Strategies to Pass a National Public Option/State Single Payer Health Care Plans: Will They Work?

Lately there's been a lot of angst from liberals and moderates who favor health insurance reform regarding the fate of a public option* in Congress. What's missing is a sense of how national policy debates intersect with state efforts to reform the provision of health care.

Listen up if you live in the states of California, Illinois, Minnesota, Pennsylvania, or Ohio (pdf).

Listen up if you're belong to or agree with over 572 union organizations nationwide who support single-payer health care at a national level, also known as H.R. 676.

Listen up if you've gotten increasingly concerned over the mainstream media reporting on reputed White House wavering on the public option.*

MOMocrat CityMama gave an excellent overview of the situation which I encourage you to revisit and plunder for talking points WHEN YOU CALL OR FAX your representative. You are making those calls, right?

I wanted to give a little space here to review what's happening on the state level, and encourage you to mobilize there as well.

Conventional wisdom has it that single-payer health care--in which the government pays for the health care of all universally-covered citizens--is a non-issue. Of the different versions of bills and many amendments to make it out of House committees, single payer was said to be off the table from the beginning of the conversation about health insurance reform and recent comments from Obama administration officials have only confirmed this.

Yet what may have flown under your radar is a late July announcement by Speaker of the House Nancy Pelosi that a House floor vote on single payer will be held in early September when Congress returns from August recess. That means any day now.

Congressman Anthony Weiner of NY (D, CD-9) explains how single-payer would work:

The truth is that the United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veterans Administration, the Department of Defense and the Bureau of Indian Affairs.

...

If Medicare has been such a success, why not extend it? Why not have single-payer plans for 55 year olds? Why not have one for young citizens who just left their parents or college coverage?

So far, the answers we hear to these questions have simply not been very convincing.

...

If Wal-Mart can pool its customers to be able to offer the $4 prescriptions, why shouldn't the federal government drive the same hard bargain on behalf of the tax payers so they too get the best prices under Medicare?

So if single-payer "isn't really on the table," why the House floor vote?

Here's my speculation on this. There is a Kucinich amendment that would enable HR 3200, our current bill on health insurance reform that contains a public option, to permit states to pass and implement single-payer plans. That would mean we'd have a national public option on health insurance, and single-payer coverage for residents of those states that pass that legislation.

The states I mentioned above--California, Illinois, Minnesota, Pennsylvania, and Ohio--already have state single payer bills ready to go. Pennsylvania has two bills, HB 1660 and SB 400.

In my state, California, SB 810 has already passed the state senate health committee in a 7-4 vote and now needs approval from the senate appropriations committee. It's already passed all the committees it needed to twice before, only to be voted down TWICE by our Republican governor Arnold Schwarzenegger.

In fact, the city of San Francisco already offers a public health care plan to all uninsured city residents. It's called Healthy San Francisco.

Healthy San Francisco, created by City Ordinance in July 2006, is San Francisco’s health access program for the uninsured, the first of its kind in the nation.  Healthy San Francisco is not insurance, but provides uninsured San Francisco residents access to affordable basic and ongoing health care services, including primary care through a medical home, as well as specialty and inpatient care, diagnostic and mental health services, and prescription drugs.  All uninsured adult City residents who are not eligible for other public programs are eligible to enroll in Healthy San Francisco, regardless of immigration status, employment status, or pre-existing medical conditions.

And a recent survey conducted by the Kaiser Family Foundation found near-universal rates of satisfaction with the quality of care provided and a high endorsement of the plan for other cities (94% are at least somewhat satisfied, 92% would recommend to a friend and the same proportion believe other cities should create similar programs).

Interestingly, together the five states comprise 127 electoral votes. The five states are represented by 53 congressional seats from California, 25 seats from Illinois, 8 seats from Minnesota, 19 seats from Pennsylvania, and 18 seats from Ohio. This is 123 representatives out of 435 total, or just under a fourth of the total House of Representatives. As you can imagine, the 80+ Congressional Progressive Caucus overlaps considerably with both the legislators in favor of a public option and those in favor of making single payer possible in their states.

Out of a total national population of roughly 300 million people (slightly over 281 million by the outdated 2000 Census), the five combined states comprise about 70.5 million people, or approximately 23.5% of the nation.

Now in order for the House floor vote on single payer to have impact, it seems to me that voters who really want health insurance reform and are living in California, Illinois, Minnesota, Pennsylvania, or Ohio should make an all-out effort to get their congressional representatives to vote yes on the following

• single payer in the form of H.R. 676 for all 50 states
  
• if that's not a political reality given the conservatism of many states, demand that your representative vote for a robust national public option in H.R. 3200
• vote yes on the Kucinich amendment to allow single payer at the state level
• California, Illinois, Minnesota, Pennsylvania, and Ohio voters, urge your state assembly reps to vote YES on respective pending state single-payer bills. Urge your governor to SIGN the bill (Schwarzenegger, I'm looking at you, you useless good-for-nothing).

Actually, everyone needs to raise his or her voice on this, not just people who live in the five single-payer ready states. 13 House Republicans voted in the HELP committee to support Kucinich's amendment--maybe not for the right reasons, but nevertheless they voted. And they're from all over. This is a national issue.

Yes votes for the Kucinich amendment will definitely greenlight states ready with their single-payer bills. Yes votes for single payer in the upcoming floor vote might in turn give political cover as well as leverage to state assemblypeople when it comes time for them to vote on their respective state single-payer bills.

And more than one out of five Americans needs the Kucinich amendment to pave the way to single payer in the states. This is how democracy works--let the states be the laboratories of policy.

Look up your congressional representatives here.

Look up your state representatives here:

• California State Assembly & State Senate
• Illinois State Senate & House of Representatives,
• Minnesota State Senate & House of Representatives
• Pennsylvania State Senate & House of Representatives
• Ohio State Senate & House of Representatives

All right, go burn up some fax lines or send emails, NOW! (Snail mail's not recommended as it takes several weeks to go through security.) Lay some ground now in case the national vote on health insurance reform doesn't have enough reform in it for you.

And of course, I welcome comments on how to work the national and state angles in productive ways together.

* The public option is a government-backed insurance plan which would co-exist alongside private insurance plans and be serviced by privately run medical services and hospitals much like the way Medicare currently works.

H/T to ParkingMeter for the DK diary on Healthy San Francisco and the Kaiser Family Foundation survey.

Cynematic blogs at P i l l o w b o o k.

Comments

[nancy]

I am also a resident of California and I giggle at the idea that California should pass universal anything. They can't pay the rent on an outhouse at the moment. Reality of our state is that we have been too generous with social programs and not mindful of the actual budget. We spend far more than we take in and the chickens have come home to bark.

[Cynematic]

Nancy, I might agree with you more had the Governator not eliminated revenue-producing policies like the car tax (http://bit.ly/isuZv) which would've brought in $4 billion/year, or over $16 billion since he repealed it in 2003.

DUMMY.

It's not the domestic violence shelters, schoolteachers, and police and firefighters we've spent too much money on. It's the IDIOCY of thinking we can run this state without ever raising taxes.

That's why our state is broken.

And that's why the 2/3 vote to pass a budget has to go.