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Want Single-Payer? Can’t Get Excited About the Public Option?

There’s been something of a rift growing on the left over healthcare reform. The ambiguity, questionable efficacy, and pre-compromised position of the vaunted "public option" has left swaths of progressives only tacitly supporting, or sometimes outright rejecting, the current healthcare reform proposals. Many of these people, of which I include myself, view a single-payer system as the only way to legitimately optimize for the multiple objectives of lowest average cost and maximum average coverage.

Despite the fact that HR 676 (the national single-payer proposal) is going to be allowed to hit the floor for a vote, and as much as I’d still put some resources in gathering support for it, there is some truth to the political reality that even if by some miracle HR 676 made it through the House, it’d take a blood-pact between Christ and Lucifer working in harmony to get it through the Senate.

Over the next couple of days I’ll be meeting with or talking to representatives and policy aids (barring an inability to meet with the Congressmen directly) for Senator Merkley, Senator Wyden, and Representative Wu. I already know what their talking points are largely going to be. So, what can I do to move the debate where I want without forcing them to wholesale abandon their policy platform? I can whip for Representative Kucinich’s "State Innovation" amendment to HR 3200 with all three of them. That’s the amendment which clears the path for a state to create its own single-payer healthcare system.

The amendment has bipartisan support from single-payer advocates on the left and state’s rights advocates on the right. Single-payer has strong support in several states, and represents a significantly less divisive policy position in many regions than it does nationally. Some states have pre-existing plans and/or programs that could be drawn from and expanded upon to implement an effective system using money no longer being diverted to fund Federal programs. Perhaps most importantly our local legislators and governor are a lot easier to engage and influence than their counterparts on the national stage; they actually know the doctors, patients, and small businesses in our communities that would be helped by removing the myriad burdens associated with a multi-payer for-profit system (even one that includes a public option).

With the possibility of state-level single-payer systems and perhaps expansions for reciprocity between states, we might be able to get what we’re after and get motivated to stand behind the public option platform.

If whipping for the "public option" absolutely includes the "state innovation" provision as a point of policy and principle, then that’s a prerogative I can put passion, enthusiasm, and force behind. Better still it gives all of us that much needed crystal clear, "What’s next?" mission to organize behind, and at levels of government much closer to home. Much as it would be nice for a top-down solution, we all know this is going to have to be a bottom-up effort, because the top isn’t too interested in what’s going on down here. Works for me, grassroots is what netroots does best.

Do you think this should be a central point of our whipping efforts, and does it present a valid way to find common ground between the rift that’s developed on the issue of healthcare reform?

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Nathan Aschbacher

Nathan Aschbacher

I'm a business owner in the fields of IT and business strategy, and have a strong interest in solutions-based policy built on empirical evidence, and validated through logical analysis. I am neither right, nor left. I am a functional ideas advocate.