A Tale of Two Senators

by Tim Foley

categories: Obama and Congress, Public Plan, Single Payer

Published March 27, 2009 @ 03:14PM PT

For those of us who believe that the health care reform legislation to be worked on in Congress this year needs to, one way or the other, decrease the influence of private insurance and increase the opportunities for public program coverage, it was the best of times, and it was the worst of times. For “the spring of hope,” Sen. Bernie Sanders introduced the first comprehensive single-payer bill in the Senate that we’ve seen in seven years. For “the winter of despair,” Sen. Max Baucus gave very public statements suggesting his support for the public competitor is just a bargaining chip. How can we take a step forward and a step back on the same day? Ladies and gentlemen, your United States Senate!

Let’s start with Sanders. Although HR 676 enjoys some broad support among House Democrats (and enjoyed a lot more last session), the Senate has been a vast wasteland for the Medicare-for-all approach since the untimely death of Sen. Paul Wellstone. The “American Health Security Act of 2009” is actually more similar to the Wellstone approach than it is to HR 676. In essence, the Federal government sets the regulations for comprehensive benefits (including dental, mental health and prescription drugs) and provide funds to the states to pay for health care. However, the states themselves set up their own single-payer administration, including figuring out how to get all of their citizens enrolled, getting them a Health Security ID Card. Once the State sets up its system to cover the comprehensive benefits it can, if it wishes, then find a way for paying for additional benefits. You can easily see Massachusetts, for example, paying for lots of services outside the Federal standard and Wyoming paying for the minimum and only the minimum.

Sanders’ bill also adds on some of the more popular policy items relating to increasing access to primary care, including fully funding community health centers in underserved and rural areas, and giving the National Health Service corps the funds for an additional 24,000 National Health Service Corps doctors. The remarkable thing is not that this bill has a chance of passing – it has zero co-sponsors and has been assigned to the Senate Finance Committee whose Chairman, one Max Baucus, has been outspoken in stating his objections to single-payer – but indeed that it exists at all in the chamber of Congress where the most progressive reforms go to die.

I’m going to be honest, though. I’d feel more comfortable explaining to people how this legislation isn’t socialized medicine if it hadn’t been introduced by the only Democratic Socialist in the Senate. Awkward… awkward…

On the flip side, that same Sen. Max Baucus has advanced a vision for reform that matches up quite well with the campaign plan of President Obama, the broad strokes of a plan coming out of the House and Sen. Ted Kennedy. This includes a public competitor, a plan similar to Medicare and available to those without insurance that would be publicly administered and compete with private insurance on the merits. Given the mounting firestorm over this policy coming from both among those opposed (including AHIP, Sen. Chuck Grassley and others) and from those supporting, including Howard Dean, who launched a Web site dedicated to supporting the public option, you wouldn’t expect Sen. Baucus to undercut his own negotiations by saying something like this:

Essentially, it's to keep it on the table to encourage the private health insurance industry to move in the direction it knows it should move toward.... And the public option helps encourage the private companies to move in that direction, because they're worried. We might have to modify the public option to get enough votes. I hear some concerns among Republicans about the public option. The main purpose is to keep the health insurance feet to the fire.

Wow. That’s not a ringing endorsement – it makes the public competitor sound like something that exists to drag out concessions from the private insurance companies and Republicans during bargaining. The excellent post by Karen Tumulty goes on to explain that many, including Len Nichols of the New America Foundation, have gone from vociferously defending the necessity of the public option to coming up with a weaker version that won’t engender the opposition’s ire.   Suffice to say, denying people the choice of opting out of manipulative private insurance altogether, if we want to, only to receive promises that the private companies will be less manipulative doesn’t sound like a good bargain.

Dickens words in A Tale of Two Cities capture well the spirit of reform today. “We had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way.” Let’s hope more principled heads prevail before we all wind up going the other way.

(Photo credit:  The Udall Legacy Bus Tour on Flickr.)