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Can Obama steer the health care debate?

Paul Jay speaks to Anthony Wright at the Tides Foundation’s Momentum Conference in San Francisco about health care supporters’ expectations of the Obama’s Congressional speech.

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Story Transcript

PAUL JAY, SENIOR EDITOR, TRNN: Welcome to The Real News Network, coming to you today from San Francisco. We’re at the Momentum Conference of the Tides Foundation. Joining us now is Anthony Wright. He’s the head of Health Access California, which is a state-wide lobbying organization, activist organization, on issues to do with health-care reform in California, and now the nation. Thanks for joining us.

ANTHONY WRIGHT, EXEC. DIRECTOR, HEALTH ACCESS CALIFORNIA: Thank you.

JAY: President Obama is going to speak Wednesday night, and, of course, there’s great anticipation. And the debate, certainly in circles that are very concerned about health-care reform, is where is he going to be on the question of a public option. Everything is focused on the public option. We have been getting kind of increasingly set up for by the White House to kind of lower our expectations about the public option. We’ve been told it’s not the only element. We’ve been told it’s a sliver of the plan. We were told by the health secretary that it’s possible—health-care reform doesn’t have to have a public option. So people that are very committed to needing a public option are quite wary. The drumbeat is that we might be told that there’s going to be a public option, but with a trigger. So we start with a regulated insurance industry, move if they don’t meet a certain bar; then it triggers a public option, which many people in the public option constituency thinks means no public option. And certainly the single-payer people are saying, "I told you so. This strategy was going to weaken the public option from the beginning." So Wednesday night, one way or the other, he has to lay out that the bill that’s going to come out of the Senate, where the real problem is, is still going to be real reform. So for you, for that to be real reform, to call this bill a victory for people who want real change in health care, what does it need to contain, and what are your expectations?

WRIGHT: Well, I think one of the things that President Obama wants to do is simply make clear what the plan is and what the plan isn’t, that there’s been so much misinformation that it’s easy to get confused, and confusion is the weapon of the opposition to health-care reform. If people are confused, especially about something that’s so core to them like health care, then they tend to be against it, whereas this is not actually that complicated a proposal. It’s not rocket science.

JAY: Okay. Let’s first say what proposal we are talking about, ’cause—.

WRIGHT: Well, there are two main proposals, one in the Senate, one in the House. There are some key differences, but there’s a lot that’s in common with what President Obama has said and what is in the two proposals. One is—you know, and it’s three things. One is if you have employer-based coverage, which is more than half of the population, it will make it stabilize and secure that coverage by setting a minimum standard for what employers provide their workers, much like the minimum wage does for pay, but at the same time also providing subsidies to small business so that more people can continue to have their coverage or even expand coverage. For people who are on Medicaid or Medicare, it improves and expands those programs, filling in the donut hole in Medicare; improving the reimbursement rates in Medicare; expanding Medicaid so that all people who are under the poverty level, not just some, have some basic coverage; and getting rid of a lot of the bureaucracy and red tape that exists in those programs now. And then, third, for those people who have to buy coverage as individuals, which, if you expand employer-based coverage and expand the safety net of Medicaid and Medicare, ’cause that would actually be a relatively smaller percentage of the population, then you—. But it’s the place where consumers are most at a disadvantage; it’s where people are left alone at the mercy of the insurance industry, where coverage is unaffordable, unavailable, and administratively very complex. So what did they do? They first of all provide subsidies to people so they can afford the coverage, and coverage is no more than a certain percentage of their income, which would be a huge improvement over now, where premiums are based on how sick you are. Number two is it would prohibit denials based on pre-existing conditions. And then, three, it would create not just a basket of options that—not only include private coverage, but also a public health insurance option. That’s where a lot of the debate is. But I think it’s important in that context, because I think the president is right: it’s not the only part of health reform. I think it’s a crucial part of health-care reform, because I think it acts as a very important check on the health-insurance industry to make sure that a downward pressure on costs, to provide some competition, so that even with the regulations, if the regulations don’t work, there is a safe harbor for people to go to to get the care and the coverage that they need. I think the president will reiterate his support for the public option tomorrow night. Whether it can get through the Senate is the fight that we need to have. But at the end of the day, the president can only sign a bill that gets to his desk. And so it’s up to us to get Congress to put the best possible bill on the president’s desk.

JAY: So the argument up until now has been to have a regulated—there’s been two arguments. The single-payer argument is over here and is not being talked about with any weight at all now, although there is a bill coming [inaudible] Go ahead.

WRIGHT: Right. Well, a couple of things. My organization has supported single-payer for its 20-plus years. We’ve had an active campaign in California for bills like, currently, SB 810, that continues to—has a lot of support in the state legislature in California. But at the national level, I think that the principles of single-payer are in the debate: the principle of getting everybody in the system; the principle of getting everybody to have some shared responsibility to pay, including employers, including making sure that people pay, but they pay based on what they can afford rather than how sick they are. And then this notion of expanding public programs, whether they’re safety net programs like Medicaid or Medicare, or having this public health insurance option for other folks to buy into, that’s, I think—these are all elements that I think those of us who support single-payer see are ways that can get us closer to the things that we’re actually fighting for.

JAY: One of the amendments—I believe Kucinich is one of the backers of it—is to allow states to have single-payer.

WRIGHT: The Kucinich amendment would allow states to go forward with single-payer plans and make it easier for them to get the federal approvals that would be necessary.

JAY: Does that look like it has any possibility within the context of this bill?

WRIGHT: I think, you know, a possible in the house. And then, you know, the entire question is what happens in that conference committee. I mean, we need to get to the point where the House bill and the Senate bill are in a conference committee and then they negotiate out the differences. And there will be differences based on the public option; there will be differences based on, you know, what flexibility are granted to states; there’ll be differences based on how much the bill costs and what kind of help is given to low- and moderate-income families, which I think is actually the most crucial part of this debate. But it only works if the House passes as strong a proposal as possible and the Senate passes as strong a proposal as possible. And then the conference committee is another opportunity to make the bill better.

JAY: Now, up until now, the people promoting a public option have said in this model of a competitive environment, where the public option competes with a private option, the only way to have a seriously regulated insurance industry [is] if the public option is there to hold their feet to the fire, more or less, and the argument’s been against just the regulated model. So doesn’t that mean that the public option is critical to this? And can one back off this argument?

WRIGHT: I think—I mean, I think it is critical. I think that—I mean, I think the key principle here is that people should not be left all alone at the mercy of the insurance industry. And so that means we need government as a regulator. We also—I think the more that we can get people into group coverage and have that coverage be a negotiator so that they can bargain with the insurers for the best possible price, and then having this option as a competitor, this is something that is—you know, we see—. You know, we have public and private universities. We have public broadcasting. We have—in all sorts of life, areas of life, we have a public option that helps provide stability to the market, helps provide a safe harbor, sets a standard by which then private industry builds on top of, offers additional benefits, you know, provides additional competition. But, you know, this is something that’s very common in lots of different facets of American life. It should be part of the health industry. And I think the question is how far along does this health reform build an infrastructure to get us closer to a health system that works.

JAY: Well, in the next segment of our interview—’cause we do these in Web-size bites—let’s talk about "what if". And if the "what if" is either Wednesday night or we find out that the only plan that’s going to pass the Senate is a trigger for a public option, that the insurance companies have to meet a certain bar within a regulatory framework, if they don’t, then in X number of years it would trigger a public option, if that’s what we hear either Wednesday night or not long after Wednesday night, is that a victory? Is that acceptable, acceptable by people that are fighting for health-care reform? So in the next segment of our interview, we’ll discuss the trigger and what else is in this bill. Can this bill be called a victory without a public option? Please join us again on The Real News Network.

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