"Barack Obama has created the best opportunity to enact universal health care with a public option "

Obama: It’s Up to Activists to Enact Real Health Care Reform

by Randy Shaw‚ Aug. 03‚ 2009

It’s been over 60 years since President Harry Truman urged Congress to enact a national health care system. Now, even longtime activists seem surprised that Barack Obama could not simply snap his fingers and win universal health care during his first seven months in office. That’s not how major social change is won. It’s not that easy, and movements, not politicians, typically drive success. That’s why the armchair critics who see President Obama, rather than activists, as holding the key to passage are so off base. Barack Obama has created the best opportunity to enact universal health care with a public option since Truman’s presidency. He has made a strong case for the public option, and used his personal popularity to drive the issue. But it is now up to constituency pressure to get the job done. It will take activists’ grassroots pressure campaigns targeting key legislators from the August recess through the day Congress votes to transform this opening for health care reform into a landmark victory.

As the media continues to present slanted and hostile coverage of health care reform with the massive coverage of opposition to Obama’s plan from a self-identified “raging Republican” small businesswoman only the latest example – progressive criticism of Obama’s handling of the issue has grown. Separate from the longstanding complaint that the proposed reform is not a single-payer plan, much of the criticism implies that passing health care requires a specific presidential negotiating strategy with Congress, rather than increased pressure from below.

It’s tempting to see politics in these terms, because it absolves activists and progressives of any responsibility for political outcomes. If we can blame Obama, Pelosi or the large target of Harry Reid for health care not passing, we do not have to ask ourselves what we have did to bring a different result.

But with polls showing strong support for both universal health care and a public option, activists can’t sit on the sidelines. Progressives should view August and September 2009 as equivalent to September and October 2008, recognizing that if the Republicans stop health care reform, all hopes for a new progressive era are at risk.

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I understand the Committees are moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone's costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.

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I feel pretty good that I've been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn't afford it. And that remains my position.

I think other than that we've been pretty consistent about how I think we need to approach the problem. And by the way, I in no way want to suggest that cost is more important than coverage. My point has been that those two things go hand in hand. If we can't control costs, then we simply can't afford to expand coverage the way we need to. In turn, if we can expand coverage, that actually gives us some leverage with insurers or pharmaceutical industry or others to do more to help make the health care system more cost-effective.

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...The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn't afford it. And that remains my position.

"Cost-sharing" aka "out of pocket" expenses of up to $5,000 for a single person are not affordable and may actually prevent people, especially those with chronic conditions, from seeing a provider until they are really sick (that's how large out of pockets are working now).

None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.

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