The health care debate-17: Obama’s choice

(For previous posts on the issue of health care, see here.)

In this last post in this series, I want to look at the way the health care ‘debate’ has progressed because it provides a classic example of how Congress and the president, supposedly meant to represent the ‘will of the people’ who elected them, maneuver to actually do the will of the business interests.

Polls have repeatedly shown that people are highly dissatisfied with the current system of employer-based health care in this country in which the private, profit-seeking insurance companies exert such a stranglehold. As Paul Street writes in the September 2009 issue of Z Magazine (not online), 73 percent feel that health care is either in a “state of crisis” or has “major problems” (Gallup, November 2007), and 71 percent feel that we need “fundamental changes” or have the US health system “completely re-built,” compared to just 24 percent who wish only for “minor changes” (Pew Research Center, 2009).

Real reform would consist of introducing a single payer system along the lines of France or Canada or a socialized system along the lines of England. And Street points out that polls consistently show that a majority of people would support changes along those lines.

  • 64 percent would pay higher taxes to guarantee health care for all US citizens (CNN Opinion Research Poll, May 2009)
  • 69 percent think it is the responsibility of the federal government to provide health coverage to all US citizens (Gallup Poll, 2006)
  • 67 percent “think it is a good idea [for government] to guarantee health care for all US citizens, as Canada and Britain do, with just 27 percent dissenting” (Business Week, 2005)
  • 59 percent support a single-payer health insurance system (CBS/New York Times poll, January 2009)
  • 59 percent of doctors back a single-payer system (Annals of Internal Medicine, April 2008)

But of course the business lobby has enough clout to ensure that those options are not even discussed, let alone considered seriously. So the fight has been reduced to whether even a watered-down so called ‘public option’ should be introduced.

Political scientist and health policy analyst Jacob Hacker is the person who originally formulated the public option plan that Obama once acted as if he embraced but now seems to be trying to distance himself from. In a recent paper Hacker describes why a public option is essential for any meaningful reform, and the futility of the health-industry friendly alternatives like the health cooperatives that are being floated. He concludes:

That the two bills under consideration in the House and Senate contain a public health insurance option is considerable cause for celebration. Yet it is no cause for complacency, because the Senate Finance Committee appears unlikely to produce a bill that contains a true public plan. If, as expected, the Committee endorses federally promoted health cooperatives, they should be understood for what they are: an effort to kill the public plan and, with it, the prospect of an effective competitor to consolidated insurance companies that have too often failed to provide affordable health security.

What is interesting is that despite the concerted propaganda campaign against reform this year by the crazed ‘deathers’ supported by the health industry and backed by the Republicans and conservative Democrats and tacitly encouraged by the Obama administration, support for the public option remains strong. A new SurveyUSA poll released last week puts support for the public option at 77%, one point higher than it was in June. Another poll finds that 79% still support measures that constitute what is effectively the public option. The success of the propaganda campaign has been solely in confusing people as to what the phrase ‘public option’ implies, with only 37% being able to identify correctly what it means and 26% incorrectly thinking it refers to a British socialized system.

So Obama and conservative Democrats still have some way to go in implementing their sell-out plan to satisfy their corporate overlords while persuading the public they are true reformists. In the process they run a huge risk. Economist Paul Krugman warns Obama that the progressives who were so crucial to his electoral success are turning on him because of his subservience to the health industry.

A backlash in the progressive base — which pushed President Obama over the top in the Democratic primary and played a major role in his general election victory — has been building for months. The fight over the public option involves real policy substance, but it’s also a proxy for broader questions about the president’s priorities and overall approach.

And let’s be clear: the supposed alternative, nonprofit co-ops, is a sham. That’s not just my opinion; it’s what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers. (emphasis added)

Obama has a choice. He can go down in history as a footnote, the answer to a future trivia question as to who was the first person of color to become president of the US and as someone whose main accomplishment was to show that a president of color can be as subservient to the interests of the pro-war/pro-business one party ruling class as his white predecessors. Or he can decide to use his considerable clout and rhetorical skill to push for real health care reform and be remembered in history as one of the greatest US presidents of all time, the way that Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country, was chosen as the greatest Canadian of all time.

I fear that Obama’s ambition does not match his soaring rhetoric. I hope I am wrong.

POST SCRIPT: Health reform information

Our local paper The Plain Dealer ran an informative series on the health care debate and provided some links to the major documents. The media has been focusing on the one that is still in the Senate Finance Committee led by reform opponent Democrat Max Baucus because that committee is the Obama Administration’s best chance of avoiding real reform, which is why they have given that committee and its so-called “Gang of Six” reform opponents an effective veto over health reform legislation.

But there are other versions of health care legislation emanating from the various committees.

The 1,000 page House Bill HR 3200 can be seen here. The Congressional Budget Office (CBO) analysis of the bill can be seen here and a summary of the bill’s provisions can be seen here. This site gives a detailed breakdown on what the bill would imply for each congressional district.

The Senate’s Health, Education, Labor and Pensions (HELP) Committee’s proposal can be seen here. The CBO analysis of the HELP plan can be seen here.

We should also not overlook the important step that the House Committee on Education and Labor that is chaired by Dennis Kucinich took when, by a vote of 25-19, it “approved an amendment to the House’s health-care reform bill allowing states to create single-payer health care systems if they so choose.” After all, the Canadian single payer system began at the provincial level, and only later spread nationwide.

You can also view a side-by-side comparison of the various health reform proposals and a timeline of health reform.

Sam Smith has a good article on health care reform that asks some important questions.


  1. Jared says

    I had not heard of the amendment to the bill that you mentioned in the postscript that allows states to create their own single payer systems if they choose.

    I have been wondering for awhile if the only way to do this is by creating a true single payer system in a single state. While the very populous states are probably in the most need of such a system, the larger the state is the more difficult it is to build a working coalition. I suspect that it would be a less populous state that could most easily get the momentum necessary to get a state-wide single payer system implemented.

    Perhaps the most likely candidate would be a state with a popular progressive leaning governor, and where the republicans tend to be motivated more by social issues than pro-big business ideology. Something in the mountain west is a likely choice. Perhaps Montana? I actually don’t know much about Gov. Schweitzer, so I don’t know how that would go.

  2. Jared says

    A little more research has indicated that Bill Ritter of Colorado would be a likely governor to initiate a state-wide single-payer system.

  3. peter lafond says

    C-span has finally started to present some views of doctors. I have noticed that doctors are not really present in this debate. Now have you noticed how Fix i mean Fox news is suddenly concerned about budget deficiets and the right to redress our government? Gee can anybody say ” Dixie Chickss.” And where were all the town meetings about the Iraq war? Regarding Obama he is a man cleary used to comfort and like all people of his ilk he will not trade that comfort or his family’s comfort to help out- much like the Kenndy family. this would liberalisms great failure- they are all about using other people’s money to achieve goals. We need to work on that.

  4. Paul Jarc says

    Doesn’t the tenth amendment to the U.S. Constitution make this bill amendment redundant? States already have authority over areas that aren’t constitutionally delegated to the federal government. This would also seem to make Medicare and any other single-payer system at the federal level unconstitutional, in the absence of an amendment authorizing them.

  5. says


    The amendment is not to deal with a constitutional issue. It is to override other federal legislation that stands in the way of implementation by the states of single payer systems.

    In particular, the “amendment removes a legal obstacle to states that choose single payer plans. The Employee Retirement Income Security Act (ERISA) pre-empts legislating health care reform at a state level if the state efforts challenge employer-based health care plans.”

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