Other progressive groups are withholding judgment for now, hoping the good aspects will ultimately outweigh the bad. "We're digging through them now. We support a bill that has a true public option, and the House bill has that," said Consumer Watchdog's Jerry Flanagan. "But we really dislike the individual mandate [to purchase health insurance]. The insurance companies really don't want the public option, but they really want the mandate."
LEAVING OPTIONS OPEN
Even if single-payer isn't going to be the national model yet, advocates say it's crucial that states such as California be allowed to experiment with the option anyway. Single-payer advocates in Congress have insisted the health care legislation be amended to explicitly allow states to do single-payer (otherwise, federal preemption laws and the Employee Retirement Income Security Act might prevent states from doing so).
On July 17, Rep. Dennis Kucinich (D-Ohio) successfully inserted such an amendment into the bill that cleared the House Committee on Education and Labor with a 25-19 vote, which included significant Republican support. The amendment was opposed by Miller, indicating Democratic Party leaders oppose the change and may ultimately succeed in stripping it from the bill.
"George Miller is a longtime supporter of a national single-payer plan and health care reform. The truth is, however, there are not enough votes in the House or the Senate to pass a final bill that contains single-payer language. That is unfortunate but it is also the truth," Miller spokesperson Rachel Racusen told the Guardian.
California is a hotbed of single-payer activism. Even a leading candidate for state insurance commissioner, Assemblymember Dave Jones (D-Sacramento) — who appeared on the steps of San Francisco City Hall on July 15 to receive the endorsements of a long list of local elected officials — has made single-payer advocacy a central plank in his campaign.
The movement is so strong in California that it actually had legislators vying for who would get to carry its banner. San Francisco's own state senator Mark Leno, a longtime single-payer supporter, was selected this year to take over the landmark single-payer legislation previously sponsored by termed-out legislator Sheila Kuehl, which has passed twice, only to be vetoed by Gov. Arnold Schwarzenegger.
"The more I dive into this issue, the more convinced I am that the answer has to be single-payer," Leno told us. "The only reform that truly contains costs is single-payer."
Leno doesn't fault Obama for taking a more cautious stance — but he does believe the federal government shouldn't block states like California from creating single-payer systems. "States should be incubators of trying different proposals. We have a great history with that," Leno said.
But even with a Democratic governor, there's no guarantee that single-payer would be approved. Mayor Gavin Newsom is running for governor, featuring health care reform in his platform. He chairs the U.S. Conference of Mayors National Health Care Reform Task Force, which is pushing for approval of the Obama plan. But even Newsom won't promise to back the Leno plan.
"He doesn't think single-payer is the best option now," Newsom's campaign manager Eric Jaye told us when asked whether Newsom would sign the legislation as governor. "He hopes and believes that as governor he will be supporting a national public option."
But in the end, the governor may not matter. Leno said the political reality in California is that voters, rather than legislators, will need to approve the single-payer system. The funding mechanism for any ambitious health care plan would require a two-thirds vote in the legislature, a political impossibility.