“Congress owes the American people a final vote on health care reform,” Obama said, vowing, “I will do everything in my power to make the case for reform.”

Other highlights:

1) A Call for Reconciliation: Pointing to past legislation that has been enacted using the budget reconciliation approach — including the sweeping Bush tax cuts — Obama argued that health care reform “deserves the same kind of up or down vote.”

2) Rejection of Single Payer Health Care: Supporters of a Medicare-for-all-style system of reform have complained that such a proposal has rarely been mentioned throughout the debate. They can’t make that claim anymore, though neither will they like the attention Obama gave single-payer Wednesday. “In America,” the president said, “it would be neither practical nor realistic.”

3) Comprehensive vs. Piecemeal Reform: Republicans, behind Sen. Lamar Alexander (R-Tenn.), have argued that “Congress doesn’t do comprehensive well.” They’ve been pushing for Democrats to scrap their comprehensive proposal in favor of smaller, more incremental reform steps — a strategy that Obama rejected outright. “The insurance reforms rest on everybody having access to coverage,” he said. “Health reform only works if you take care of all of these problems at once.”

4) Funding: Covering 30+ million uninsured folks will cost money, Obama conceded. But the additional costs — which he estimates to be $100 billion per year — can largely be covered using funds the country already spends on health care (roughly $2.3 trillion annually). “The bottom line is [that] our proposal is paid for,” he said.

5) The Enthusiasm Factor: Liberals have been all over Obama for what many viewed as a tepid approach to health reform in the last year. He let Congress draft the bills, they say, and he hasn’t nearly used the bully pulpit to sell his message that health reform is not just a moral concern but an economic necessity. His actions in recent weeks indicate that he’s ready to get more aggressive. And his promise to do “everything in my power” to pass reform this year is sure to light a fire under at least some moderate Democrats who have been wary that they’ve been left dangling in the wind.

“I do not know how this plays out politically, but I know that it’s right,” Obama concluded. “Let’s get it done.”

Waiting now for the GOP attacks.

In a letter to Obama today, Kucinich argues that single payer is “the only health care [system] that has consistently proven to address each of the criteria you have outlined for a satisfactory heath care plan.”

As you know, Medicare for All increases quality, provides coverage for everyone, and controls costs.

The Ohio liberal is urging Obama to include a single-payer advocate as part of the bipartisan health reform summit the White House will host on Feb. 25. Indeed, Kucinich offered himself to be that advocate.

Sen. Bernie Sanders (I-Vt.) today withdrew his Medicare-for-all amendment after Sen. Tom Coburn (R-Okla.) launched a procedural move forcing a Senate clerk to read the entire 767-page text. The Hill has the rest:

“The day will come, although I recognize it’s not today, when the U.S. Congress will have to vote to stand up to … all those who profit every single year off of human sickness,” Sanders said. “That day will come.” [...]

Senate aides estimated that the bill reading would have taken eight to 10 hours, which would have sidelined the healthcare debate as Democratic leaders are attempting to pass the overhaul by Christmas.

Sen. Bernie Sanders (I-Vt.), the only member of the upper chamber to endorse single-payer health coverage, said Monday that he plans to introduce an amendment to the Democrats’ health reform legislation that would establish a Medicare-for-all insurance system.

We have got to understand that one of the reasons that our current health care system is so expensive, so wasteful, so bureaucratic, so inefficient,  is that it is heavily dominated by private health insurance companies whose only goal in life is to make as much money as they can. [...]

The result is [that] we are wasting about $400 billion a year on administrative costs, profiteering, high CEO compensation packages, advertising and all the other stuff which goes with the goal of private insurance companies to make as much money as [they] can.

Michael Briggs, spokesman for Sanders, said Monday that Democratic leaders have indicated that Sanders’ single-payer proposal could be fourth in line among the amendments to get a vote on the Senate floor — the first vote of its kind in the history of the upper chamber. That the provision is certain not to pass hasn’t discouraged the Vermont Independent.

“I am not naive. I know that we will lose that vote,” Sanders said. “But … at the end of the day — not this year, not next year, but sometime in the future — this country will understand that if we’re going to provide comprehensive, quality care to all of our people, the only way we will do that is through a Medicare-for-all, single-payer system.”

Rep. Anthony Weiner has been one of the most tireless and effective advocates for health care reform. His decision not to offer his amendment on the floor was a difficult one for him, and for supporters of the measure. I believe Rep. Weiner’s choice will be enormously helpful in passing the health care reform package. His step is a correct and courageous one. I thank Rep. Weiner for it, and look forward to working with him closely. Rep. Weiner deserves a great deal of credit for helping to make quality, affordable health care more available to millions of Americans.

The decision might please Democratic leaders, but it won’t make Rep. Dennis Kucinich happy. The Ohio Democrat, who has also pushed tirelessly for single-payer health coverage, wondered yesterday how the proposal’s popularity can even be gauged without giving lawmakers the chance to vote on the measure.

“To those who want a stand-alone vote on single payer now, I want to ask this question,” Kucinich said on the House floor. “Is this a time to plant or a time to reap? What fruit will be borne from a tree that has received no light and no water in this Capitol?”

“Like many other important reforms included in the underlying bill, the Kucinich amendment is the object of attack by the insurance industry,” Kucinich wrote in a letter. “Unlike other reform measures, Leadership has chosen to strip the Kucinich amendment of the protection it deserves.”

Kucinich’s provision, which would allow states to set up single-payer health care systems modeled after Medicare, passed the House Education and Labor Committee in July, but was stripped out by Democratic leaders as they pieced together their final bill from the various committee proposals. Kucinich concedes that the provision represents “incremental reform.” “But,” he adds, “it allows the country to move incrementally in the direction that is needed.”

If Education and Labor Chairman George Miller (D-Calif.) is right about there being no floor amendments, this plea could be Kucinich’s last shot.

Update (4:46 p.m.): Democratic Reps John Conyers (Mich.), Eric Massa (N.Y.), Neil Abercrombie (Hawaii), Janice Schakowsky (Ill.), Lynn Woolsey (Calif.) and Raúl Grijalva (Ariz.) have also signed the letter.

Neither group will be pleased that the $894 billion health reform bill released yesterday by House Democratic leaders cuts the provision out altogether. Indeed, here’s Rep. Dennis Kucinich (D-Ohio), who sponsored the Education and Labor amendment, reacting yesterday to the news:

If a state wants better health care than can be provided by the federal government in the health care bill we are seeing today, the federal government should not stand in their way. The removal of the Kucinich amendment constitutes yet another capitulation to the health insurance and pharmaceutical industries who are already reaping billions of dollars from the bill.

Not that many states have the budget surpluses at the moment to adopt single-payer health coverage for their residents, but that only makes the decision to pluck the provision from the final bill that much more inexplicable.

Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

Democrats pushing for a government-backed insurance option as part of their health reform strategy are finding out the hard way that, by taking single payer health care off the table early, they have little leverage now to force a strong public plan.

Illustration by: Matt Mahurin

Unlike the Republicans, who adopted the strong conservative position of resisting almost every Democratic reform proposal from the start, Democratic leaders ruled out the liberal single-payer proposal early in the debate. Now in search of a centrist compromise, GOP leaders have plenty of room to maneuver, while Democrats are left facing proposals that either dilute the public option or eliminate it outright. Indeed, the Senate Finance Committee is expected on Tuesday to unveil long-awaited reform legislation promoting the creation of private health cooperatives, not a public plan.

For many health reform and patient advocates, the developments have been a disappointment. After gaining both the White House and large majorities in Congress this year, the Democrats have made comprehensive health reform their top domestic priority. On the campaign trail last year, then-Sen. Obama came out in enthusiastic support of a strong public insurance option to compete with private insurers as a way to control premium costs, which are skyrocketing. In Congress, Democratic leaders in both chambers also gave clear endorsements to the public option. Even conservative Democratic Sen. Max Baucus (D-Mont.), who chairs the Senate Finance panel, promoted such of plan in a November 2008 policy paper detailing his “vision for health care reform.”

Republicans have adamantly opposed such a plan. But they’ve also had the advantage of knowing for months that Democrats wouldn’t push for anything more liberal. In August of 2008, for example, Obama said that the best option for health reform might indeed be single payer — which would eliminate private insurers in favor of government-backed, Medicare-style insurance designed to provide universal coverage. But he also conceded that it would be too difficult to launch quickly.

“People don’t have time to wait,” he said.

In May, the White House’s top health official told lawmakers that single payer coverage “is not something that the president supports.”

In the House, Democratic leaders held just one hearing this year on single payer, almost as an afterthought. And Baucus, for his part, ignored single-payer supporters until June, when Sen. Bernie Sanders (I-Vt.), the only upper-chamber lawmaker to support single-payer health care, set up a meeting between advocates and the Finance chairman.

The message to Republicans was clear: Single-payer health care would be off the table from the start.

By choosing the public option — not single payer — as the left-most negotiating point, Democrats left themselves with few places to go but toward more conservative proposals for insurance reform, experts say, including the co-op model and a system of triggering public plans only if private insurers fail to meet certain cost and coverage targets. In the blood sport of congressional negotiating — which dictates that you over-ask, and then move toward your goal during the subsequent bartering — Democrats were asking merely for the public plan they wanted in the final bill. The move, some experts say, provided Republicans with greater leverage to fight the public option. Sen. Kent Conrad (D-N.D.), a lead negotiator for the Finance proposal, has said bluntly that a public plan can’t pass the Senate. Even Obama, in a speech on Capitol Hill last week, walked back his support for the proposal by not insisting that it be included in the final reform bill.

Quentin Young, national coordinator with the Physicians for a National Health Program, a single-payer advocate, said greater congressional support for single-payer coverage early on would have given Democrats greater sway to press their public option proposal now in the face of Republican opposition fueled by August’s town-hall protests.

Not that all Democrats are resigned to defeat. House leaders have promised a floor vote on a single payer bill, introduced by Rep. John Conyers (D-Mich.), which has 86 co-sponsors. Young said the vote, the first of its kind, “in a way legitimizes single payer,” which has never had a vote in the chamber despite decades-worth of proposals endorsing it. Young also theorized that Democrats were forcing the single payer vote in order to “put something up to the left of the administration with hopes of pulling some Republicans to the center.”

Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, pointed to another reason that the single-payer vote is significant: It might rally support from some liberal Democrats who are threatening to oppose the final bill if they deem it to be not progressive enough. The vote, Hobson said, “doesn’t allow any of the various factions to say they didn’t get a shot on the floor.”

The comments arrive as the so-called Gang of Six, a bipartisan group of Senate Finance Committee members, continue their slow negotiations in search of a bill that can win support on both sides of the aisle. Baucus told reporters Monday that he expects to unveil the legislation Tuesday. Last week, Baucus released an 18-page draft summary of the bill, which proposed the creation of regional health cooperatives, but no pubic option. Tuesday’s proposal is expected to offer the same.

Some key Republicans, however, are already voicing doubts that the Baucus bill will attract any GOP support.

There remains the possibility that Democrats could somehow ram a public option provision through the Senate. Indeed, Sen. Tom Harkin (D-Iowa), who was recently named to replace the late Sen. Edward Kennedy (D-Mass.) atop the Senate Health, Education, Labor and Pensions Committee, vowed over the weekend that the Democrats’ final bill would include a public option.

“Mark my word — I’m the chairman — it’s going to have a strong public option,” said Harkin, who as recently as this summer reiterated his long-time support for a single-payer system.

Still, following Kennedy’s death, the Democratic majority in the Senate fell to 59, meaning that party leaders will need to entice at least one Republican to defeat an almost certain GOP filibuster. All eyes are on moderate Sen. Olympia Snowe (Maine) as perhaps the most likely Republican to stray from the party line on health reform. Yet over the weekend, Snowe reiterated her opposition to the public option, telling CBS’ “Face the Nation” that “there’s no way to pass a plan that includes the public option.”

Neither single payer nor the public plan are as unpopular among the public as some on Capitol Hill and K Street like to portray. Indeed, a 2007 poll conducted by The Associated Press and Yahoo found that 65 percent of Americans support adoption of “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” A more recent poll, conducted by the Kaiser Family Foundation in July, found that 24 percent of the public “strongly favors” single payer, with another 27 percent “somewhat” favoring the proposal.

Furthermore, a study released Monday by researchers at Mount Sinai School of Medicine found that 63 percent of doctors support the public option, while another 10 percent favor a single payer system that would eliminate private insurers altogether.

Young, who practiced medicine for 61 years before joining Physicians for a National Health Program in 2007, said his group sides squarely with the 10 percent. The public plan wouldn’t accomplish the Democrats’ coverage and cost-containment goals, he said, because it would leave in place the private insurers who “account for virtually all the problems we’re confronting.”

“It’s funny that both the conservative critics and the liberal supporters [of the public option] argue that it’s a stepping stone [to single payer],” he said. “We don’t believe it.”

A single-payer system, such as the one proposed by my colleagues and myself, not only covers everyone, but also eliminates co-pays, deductibles and virtually all uncovered medical bills … That’s how it works in Canada. Every Canadian has coverage with zero co-pays and zero deductibles. As a result, when they get sick, they’re not forced to pay for care. It’s the coincidence of bills coming when you’re least able to pay them that creates the problem.

Not that the single-payer model is politically feasible at this point in the debate. Indeed, by framing the public option as the left’s starting argument, Democratic leaders — including President Obama — ensured that the single-payer strategy was dead before the debate began in earnest.

Still, Himmelstein’s research — including the troubling statistic that three-quarters of medical bankruptcies hit patients who had insurance coverage when they got sick — is something for policymakers to consider while they’re extolling the virtues of the other proposals being floated on the Hill. Here, for example, is David Axelrod on Meet the Press Sunday:

The idea here is to keep the American people from going broke as a result of soaring healthcare costs that have doubled in the last 10 years, risen three times the rate of wages. We want to bring security to the people who have insurance so that they’re not thrown off their insurance if they get sick, so that if they lose their job or change their job, they’ll still have coverage, so that people with pre-existing conditions can get insurance. That’s what the American people need to know.

With stories like these popping up nationwide, it’s clear that cost — not just coverage — also needs to be a focus of attention.

If he stands up Wednesday and says, “To the country and to my colleagues in Congress, we are going to have a public option in this plan because we need and here’s why,” it’s going to get done. If he doesn’t, we’re going to have to settle for less and that will be a tragedy.

Obama will address a joint session of Congress Wednesday to lay out more specific health policy demands than he’s done to date.

–

You can follow TWI on Twitter and Facebook.