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Democrats Let the Tail Wag the Dog, Fail to Make the Best Case for Reform

05/31/2010 05:12 am ET | Updated May 25, 2011

At a candidate forum in February, Colorado U.S. Senate candidate Andrew Romanoff was asked to describe the best way to health care reform. "Lower the age of eligibility for Medicare to '0'," he responded, without missing a beat. In one sentence he distilled the essence of an issue that for over a year has turned Democrats into contortionists, and produced reams of rhetoric and paper toward placating the bottom line of unsustainable for-profit insurances with hundreds of billions of dollars in taxpayers subsidies.

Which begs the question, why haven't Democrats advocated the best case for reform, also the simplest to define and legislate - improving and extending Medicare to all? As a basis for economic recovery, a Medicare-for-All model capable of saving up
to $400 billion a year
would trump pretensions of concern by born-again Republican and Blue Dog Democrat deficit hawks who protest inflated budget deficits (unless traceable to war or tax breaks for the rich). Democrats' professed aim of "bending the cost curve" to slow rising health costs pales next to projected savings of trillions of dollars over a decade with single payer health care.

Even failing to achieve best-case reform, simply making the case would refute specious arguments, e.g., the right's treatment of health care as a commodity subject to tender mercies of free market fundamentalism, sacrificing benefits to rising costs and elevating profits above people. Republicans offer the false "choice" of private plans, each with a limited provider network, contrasted with a Medicare-for-All model offering full choice of providers and hospitals.

The Washington Post economic policy reporter Ezra Klein writes that more than 400 corporate mergers of health insurers have "effectively ended competition" by highly concentrating 94 percent of statewide insurance markets, greatly limiting choice. He observes that between 2000-2007 "health care premiums shot up more than 90% and the profits of the 10 largest insurers increased 428%." Klein's apt analogy: "Private insurance is a bit like a fire department that turns a profit by letting buildings burn down."

Railing against "government" health care, Republicans are mute about multi-billion dollar taxpayer subsidies to private insurances, or deals cut to guarantee highest-price drugs. Rather than oppose taxpayer subsidization of for-profit insurances, Democrats allowed conservatives to make the debate about the faintest possible hint of coverage for women's reproductive health care; once again, women's health was bargained away as a commodity to appease the most extreme legislative minorities.

Do apologists for "free-market" reform feigning apoplexy over "government health care" - Rep. Mike Coffman (R-Co), Sen. Lindsay Graham (R-SC), Rep. John Boehner (R-Oh) et al - reject their own taxpayer-funded coverage? Only Sen. Sherrod Brown (D-Ohio) and Colorado U.S. Senate candidate Andrew Romanoff have foresworn congressional health care coverage until all constituents are covered.

Democrats conceded the debate before it began, permitting the minority tail (Republicans and Blue Dogs) to wag the dog. Democrats' failure to push back in many areas against Republican distortion, distraction and demonization of opponents has resulted in the political center being re-defined ever further to the right. Nevertheless, the real "middle" is somewhere to the political left, where a majority have supported both a single-payer model of reform and a public option.

Despite claims that the bill just passed eliminates "pre-existing conditions" as basis for denial of coverage, there is no protection against insurers continually raising premiums, deductibles and copays, pricing the sickest out of the market. Sen. Bernie Sanders rightly notes that the best provisions of current reform will increase by 17,000 the number of primary health care providers over the next five years, and double the number of community health clinics for access to primary health care, including dental and mental healthcare.

Now is not the time to declare victory and go home. It is sickening that health care reform has made the U.S. the only advanced nation mandating that all be held hostage to for-profit primary health insurance coverage. Rep. Alan Grayson's bill proposing universal buy-in to Medicare, named the Public Option Act, HR 4789, would be a first step to restore a public option that was widely touted, then diluted and eliminated altogether.

Short of converting U.S. health insurance to Germany's not-for-profit insurance model, Medicare-for-All remains the gold standard for comprehensive universal health care access, and the best means to economic recovery. Named The Cure That Dare Not Speak Its Name by Robert Kuttner, it is the conversation thus far denied, and necessary to move forward to real reform. Will the Democrats start acting like the majority that they are, and stop permitting the tail to wag the dog?