Predicting – and preparing for – the future: Health care reform debate in Congress

Opinion commentary by Craig Salins, July 1, 2009

In political organizing, as in traveling or hiking, it’s always useful to have a compass, and a sense of what’s around the bend – the immediate future.

Accordingly, what can we expect by this fall, re: health care reform legislation in Congress?

Why is this conjecture relevant? Because it can help to guide what we do, as advocates of any particular point of view.

At least three things may be true by October/November this year, that are not yet true today.

1. Re: Legislation. We’re likely to see a “least common denominator” health care reform bill, one which is tremendously costly (triggering further taxpayer concern and perhaps revolt), and/or which brings dubious benefits and coverage to households that today lack coverage (or adequate coverage).

If it includes a public plan as an option, there likely will be trade offs between high cost and good benefits. And any public plan may be hobbled by legislative or budgetary restrictions (restricted availability of the plan; tiered benefits traded for lower cost; etc.) – items we disapprove of – yet demanded and enforced by private special interests during the lawmaking process.

Some of these restrictions may prove destructive or even eventually fatal – either to the workability of the plan itself, or to public confidence in government ever to provide a generic service that citizens need – like health care coverage and services.

Keep in mind: Our patchwork quilt of participants in the health care system today consists of many hundreds (if not thousands) of entities, each protecting their turf and silo – totally understandable.  But the result is: If powerful interests and players need to be bought off to achieve any reasonable “reform”, it threatens to break the bank even further. Money trumps good policy every time.

And so, as reform advocates seek changes including cost containment – partly by trimming the profit, overhead costs and administrative waste inherent in the system, it is precisely the private corporate “fat” we seek to trim that has the most staying power – the most political influence – and therefore is least likely to be trimmed. Congress will “tailor” any legislation with edits to garner votes – and those votes (and edits) will be heavily influenced by corporate players in the health care industry.

In any case, we should fight to include single payer principles and features in any public plan option – principles and features such as:  a) available to all;  b) same good benefits to all who are enrolled;  c) financed according to ability to pay;  d) fair reimbursement to health care providers.  This might be the only chance we’ll have to shape a public plan that might eventually evolve into a true national program, serving everyone, with good benefits, financed socially (like Social Security), and with full choice of any health care provider we choose.

2. Re: Awareness/Support for Single Payer: By this fall, more people everywhere may have learned that only a single payer system can bring truly affordable coverage (with cost control), comprehensive benefits, and full patient choice of providers and care – all in a manner that is sustainable over time.

How many more people? – and at what level of awareness? It may be depend on what advocates choose to do, and can do with limited resources – working with like-minded allies locally and nationally.

How staunch and steadfast will be their understanding and support? Again, it may depend on what advocates do during this “teachable moment” – along with a willingness to recognize actual public worries, doubts and concerns, and to respond in ways that allay these fears.

3. Re: Campaign finance reform: Lastly, and importantly: Public awareness is likely to grow, how lawmaking in Congress is in effect “for sale” – skewed by the influence of money and lobbyists, mostly corporate, with seemingly unlimited ability to quietly shape law and regulations to their benefit.

Perhaps, more people will see how this stymies progress on issues important to ordinary households.  It will be an opportunity to explain public financing of campaigns as a way to “buy back our democracy” and to make elected lawmakers accountable to constituents rather than to private campaign financiers.

And if we truly believe that campaign finance reform is essential to any real progress on many issues, we should take full advantage of this “teachable moment” – this rising tide of opportunity.
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Craig Salins is executive director of Washington Public Campaigns – a grassroots statewide organization with the mission to bring public financing of campaigns at every level. www.washclean.org

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