong “public option” for health care is both necessary and doable.

Keep Up The Struggle

Getting national health legislation enacted by Congress gives us the possibility of making something out of something. Not doing that will leave us out in the cold and in a very dangerous situation.

Single-payer and National Health Service advocates should not give up. Community Health and Primary Care supporters must keep up the struggle. Those fighting to strip the health systems of excessive administrative costs must keep up the heat. Eliminating the racism and gender discrimination and other unfairness in the system must continue.

There are still so many “i”s that are not dotted and “t”s not crossed that to abandon the struggle now would leave the policy rooms in the hands of the insurance carriers and drug companies. The profiteers are counting on progressive health forces turning their backs on the new administration. The Obama administration is counting on its electoral and peoples’ coalitions to stay involved and pressing for their individual and collective demands.

We have to increase the heat for a fully universal national health program without the profiteers.