Pelosi keeps public — and her own — options open in San Francisco talk

House Speaker Nancy Pelosi rallied the faithful in San Francisco Saturday afternoon, drawing the loudest applause (there had already been cheers for heavy-hitter Democrats, San Francisco liberal causes and hometown heroine Pelosi herself) with an assertion that passage of the health reform bill will happen soon. She said the House bill is the stronger,  and negotiations to reconcile House and Senate versions into a final bill “are intense.”

Whether that final bill will include the public option her audience of several hundred supporters clearly wanted remains in doubt – and Pelosi was keeping her own options open. “Any bill we approve will have to pass the Triple A test,” she said: “Affordability, specifically for the middle class, Accountability – insurance companies will have to be held accountable; and Accessibility.”

Accessibility, of course, brings the issue back to the public option, which the bill will have, Pelosi maintained, “…or what the public option was intended to do: keep the insurance companies honest.”

The invitation-only Saturday event was billed as a New Year Celebration, and held on the first anniversary of a similar gathering hailing her ascension to Speaker last year.  Both took place at Delancey Street, a residential self-help community founded in 1971 to help substance abusers, ex-felons and “people from America’s underclass” get back on their feet and into productive lives. A few of the 14,000+ who have graduated from Delancey Street programs mingled with the likes of former state senator and current California Democratic Party Chairman John Burton, prominent gay California State Senator Mark Leno, and San Francisco Mayor Gavin Newsom. Almost anyone who is, or aspires to be, anyone in local Democratic politics was working the room.

Pelosi worked it herself, smiling and greeting her way through the crowds for several hours. When she returns to Washington after this weekend at home, the greetings and workings are guaranteed to be a little more fractured.

Public option still alive: believe it…or not

The fact that there are still believers in the public option, and its inclusion in whatever health bill eventually survives, may say more about the believers than the belief. But Nancy Pelosi hasn’t yet caved, and a few among the many who see this as the only way real reform will happen are still betting on it. Two of those are strategic technology consultant Robert Weiner and his research chief Rebecca Vander Linde who penned an op ed in the San Francisco Chronicle Friday. I’m not a gambler, but I cheer their position.

Opponents’ caricatures have become commonplace – the Republican National Committee video puts House Speaker Nancy Pelosi side by side with James Bond’s villainess, Miss Galore. The Iowa Republican, a party newsletter, on Sept. 18 called Pelosi “inept at her job.” Actor and former Sen. Fred Thompson labeled her “naive.” On Sept. 10, master Republican strategist Karl Rove asked, “How much capital will Speaker Nancy Pelosi have” to pass health care?

Pelosi answered that in a conversation Sept. 29 at House Judiciary Committee Chairman John Conyers‘ 80th birthday party, after the Senate Finance Committee had just rejected the Medicare-like public option for all by a 10-13 vote: “We will not be deterred. We will pass the bill.”

The public option is still viable. The House is set to pass it. It is neither “fading” nor “waning” (New York Times) nor on “life support” (ABC News).

Citing a recent CBS News poll that showed public support for the public option rose from 57 to 68 percent after President Obama’s speech to Congress in September, Weiner and Vander Linde argue that keeping it is the only way to “counter the insurance stranglehold” that makes our current system so dysfunctional — and that Pelosi will keep it in the blended version of the three House bills and eventually see it through.

For those who doubt Pelosi’s ability to pass the bill, know that she has passed every bill she has brought forward, usually with 60-plus margins, since the Democrats recaptured the House in 2006. These include the Recovery Act, Credit Card Bill of Rights, Homeowner Affordability, Lilly Ledbetter Fair Pay, Troubled Assets Relief Program (TARP) and State Children’s Health Program expansion to 11 million youths.

About the Senate…

Senate Finance Chair Max Baucus, D-Mont., said he could not vote for the public option because “I can’t see how we get to 60 votes.” The Constitution and the law require only a majority 51. The Senate amended its rules to require a “supermajority” to end debate. This procedure, called cloture, is a pander to allow special-interest contributors (Baucus has a million dollars from insurance companies) to block bills. Pelosi is right to support Senate “reconciliation,” which would allow a simple majority to pass health reform Americans want.

We believers may turn out just to be dreamers, but we’re still sending e-mails to Speaker Pelosi.

via Public option still alive – believe it.

Healthcare: Could We Get A Moral Commitment?

Is there a simple way to get universal healthcare in this country? In a word, yes. Or rather, in two words: moral commitment. If we were to make a moral commitment to what is, after all, only the fair, humane, equitable thing to do, author/reporter T. R. Reid told an audience at San Francisco’s Commonwealth Club today, there would be no problem.

Reid, a reporter for the Washington Post, documentary film maker and NPR commentator, was in town to promote his new book, “The Healing of America: A Global Quest for a Better, Cheaper and Fairer Health Care .” In it he tells the story of his journey around the world in the company of a painful shoulder, consultations about which were his introduction to personal encounters with health care systems of every sort. He also met with government representatives and policy makers across several continents.  It is an informative and highly readable (no pun intended, that’s just an appropriate adjective) book.

Reid outlined the four primary models of health care currently in existence on our small planet, each with different versions of who pays and who provides. In Britain’s socialized medicine model, health care is the government’s job and it does both. A “mirror image” of this plan is that put into place in Germany shortly after the country was established in the late 18th century, a “National Health System” in which the providers — doctors, clinics, etc. — are private but the payer — government — is public. Workers are covered through their employers. One advantage to both, Reid points out, is that everyone buys into preventive care. He told of British ads asking passersby if their feet hurt, and urging them to visit a podiatrist right away if so; “It’s free.” Or commercials featuring a coughing “Mum” and giving a phone number to call so a nurse may visit. “It’s free.” Each is aimed at diagnosing other illnesses early, and/or preventing the spread of disease.

The Canadian Medicare (that’s where Lyndon Johnson got the name for our elder care) system now copied by Australia, Taiwan and others would have had Reid waiting an long as a year for consultation and treatment of his shoulder. Although he proclaimed his pain to be a very present issue, it was not seen as an urgent need to the primary care doctor he consulted. It is this often extensive wait for non-urgent care that is most criticized (especially by Americans) about the Canadian system. But Reid got a Canadian answer to that. “We Canadians,” he was told, “don’t mind waiting, as long as rich Canadians have to wait as long as poor Canadians.”

The fourth model cited is the out-of-pocket model, which Reid illustrated with a story of climbing a mountain in Nepal to seek shoulder relief. At the top of the mountain, in an extremely simple one-room building with its four walls painted in four different colors, the doctor explained his payment was generally in whatever the patient could afford. Someone relatively well off might pay in funds, others in whatever they had. Many of the patients could pay only by painting the facility, the doctor said; they seldom had the same color of paint, and thus the many-hued room.

“We have them all,” Reid told a hushed audience: Native Americans and veterans have the British/NHS; over-65, the Canadian Medicare; working people, Germany’s system. But 40+ million Americans have medical care equivalent to Afghanistan or Angola, and tens of thousands of Americans die every year because they cannot afford medical care.

One audience member called Reid on that issue, saying hospitals were required to treat people who came to them, but he was not backing down. True, he replied, if someone is actively dying or about to give birth, hospitals cannot turn him or her away. But for cases (such as one cited at the beginning of The Healing of America) of lupus, or diabetes, or in countless other instances, the inability to pay for necessary care causes ongoing pain and death for thousands.

Other audience questions raised the illegal immigrant issue. In most countries, it simply would not be an issue, he said. Citing Britain as an example, he said “you get (care) whether you’re a citizen or not.” Reid also said the public option is a non-issue elsewhere, because “you don’t need it.” And he threw in another few illustrations that argue for reform: In Britain, you have to cover everyone, you have to pay every claim, and you have to pay every claim fast. In Switzerland, if a claim is not paid within five days, the next month’s premium is free. In Germany you have a choice of well over 100 insurance companies; if you don’t like one, you simply switch to another.

Having set out to answer the question of how other countries provide health care for all of their citizens, Reid said he then turned to the why. Why every other wealthy, industrialized, developed country in the world has universal coverage and the U.S. does not. Others have it, he said, because “they think it’s fairer, equitable, humane, just — and these are moral issues. Health care reflects a country’s moral values.”

It was clear that Reid, like most in his audience, sees the U.S. as having moral values. “If we had the political will,” he commented, “other countries could show us the way.”

But the author was pessimistic about the possibility of universal care coming out of the current reform efforts. Asked how it might somehow come to the U.S., he said it could well be the way Canada’s plan came about; “we might get it state by state.” The Californians listening might have taken heart. Twice that state has passed single payer plans, only to have them vetoed by their governor. Reid suggested that other states might also be ready to implement statewide health coverage.

As to his painful shoulder, its current status was not given. Presumably, it will be necessary to read the book to find out.

Public Option: the Single Payer Salve

Single payer proponents are still stung by the loss of their big issue to other big issues — or big players, if you will — but the prospect of a strong public option is the balm that may still salve that wound. This was one of the messages delivered by Giorgio Piccagli, President of the California Public Health Association, North and member of the Executive Board of the American Public Health Association at a panel discussion tonight sponsored jointly by OWL of San Francisco (The Voice of Midlife and Older Women) and the League of Women Voters of San Francisco. Audience members were urged to fight, among other things, for retention of the provision which would allow states to have single payer. (A California single payer bill passed the Senate Health Committee this spring and will be heard by the full Senate in 2010.)

Fellow panelist Debbie LeVeen echoed the call, saying a “robust public plan” must be national, to insure it’s large enough, must have authority to set prices and to bargain on drugs, and use the Medicare provider network.

Backing his call for reform with increasingly heard data such as sobering figures about uninsured Americans (45 million uninsured and another 50 million under-insured, for a total of about 1 in 3 of us) Piccagli said the lessons of the past 40 years include the fact that classical economics of supply and demand do not apply to health care: increasing the number of doctors, or competition among hospitals, only results in rising costs.

If the energies formerly tied to single payer can be channeled into a push for a public option some feel a viable reform bill will emerge. The San Francisco audience, many of whom were fervent proponents of single payer (which was endorsed by both OWL and the League of Women Voters) and most of whom are seasoned activists, left the room armed with cards to send appropriate legislators and plenty of ammunition to support their call now for a public option.

Said the third panelist, Co-Director of the Center for Policy Analysis Ellen Shaffer, about prospects for a robust public plan, “I think it’s up to us.”

Pelosi Sticks With Public Option

Speaker Nancy Pelosi at a gathering of interfaith leaders in San Francisco today (Justin Sullivan/Getty)
Speaker Nancy Pelosi at a gathering of interfaith leaders in San Francisco today (Justin Sullivan/Getty)

House Speaker Nancy Pelosi held a press conference in San Francisco this morning at which she reiterated her commitment to a public option in the health reform bill and expressed hope, though with somewhat  lowered optimism, for coverage of end-of-life conversations. She did get in a dig at opponents of the latter: In response to a question about whether voluntary reimbursement for discussion of end-of-life care would stay in the bill, Pelosi said, “You know, the language is almost exactly the same as what the Republicans put into the prescription drug bill.”

The press conference, hosted by the San Francisco Interfaith Council, was an apparent reinforcement of the Democrats’ strategy of  broadening health reform support among members of religious communities. With leaders from the San Francisco Bay Area Christian, Muslim and Jewish communities arrayed behind her, the Speaker made repeated references to health care for all being a moral issue. Responding to the above question, she said, “People of faith, people in healthcare” and others know that “it makes life better if a person has expressed his or her own wishes. The key to this is that it is voluntary; it serves the purpose of saying what is your wish, rather than someone else having to make a decision you might not want. I don’t know what will happen (to the provision); I surely hope it will stay in.”

Pelosi was unequivocal, however, in her response to questions about the public option and to one reporter’s comment that “some Democrats and liberals are frustrated because it seems you are caving in to the far right.” “Is that you?” she repeated, pointing to herself. “The public option is the best way to go. If anybody can come up with a better alternative we’ll consider it. But the President is not backing off. The co-op might work in some states and that’s fine.  There is no way I can pass a bill on health reform without the public option.”

Pelosi was equally emphatic about her intention to retain the 400% of poverty measurement. Hesitantly using the term “seniors,” she said that many people between the ages of 50 and 65 have lost jobs, or may be making just $30,000 to $40,000 per year, and cannot afford needed medical care or prescription drugs. “I believe we have to have the 400% of poverty for them.”

Would the Democrats accept a scaled-down version of health reform? Pelosi repeated her litany of what is needed: reduced costs, improved quality, expanded coverage, affordable care for all; “What are you going to give up? At the end of the day, this is what we must have. And we must have reform of the insurance industry.”

In the small, carefully selected audience assembled at St. James Episcopal Church where her children attended preschool, Pelosi was on her own turf and among friends.  And she was characteristically upbeat. “Have we lost control of the debate? I disagree. I have 218 votes, and expect to have more. I am optimistic, and the President is committed to change.”