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Editor's note: this originally appeared on AlterNet's blog, PEEK. No time today for a lengthy analysis of the Tri-Committee health bill. My quick-and-dirty take is this. Those who think the bill is a wonderful progressive victory with a robust public option are wrong, and, on the flip side, the charge that it's a "bailout for the insurance industry" is totally divorced from what the bill would actually do if passed. It is the most progressive, comprehensive and significant health care legislation to come down the pike since Medicare was passed in 1965. If it were enacted as written, it'd go a long way to solving a lot of our problems (but by no means all) and wouldn't break the bank in the process. But it also fails some of the basic criteria that most progressives have long said is a red-line that can't be crossed. First and foremost, it doesn't have a public option that can compete with private insurers and result in significant cost savings. It has a public plan in which -- as far as the statute goes (it can be expanded in 2015 but there's no mandate to do so) -- only 9-10 million people will be eligible to enroll by 2019. Similarly, the publicly-administered exchanges are projected to cover about 30 million by that year. (These relatively small insurance pools will be able to bargain in concert with Medicare to some degree, so their power will be magnified, but still...) That greatly limits the potential for cost containment. What it does is bend the curve of projected cost growth downwards, and cover about 2/3 of the uninsured. But we'll still have 3-6 % of the population uninsured and being treated at the ER. And while bending the upward curve down a few notches is a very good thing, it doesn't get us where we want to go -- not when you consider that we pay $2000 upwards of $4,000 more for every American than the OECD average each and every year. But it's more than just the costs or the people left out. Crucially important is that the public plan won't be big or effective enough to serve as a living example of the kind of large-pool public exchange models federal employees now enjoy. And that means it won't be a back-door to a European-style health care system. This is really key. As I wrote last week about the divide between single-payer advocates and those pushing a public insurance option: The divide that does exist in progressive circles is tactical, not ideological. Most of those pushing the public option would, if they had their druthers, enact a single-payer system. But they recognize that the two commercial enterprises that have spent the most on political lobbying in recent years are the "disease care" and insurance industries. Like single-payer advocates, they believe that a large insurance pool with extensive government regulation and some subsidies afford the greatest potential for (near) universality and cost containment. And they think that given the choice -- given a demonstration that this approach works better than having a fragmented system of private insurers -- most people will eventually opt into the public plan, and we'll end up achieving something approaching a single-payer system -- although an American-style variation -- through the back door.
Obviously, a public insurance plan for which 10 million are eligible to enroll isn't going to serve as an example of the efficiency that comes with a single-payer type system. And the fact that they designed a pretty good public option for which most of the public will be ineligible to enroll (and that wouldn't have as much potential for cost savings as one would hope) was enough to make me consider opposing it. Howard Dean told me recently that he thought a bill without a robust public option wasn't worth passing, and I agree. And that's where Kucinich, a supporter of single-payer, comes in. He's trying to save the whole promise of this project. On Friday, an amendment he authored was added to the House bill that allows states to create their own single-payer systems instead of adopting the federally-run exchange system. The original bill allowed states only to enact their own exchange system -- it was a nod to federalism -- with the proviso that if a state (think a deep red one in the South) refused to adopt the plan, the feds could step in and set it up. The Kucinich amendment is really key. If it were to survive the legislative sausage-making and be enacted into law, the we might expect a progressive state to take advantage of the opportunity and enact a single-payer system in the coming years. And, if those of us who have been pushing such an arrangement are correct, the result will be greater access and better outcomes at a lower price tag for that state's residents. And then we can move from an often ill-informed argument over the Canadian or British systems to a debate in which we can hold up a model in which millions of real Americans see very tangible benefits from an actual single-payer system in action. Thanks, Dennis! Now let's see what comes out of the Senate. Note: I'll have more next week on the good, the bad and the ugly in the new health care bill. Joshua Holland is an editor and senior writer at AlterNet. | 
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