03/18/2010 05:12 am ET | Updated May 25, 2011

In The Public Interest : Lobbyists and Special Interest Groups are Winning the Battle for Reform; Can They be Stopped?

An Open Letter to Supporters of Health Reform:

Call the death of the public option what it is: A defeat.

This year, powerful health industry groups spent more than a million dollars each day lobbying Congress, trying to defeat and weaken reform. For them, it has proven to be money well spent. Sen. Joe Lieberman (I-Conn.) drew a line in the sand, and his intransigence stripped the health reform of the public option, handing the insurers a big win.

But the fact that they won this very real battle doesn't mean that reformers should cede the entire war to the special interests.

It's not time to quit the field and go home as some have urged.

It's time to get angry. It's time to fight back.

Even stripped of the public option, the bill would end pre-existing condition denials, establish tough, federal regulations that clamp down hard on the insurance industry's abusive practices, and, according to the Commonwealth Fund, slice $1900 from the average family's yearly health care bill by 2019. This bill brings us closer to the goals of system-wide cost containment, consumer protection and coverage security than any law passed in living memory.

However, for those of us who believe it ought to be even stronger, who believe we have to do more to take on the inflated costs that drive up health care premiums - and fuel special-interest lobbying, here are three ideas worth fighting for, if not in the Senate bill, then during the coming conference committee.

First, we have an opportunity to guarantee that each and every American consumer finally gets their money's worth from their premium dollars. Today, in many states it's perfectly legal for insurers to take as much as half of our premiums and spend it on administration, paperwork, and executive salaries, instead of needed health benefits. Senator Al Franken (D-MN) wants to change that by requiring insurers to dedicate a certain minimum percentage of your dollars to actual medical care. If insurers don't meet the standard, Franken would force the them to give consumers their money back. Right now, the Senator from Minnesota is fighting to bring that standard up to 85% or 90%, and he needs all the help he can get.

Second, we can do more to insulate Medicare from special interests, as well as drive down private-market premiums. For decades, health care industry lobbyists have used their influence to prevent Congress from reining in wasteful spending in Medicare. Senators like Jay Rockefeller (D-WV) and Mark Warner (D-VA) are fighting to strengthen an Independent Board empowered to squeeze the waste from Medicare's payment systems and secure Medicare for the future. At the same time, the Board would have the authority through the exchange to target wasteful spending among private plans as well.

Third, the heart of this reform bill remains the creation of new health insurance exchanges, where individuals without coverage and small business can go for more affordable, higher-quality coverage than they get today. Long-time health care champion Senator Ron Wyden (D-OR) has an idea to expand the choices and competition in those plans, even without the public option. Under his proposal, large employers could allow their employees to enroll in an employer-sponsored plan or give their employees a voucher which they can use to choose a plan within the exchange. Wyden's amendment, which has bipartisan support, could open up new coverage choices for millions more Americans trapped in employer plans that don't work for them.

A victory on any one of these three would hand a serious defeat to industry lobbyist across the nation's capital... And because the special interest armies have already spent much of their strength on the fight over the public option, reform supporters might very well win them in either the Senate bill or the House/Senate conference negotiations. But to win, we must stay in the fight.

Make no mistake. These fights are every bit as real as the one over the public option. Industry clout will prevail unless pro-reform activists push lawmakers to adopt these needed, cost-saving policies.

For those who care about the public interest, the struggle for meaningful health reform is not over. Our opponents are still on the field. Let's make sure we are too.