Health Care Reform: Time to Go All In

It is time to go all in to support comprehensive health care reform. The stakes have gotten prohibitive. Republicans have essentially bet the House on it. Obama, for all intents and purposes, has wagered the White House agenda. The insurance and drug companies are pouring in dough. This month will be telling. The debate in congressional districts across the country in August will go far in determining what kind of reform we get -- or whether we get any reform at all.

The opposition -- well financed by the insurance and drug companies and by the rabid right -- is mobilizing now to stop reform. Republicans believe that they can replay 1994 when the defeat of Clinton's health care plan (and the fight over NAFTA) led to the stunning elections that resulted in the Gingrich congress. The insurance and drug companies have sought to dilute reform on the inside the process while helping to fund front groups trying to torpedo it on the outside.

Their tactic this August is clear. Run Astroturf campaigns and mobilize the zealots to disrupt congressional town hall meetings, spew anger and invective against the "government takeover" of health care that will "kill your grandmother." Intimidate legislators, cow decent citizens, sow fear and confusion. Legislators learn that if they vote to disembowel reform they'll be amply rewarded with campaign contributions. If they vote to support it, they'll face the fury of the wingnuts and the Astroturf activists. Cynical but effective politics. (For a fact check on the big lies, go to the Campaign for America's Future page here [1])

Every American has a direct stake in this debate. Every citizen faced with soaring health care bills, every one of the 14,000 [2]who lose their health insurance each day, every one of the millions frozen in jobs for fear of losing health insurance, every family that faces bankruptcy [3]because someone got sick, every one denied coverage or cut off of coverage because he or she fell sick, [4] every parent losing sleep over a child entering the workforce without insurance, every senior gouged by unconscionable prescription drug prices [5], every worker who simply can't afford adequate [6]coverage for her or his family. If the insurance industry and the Republican right manage once more to frustrate reform, all of us will pay part of the price.

We should make it a personal mission to challenge and counter the opposition's plans. Locate the town meetings that your legislator is having. (Call your legislators' district offices. Health Care for America Now provides a listing of town halls organized by pro-reform groups here [7]) Attend with friends and family, silence and shame those trying to disrupt the meeting, demand a serious discussion about this fundamental issue. Challenge your legislators to ignore the wingnuts and support real reform, not a watered down substitute.

So what constitutes "real reform?" Amid the foul odors and sordid ingredients of the legislative process, it is easy to lose sight of what is needed to insure the result is nourishing, and not dangerous to our health.

What many of us would favor -- a system of government funded insurance with many alternative plans, a sort of Medicare for all - is not on the table, to the dismay of single payer advocates. But reforms now under consideration include major changes -- all of which have passed through Senate and House committees -- that could make a dramatic difference in people's lives, and begin to mend our broken system. Those elements include:

Choice . if you have insurance, like it, and can afford the increasing costs of it, you get to keep it. Every plan on the table insures that. The charge that this is a government takeover of heath care is simply a lie.

Comprehensive insurance reform. Since most American voters have some kind of insurance, these reforms will have the greatest impact. Every plan under consideration will force a change in the insurance companies' model. They will be prohibited from refusing to cover those who are sick, and prohibited from cutting off those who get sick. Discriminatory prices against women [8]will be banned. Children can stay on family plans until the age of 26, which is vitally important to those like myself, a father of a 23 year old daughter who works at a place that doesn't offer health insurance. Insurance companies will be prohibited from hiking rates and co-pays in the middle of the year just because someone gets sick. They won't be able to gouge small businesses when one of their employees suffers a serious illness.

Shared responsibility. Everyone covered; everyone contributes. Mandates on businesses - beyond small shops -- to provide insurance or pay into a common pot; mandates on individuals to get insurance. This removes the hidden charge -- estimated at $1,100 per person -- we each pay for the 47 million who aren't insured and are forced to use the emergency room as their doctor, often putting off treatment that results in higher costs when the untreated illness becomes critical. If you have health insurance now, you've got a big, personal stake in getting everyone covered.

Affordability. You can't mandate that people get insurance without making it affordable, since cost is what keeps people from getting it. The best legislation coming out of the House would provide subsidies for low and middle income families up to 400% the poverty level (about $43,000 in individual income). The house legislation would also empower Medicare to negotiate lower prices on drugs, and allow the import of drugs from safe places abroad, saving seniors big time. This would remedy the outrageous payoff to Big Pharma in the prescription drug bill that prohibits Medicare from negotiating lower prices on drugs.

Fair financing. Not surprisingly, there's a pitched battle over how to finance the costs of the change. This shouldn't be complicated. In society with gilded age inequality and the wealthiest paying lower tax rates than their secretaries, the most sensible way is to add hike top end tax [9]rates on millionaires. Rep. Charles Rangel has been pushing for high end tax rates. The least sensible way -- floated constantly by the eternally wrong-headed Senator Max Baucus, chair of the Senate Finance Committee -- would be to tax those who have so called "Cadillac" health care plans now. Too often people with high cost plans are people who suffer terrible illnesses. The insurance companies already gouge them for getting sick; it would be truly outrageous for the Congress to tax them for it. Luckily Obama campaigned against this in his campaign, and should be held to that promise.

Public Option. For those whose companies don't provide insurance -- disproportionately lower wage workers in small businesses -- every plan offers access to an "exchanges" that provides choices in private plans and helps keep prices down. Key to this is a robust public option that can contract with providers at something like Medicare rates. That will drive down the price of private insurance, provide model coverage that they will have to compete with, and help, as the president put it, keep the companies honest. The most obscene part of this debate has been to watch so called fiscal conservatives in both parties seek to oppose or disembowel the public option. This is the corrupting influence of insurance company dollars. If they succeed in prohibiting the public option from pegging its rates to Medicare, it will be as outrageous a subsidy to private industry as the prohibition on negotiating lower drug prices. Legislators in both parties should be challenged to support a real public option.

This isn't as complicated as some in the media try to make it. Cover everyone, curb the abuses of the insurance companies, insure affordability, and send the bill to those who've had the party, use a public option and the power of Medicare to drive lower prices and better practices.

Making the case

In a town meeting or on the phone to legislators' offices, many of us get intimidated. Legislators and aides often are skilled at using detail to dazzle or distract. The right-wing claque hopes to intimidate others. But in fact, you don't need all the facts and figures. Just tell your own story about health care, and express your opinion clearly. Say you want insurance company abuses curbed. That you expect your representative to fight for a public option strong enough to cut costs and force competition. That you want the reforms paid for fairly by higher taxes on the wealthy and a cutback on subsidies to the insurance companies. And make it clear, reform is essential; the right-wing extremists don't speak for you or the district. Don't let them hijack the debate.

These reforms aren't nirvana, but they would make a difference. And committees in both the House and Senate have now passed bills that contain them. If they are passed into law,

we will have made dramatic changes in our health care system that will benefit the vast majority of Americans. A lot more work will still be necessary to fix the broken system -- particularly on cost. But most Americans will enjoy more secure, more affordable, and more sensible coverage.

Needless to say, this is all contested. The House Energy Committee, held hostage by the Blue Dogs, weakened the public option, lowered the subsidies for middle income workers, and diluted the reforms. We haven't even seen the worst of the bills, whatever comes out of Baucus' Finance Committee. But in the House and the Senate, if liberals stand tall, we've got a real chance to pass the basics mentioned above.

The first question, however, is whether any reform will pass. That is what is at stake this August. Will the insurance companies, the Republicans and the wingnuts sow sufficient fear and doubt to stop any serious reform? Or will citizens demand an adult debate about a broken health care system that must be fixed?

If Republicans are betting the house on this, so is President Obama. As Senator DeMint suggested, the right thinks defeat here will be Obama's Waterloo, that it will "break" his presidency. There is no question that failure to move health care will be treated by the press as a monumental setback, weakening the president significantly. If health care reform fails, then the other reforms on the table -- energy, financial reform, education, immigration, empowering workers -- will face more daunting odds. Many voters dismayed at the failure will stay home in 2010. Failure on health care may well strangle this era of reform in its infancy. That, of course, is what the zealots on the right seek.

But this country can't afford more drift and more stasis. We can't afford another failed presidency. We desperately need to step up to deal with the fundamental changes that can no longer be avoided. This isn't a spectator sport. The abusive tactics of the right are designed to keep the good hearted away, to create fear in the undecided, to cow timorous legislators. We can't allow that to happen. It is time to go all in.

Cross-posted at The Huffington Post [10]