For now, this health care bill seems to be the best we’ll get out of our dysfunctional national government. It does expand Medicaid coverage, it does set up new health clinics, it does expand insurance coverage in some helpful ways. But it doesn’t address at all some fundamental problems in our system.

In that sense, it is like a band-aid. Instead of just patching up the system, though, we need to completely rework it. The idea of making profit off of someone’s sickness – off of keeping someone else sick instead of treating them! – is fundamentally flawed. And the bureaucracy of the insurance companies, among other factors, inflates health care costs to a ridiculous point.

So, as most of you reading this probably agree, the solution is single payer. And we’re not going to get that at the national level. Just like they did in Canada, we’ve got to take it to the states.

In Pennsylvania, we’ve got a supportive governor, a supportive Democratic Party, and strong bipartisan support in the legislature.

And, according to the people who are at the top of this campaign, the passage of the health bill in DC isn’t stopping us.

So, politically, HR 3590 is a feat; policy-wise, HR 3590 is rife with problems, challenges, and opportunities.

Washington’s election year "spin" aside, HR 3590 does not deal fundamentally, systemically, or expeditiously (2014 implementation date) with questions of "affordable, comprehensive, quality, healthcare for all" even close to the degree that PA’s HR 1660/SB 400 tackles those questions.

Moreover, while the national healthcare bill funnels nearly a trillion dollars to buy or subsidize insurance for the uninsured in the profit-first market, and compels (through threat of fines) the purchase of more insurance in the same Blues-monopoly market, HR 3590 does nearly nothing to address the problem of underinsurance – either for the newly insured or for those who are currently insured. Insurance premiums, deductibles, co-pays, and incidence of medical bankruptcy will continue to escalate under HR 3590.

We citizens of Pennsylvania cannot afford to wait until 2014. Nor will we ignore the obvious shortcomings of HR 3590 or the new policy opening presented by this political breakthrough.

Taking action on this has become more urgent than before. If states are to establish insurance exchanges by 2014, that means that they will already by making major changes to their health care system then, and support for single payer could seriously wane. Combine this with the fact that supportive Governor Ed Rendell is not up for reelection (although pretty much all of the Democratic candidates support the legislation) in 2010, and you start to get an idea of what is needed.

So what can you do?

Well, the one organization really pushing for this is HealthCare4AllPA. If you’re not in Pennsylvania, please donate to them and tell any friends or family or colleagues in PA about the important work they’re doing. Also, check out similar national organizations and organizations in other states, including (but certainly not limited to) Montana, California, Kentucky, and Wisconsin. (If you’re in PA, this page will also help you find other groups in PA and local groups.)

If you’re lucky enough to be in Pennslyvania, there are several steps you can take. See if your representative and senator supports the bill. Email them. Call them. Lobby them. Circulate petitions around your neighborhood and then deliver them to your legislators, like I’m in the process of doing. Write a letter to the editor. There are so many options! Some are easy and only take five minutes, but if you want you can also give hours upon hours of your time to this worthy cause.

No matter where you live, no matter how you live, this is worth your time. The states are where fundamental health care reform will come from, and here in PA we’re lucky enough to be closer than most. Without your help, though, this will never become a reality