The Democratic Party has been promising a major overhaul of the health care system for a generation or more. Now, with President Barack Obama and his party's congressional leaders in a strong position to finally reach that elusive goal by next month, this should be a momentous time for the reform movement.
So why are so many health reform advocacy groups unhappy?
The answer involves policy and process. Rather than pushing for the single-payer system that many progressive groups demand and say is needed, Democratic leaders immediately opted for a compromise plan they hoped would be acceptable to economic conservatives and the insurance industry.
But Republicans are still calling them socialists for doing it, while the insurance industry — which loves the portion of the legislation that requires everyone to buy coverage — is still spending $1.4 million a day to either kill the complicated bills or turn them to its advantage.
When congressional Democrats unveiled America's Affordable Health Choices Act (HR 3200) on July 14, many reformists thought a long-awaited, dramatic overhaul to a broken system was close at hand. The insurance companies would finally be made to adhere to ethical practices, and the Democrats would defend their plan to establish a government-run health insurance option that could compete with private insurers and keep them in check.
"American families cannot afford for Washington to say no once again to comprehensive health care reform," said Rep. George Miller (D-Martinez), who chairs the crucial House Education and Labor Committee.
The Democrats' bill does address some critical flaws in the health care system. It would greatly expand Medicare to ensure coverage for low-income individuals, and would subsidize coverage for those earning up to 400 percent of the federal poverty level, defined as $43,320 for an individual and $88,200 for a family of four. The bill would forbid insurance companies from denying coverage to patients based on a preexisting condition, age, race, or gender. It would eliminate co-pays for preventative care and establish a cap on annual out-of-pocket expenses. To pay for it, the proposal would create a graduated tax on households earning more than $350,000 a year, with the top bracket being a 5.4 percent levy on incomes of more than $1 million.
Progressive members of Congress threw their support behind the bill because — and only because — it included the public option. "The public option is central to our support of health care reform," read a statement from the Congressional Progressive Caucus.
Rep. Lynn Woolsey (D-Petaluma), who chairs the CPC, was quoted in the Huffington Post as saying, "We have already compromised. More than 90 percent of the progressive caucus would vote today for a single-payer system. And so for us to compromise and get behind a really good strong public plan, I mean that's as far as we're going."
While that statement indicates the precarious nature of the current legislation — which will likely be weakened further as it works its way through the process and merges with legislation from the more conservative U.S. Senate — many progressive groups aren't even willing to go that far.
COVERAGE ISN'T CARE
Many single-payer supporters say some reform is better than none, and that the passage of HR 3200 would represent a major win. "We can advance many of the principles that we support with the House bill," said Anthony Wright, executive director of Health Access California and an organizer for the national reform advocacy group Health Care for America Now. The nation, he believes, needs to endorse principles such as universally covering Americans and making sure patients aren't left alone "at the mercy of the private insurance industry."