As Washington grapples with the outcome of the election in Massachusetts this week, it’s important to remember one key thing: Congress can still pass historic legislation that will make health care a right, not a privilege, in the United States.  While the procedural route may be different, Congress still can do what it intended to do before Tuesday. It can enact a comprehensive bill that will make good health care affordable to tens of millions of people who are uninsured or underinsured and end the practice of denying people coverage or charging people more for pre-existing conditions. It can end the specter of medical bankruptcy, provide free access to preventive care, and more. None of these historic achievements can be done through “incremental” reform, and failing to accomplish these goals would put the Democratic Party in profound political peril.

While it may seem appealing to carve up the many facets of reform into smaller bites, that won’t get the job done. Take, for example, the promise that has most resonated with the public: stopping insurance companies from denying coverage for pre-existing conditions. You can’t do that without requiring everyone be covered because many people would wait to get covered until they needed treatment and that would drive premiums too high. But you can’t require people to get coverage without providing income-based subsidies to make coverage affordable. And you can’t raise the money for subsidies without finding savings in the system, like the proposed changes in Medicare, or raising new revenue. All that adds up to comprehensive reform.

The same logic applies to the other basic items Americans most want from reform, like relief from medical bankruptcy or stopping insurers from charging more to women or making the health insurance market work for small business.

At its heart, comprehensive reform is a simple guarantee that you will have access to good, affordable coverage whether you work for someone else, are self-employed, or are unemployed. The bills that have passed both houses of Congress achieve that goal through the same basic mechanisms: expanding Medicaid, establishing new health insurance marketplaces, providing income-based subsidies for buying regulated insurance within those marketplaces, extending tax credits to at least small businesses, and establishing some requirements for most businesses to offer coverage or pay for it. Both bills raise the money through changes in Medicare and new revenues. Taken together, that will mean that for the first time every American will have access to affordable health care coverage.

If we look at history, we see that once we have built such a foundation, Congress will improve on it. When Social Security was enacted, it left out major categories of workers and didn’t provide for surviving spouses or dependents. Those omissions got fixed later.

If we fail to pass reform or pass minor reforms that don’t really change anything, it will be at least 15 years before the nation tries again. If we enact the agreed upon reforms, Congress will continue to debate how to improve upon what’s in place. And it will defend the new right to health care against those who would tear it down – just like Republicans have been trying and failing to privatize Social Security since it was first passed.

This isn’t just a policy question; it’s a political one. Republicans are counting on stopping the Democratic agenda so that Democrats will fail and voters will give the Republicans another chance. The Massachusetts election demonstrated that Democrats need to deliver on the promise of change. After a year of getting within sight of the finish line on comprehensive health care reform, the only choice from a policy and political perspective is to get the job done.

As the national campaign manager of the nation’s biggest progressive health care campaign – one that has organized hundreds of thousands of people in all 50 states and spent $45 million fighting for reforms that go well beyond what now seems possible – I understand as well as anyone how frustrating progressives find this situation. But we should never lose sight of what Dr. King said about health care in this nation: “Of all the forms of injustice, inequality in health care is the most shocking and inhumane.” Congress is on the brink of dramatically reducing this inequality even though the legislation has many imperfections.

So on behalf of the army of activists who have fought with us for more than a year, our message to Democrats in the House and Senate is simple: pick yourselves up, dust yourselves off, and enact the compromise plan you were set to pass before the Massachusetts election. You still have big majorities in both houses. Because of Republican obstructionism, you’ll need to use different procedures to get the job done. But just do it! And know that each and every year you will have saved tens of thousands of lives, rescued hundreds of thousands of families from medical bankruptcy, and proved to America you are up to the challenge of building a new and better future for our children and the generations that follow.

One huge issue that's received almost no attention in the debate on health care reform is what will happen to health coverage at work. There's been an enormous amount of attention paid to what will happen to the small percentage of Americans - less than 10% - who will get coverage through the new health insurance marketplaces called Exchanges. Will they have access to a public health insurance option? Will the government subsidies be enough to make health care affordable? Will insurance companies be able to raise rates because of health conditions, age, or gender?

This discussion - the one that's dominated the debate - has nothing to do with the majority of Americans, some 150 million, who will continue to get their health coverage at work. During the past decade, coverage at work has deteriorated with employees paying a bigger share of premiums for shrinking benefits. A study of employers released this past fall found that the trend is sure to continue in 2010. A key question is whether reform will deal with this growing problem for most working Americans.

What will happen depends on which reform bill you read. The House bill guarantees people will get good coverage they can afford. But the Senate bill not only fails to protect employees in large firms but also encourages employers in low-and-moderate wage businesses to offer barebones insurance plans and shift workers to part-time jobs.

For the key question most people ask when it comes to health reform - "Will I get good health coverage I can afford?" - the House bill provides unambiguously good news for people at work. The House bill requires all but the smallest employers to offer and help pay for good benefits or pay a percentage of their payroll to the government to help cover the cost of subsidies. Coverage must include a good package of benefits as defined by the federal government. Employers are required to pay a specified share of premiums for individual and family coverage, and the new insurance rules would apply to coverage offered by all employers, large and small. As a result, the House bill will not change a thing for people who get good coverage now at work but will establish a floor to protect people against the national trend toward skimpier benefits and higher costs to employees.

A sense of irony is clearly a luxury that politicians can't afford. So was the irony totally lost on Republican senators that after months and months of relentless attacks on a "government takeover of health care," they spent most of the week stomping their feet "defending" Medicare, our national government health insurance program for seniors and people with serious disabilities?

There have been a lot of comments on Republican hypocrisy, with John McCain as Hypocrite-In-Chief, for railing against Democratic proposals to reduce the rate of Medicare spending. Republicans have a long history of proposing gutting or privatizing Medicare which, unlike the Democratic proposals, included reducing Medicare benefits. But what has largely gone unnoticed is the broader context of the debate. Following their traditional playbook, with a refresher chapter written by longtime author Frank Luntz, Republicans have founded their major message against reform this year as a "government takeover of health care."  Then this week, they put all their political capital into defending the biggest government health insurance program in the nation.

If you ever needed proof that big government programs are popular with the American people, the Republican defense of Medicare could be exhibit one.  Medicare is so popular that the best political attack Republicans have against the health care reform bill is to scare seniors about the legislation's impact on Medicare.

For Republicans, the leading example of the alleged government takeover of health care is giving some people the choice of a public insurance plan to compete with private insurers. The public option would be a very small version of the very big Medicare program.

Sometimes it’s easy in the policy and political debates around health reform to lose sight of what, ultimately, this is all about. For me, Thanksgiving was a good reminder. There were 18 of us around the table, and at least 11 of my family members would see lower – sometimes dramatically lower – health care costs under the legislation that is likely to pass Congress. And all of us – everyone at the table– would see some benefit.

Let’s start with my cousin. She’s fought advanced cancer all year and is now in remission. Out of work during this literal fight for her life, she’s paying $18,000 a year for coverage, money she inherited when her mother died earlier this year. At this rate, she’ll use up her inheritance soon. She hopes to get back to work but will likely be self-employed when she does. Under the health reform legislation, she would pay for coverage based on her income and would have the security of coverage she could afford.

My wife’s niece, a self-employed film producer in Los Angeles, was out of work in the depressed movie industry up until a few weeks ago. Living with asthma, she kept paying for health coverage even as she fell behind on her mortgage. The legislation in Congress would also scale her health coverage to her income.

I have a singer-songwriter musician brother, a married father of two, who has been paying more and more for less and less coverage. And my sister is also married and a mother of two. She and my brother-in-law are both self-employed and buy a high-deductible plan. Both families would pay less for better coverage.

Then there’s my daughter. A year out of college, she has a low-wage job in Boston but has health coverage she can afford because of the Massachusetts law. It’s easy for people on the left to dump on the Massachusetts bill because it doesn’t do enough to control costs. But as a father who doesn’t have to worry about his daughter being uninsured or having to pay more than $300 a month for medication she needs, I’m extraordinarily grateful that Massachusetts has covered almost all of its residents now.

The legislation in Congress would help others at our Thanksgiving table too.

Ezra Klein at the Washington Post takes issue with Health Care for America Now's stance on the excise tax.

I appreciate Ezra saying he has a lot of respect for HCAN. We continue to differ on the policy issues around taxing higher cost health benefits, whether doing it head-on as was proposed in the past, or through the back-door, as is the case with the 40% excise tax on high cost plans in the Senate Finance bill.

First, Ezra claims that the excise tax is isn't really a tax on the middle class:

The ad says the excise tax is "a 40% tax on health-care benefits of middle-class workers." It isn't. It's not even a little like that. It's a 40 percent tax on employer-provided health-care benefits above $21,000 for a family, and $8,000 for an individual. If your family's health-care premiums cost $23,000, then there's a 40 percent tax on $2,000 of your premiums. It's inconceivable that anyone's full health-care policy would be taxed at 40 percent.

Moreover, your family's health-care premiums probably don't cost $23,000. The average employer-provided health-care plan cost $13,375 in 2009. There are some middle-class workers with uncommonly generous health-care plans, but they're not the norm. This isn't as progressive as a tax on millionaires, but it is, in general, progressive. Goldman Sachs traders, for instance, have health-care plans valued around $40,000 a year. Wal-Mart employees don't.

But income and the value of people's health care plans do not correlate. The Communications Workers of America, using data from the Joint Committee on Taxation (JCT) and an analysis by Citizens for Tax Justice (CTJ), concluded that 40% of health care plans will be hit by this excise tax by 2019.

Second, as Ezra notes, the excise tax "isn't as progressive as a tax on millionaires. " Yup. Health Care for America Now is for progressive financing, which is why our new ads push for having people who earn more than $250,000 pay their fair share. That's what the House bill does and it's what the President's initial proposal to fund health care through lowering tax deductions for people who earn more than $250,000 does too.

Ezra goes on to support employers buying less generous health care plans for their employees:

The argument against the excise tax is that it cuts the deficit by encouraging employers to shop for cheaper plans. The Joint Committee on Taxes suggests that the tax won't raise money because people will pay it. It will raise money because it will encourage employers to purchase cheaper plans for their employees and divert money they've saved into wages, which are taxable income. That means that a number of very generous plans will become more like middle-range plans. They'll have deductibles if they don't already, tighter networks, tiered drug formularies and so forth. Any plan that's lavish enough to even near the tax is going to remain a very generous plan, but it will become less so on the margin.

Some people, myself included, think that's a good thing.

I don't.

The problem here is confusing cutting costs with shifting costs. Cutting costs means finding ways to make health care more efficient and to provide better care for the same or less money. But shifting costs is different. By incentivizing employers to offer less generous health care benefits, which means higher deductibles and the like, "costs" may go down, but in reality the policy simply transfers these costs to the worker. Moreover, higher out-of-pocket costs can discourage people from getting the care they need.

In his The Take blog in the Washington Post (8/12), Dan Balz writes that the vocal opposition to Obama on health care isn't really about health care as much as it is about the debate over the role of government.  He's right. But Balz's proposed solution - jettisoning the public option - would do nothing to diminish the right-wing anti-government opposition. Such a move would simply take the legs out from under any progressive support for reform.

Balz is correct that extreme reaction to the health care proposal is really a rejection of the notion that government can help solve key problems in America. The election last fall was a strong repudiation of those who would limit the government's role in solving huge challenges facing the nation. President Obama's New Foundation program faces the same virulent reaction that FDR engendered with the New Deal.

No matter what the President proposes on health care, the right will loudly label it a "government take-over." Just as soon as the economic stimulus bill was introduced, the right-wing message machine began demonizing government-funded research on which medical treatments work the best.  Every component of Democratic health reform plans is characterized as a government take-over: establish standard benefit packages for insurance plans, require individuals and businesses to contribute to coverage, set up an insurance marketplace, etc.

The public option became an early lightning rod because the health insurance industry started gunning for it the week after Election Day. Republicans quickly jumped in. For the industry, having to compete with an insurance plan that has a public mission and the clout to deliver good, affordable health care is a threat. They'd like reform to deliver a government mandate for everyone to buy insurance, giving them tens of millions of new, profitable customers without making them compete with a public health insurer.

But if the public option weren't part of the Obama/Democratic reform plan, the right would still be screaming about a "government take-over" as loudly as it is now. If you look at the Frank Luntz Republican message playbook, it doesn't discuss the public option or any other policies; it's a ready-made, anti-government message for any and every Democratic policy proposal.  And the right-wing anger we're seeing now isn't directed at giving people a choice of a public health insurance plan. Instead, opponents have managed to turn a doctor's discussing a living will with a patient into euthanasia.

If scuttling the public option won't quiet the right, it will definitely quiet the left. And that would be disastrous to the prospects of Democrats passing legislation this fall. Giving people an alternative to the private health insurance industry is the one issue that highly motivates progressives. Over and over again at Health Care for America Now, it is what our tens of thousands of activists - from grassroots community people to high-dollar Democratic donors - want to talk about.  For them it has become the measure of whether health reform is about real change or just a cosmetic lift to a broken system. Responding to those same voices, the four Democratic committees in Congress have passed legislation that includes a public option, and the President has consistently reaffirmed his support.

Maybe that's another reason that Republicans in Congress are so focused on killing the public option.  The Republican strategy for health reform is the same as the insurance company strategy for paying big medical claims: delay and deny. If Republicans in the Senate succeed in killing the public option, they'll cause mass desertion from the progressive army that's powering the President's agenda for reform.

History buffs will recognize The Guns of August as Barbara Tuchman's classic history of World War I. The reference works now because August 2009 just opened with trench warfare on health care reform. Unfortunately, the right-wing mob is seeing some early superficial success. We need to enter the battlefield immediately to defend the President's top priority, providing a guarantee of good, affordable health care to all this year.  This is a call to arms for the army of activists who powered President Obama to the White House.

We are already seeing the violent excesses of the right. They hung freshman Maryland Congressman Frank Kratovil in effigy, painted Texas Rep. Lloyd Doggett as a devil with horns, and screamed insults at HHS Secretary Kathleen Sebelius. This is an angry minority, bitter about an America that they don't recognize, led by a man that doesn't look like them.

These are the same crazies that applauded calls to violence last fall at Sarah Palin rallies and made a hero of Joe the Plumber. But remember, as the public began to understand what the far right-wingers really stood for, it didn't take long for a great majority of the electorate to write them off.

But since health care won't be decided at the popular ballot box, we can't just wait for the public to recognize the reality behind this nutty minority. There are two prizes in the battle at hand - the national press narrative and Congress' support. We have to win the press war by making it clear that shouts of "socialized medicine" and "government health care" are from a mob on the fringe of American politics. And we need to be sure that wavering Democrats in Congress see that there is strong popular support for health care reform.

Health Care for America Now is joining with progressive groups throughout the country to out-gun the tea-baggers in August. Members of Congress are spending their time at home trying to gauge public support for reform before returning to Washington after Labor Day. It will be a contest all month long, and we have to take it on with all the urgency that the historical task at hand demands.

We've launched a new page on our website to help you take action in August: www.healthcareforamericanow.org/fight. Here you'll find out how you can join the fight locally. We'll list town hall meetings and events by Congressman from both political parties so that we can show strong support for reform and keep control of meetings. We'll also tell you how you can directly challenge those members of Congress who are siding with the far right, often using the same extreme rhetoric of the tea-baggers. And we'll be organizing our own actions to show how Congressional opponents of reform are carrying water for the health insurance industry. The page includes pointers for how to organize your own action and how to prepare and respond to the right-wing mob.

As President Obama said on the night he was elected, "I know you didn't do this just to win an election and I know you didn't do it for me. You did it because you understand the enormity of the task that lies ahead. For even as we celebrate tonight, we know the challenges that tomorrow will bring are the greatest of our lifetime."

Of all the challenges in American history, there is none greater than turning health care from a privilege to a right. We need everyone in America who believes that health care is a right to rise to the challenge that the President laid out before us on Election Day. Right now, this month, is the time to declare that this is our country and that an extreme right wing minority will not wreck our nation's path to health care justice.

Today in his address to the nation from a Children’s Hospital President Obama stated, "We can't afford the politics of delay and defeat when it comes to health care. There are too many lives and livelihoods at stake." He couldn’t be more right. Now is not the time to hold up health care over every single thing that needs to be fixed. Now is the time for bold action to make good, affordable health care a right. The question is, can Congress rise above the demands of every lobbying group and make it happen?

Two House committees have now approved legislation that will make good health care affordable to American families and small businesses, stop insurance company abuses and offer a choice of private insurance or a public health insurance plan. Despite united Republican opposition the bills passed the committees with the support of 90% of Democrats. With key votes ahead in the next 10 days, It’s time for all members of Congress to get on the right side of history.

There are two types of arguments in the debate. First, there are obstructionists, mostly from “the party of NO,” who just want to block health care reform to politically damage the President. In a recent call to Conservative activists in the Republican Party, Sen. DeMint said, “If we're able to stop Obama on this, it will be his Waterloo. It will break him." It is clear that they have no concern for the millions of Americans facing rising premiums and who are one serious illness away from bankruptcy.

Secondly, there are some in Congress who are missing the big picture. Yes, there are parts of this legislation that we all want to improve on. However, it is simply ridiculous to vote against an entire structural change that will provide quality, affordable health care to thousands of your constituents because it doesn’t address ever problem in health care. Work with your colleagues to make it better – don’t block it.

We can’t make any excuses that will embolden the opponents of reform. There are real consequences for people each day that we put this off. Here is what happens every three weeks that we delay health care reform in America:

• 143,250 people will lose their health insurance coverage [pdf]
• 53,507 people will file for bankruptcy because they can't pay their medical bills
• 1,265 people will die [pdf] because they lack coverage

Washington insiders want to talk about the horse race, and the political bickering, but that is not what the American people care about. People care about premiums rising four times faster than wages, not bipartisan compromises that will water-down reform.

Just this week in Tennessee, hundreds of citizens with no access to health care lined up for a Remote Area Medical event. Remote Area Medical was created to serve people in third world countries, but now spends most of their time in the U.S. as the only alternative for thousands of people all over the country to see a doctor – including thousands of children. Stan Brock, Remote Area Medical’s founder, said, “We have had to cut back on our operations in places like Haiti, Guatemala, and India because of the tremendous demand here in the United States.”

Enough is enough. Big changes like this don’t come easy. It’s time for our leaders to stand up for us and rise above the petty political back and forth. No excuses — Health care can’t wait!

The right-wing attack on health care is coming into full view. Not surprisingly, they've settled on a tried and too-often true strategy: scare the @@#% out people. Health care reform will be defined as a "government-takeover."  The result of government-run health care will be long lines, waiting for treatment, not getting the treatment you need, not being able to choose your doctor or hospital. Health care reform is government rationing and Washington bureaucrats running the health care system.

While It started this winter with Rush Limbaugh's reaction to the health proposals in the Presidents Economic Recovery bill, the message was given a huge boost a few days ago when Republican message meister Frank Luntz briefed Republicans in the House on "The Language of Health Care 2009: The 10 Rules for Stopping the ‘Washington Takeover' of Healthcare."

Luntz's message is already being used by Republicans in the Senate and House. South Carolina Senator Jim DeMint published an article this week in which he said: "That's how a government take-over of your health care will try to get costs under control: cheap, outdated treatments, long waiting lists, and low-tech hospitals. It won't take long before families realize the true costs of such a plan aren't counted in dollars and sense."

Now Rick Scott, the disgraced former head of Columbia/HCA, is running ads on TV talking about people in England who have died because of government health care.

Will this message work? Not if we get our message out in response. The big problem with the Republican strategy to, as Luntz said, "kill what they're [Democrats] trying to do," is revealed in Luntz's memo:  "…because the American people blame the insurance companies more than almost anybody else for why health care is such a mess in this country right now."

Everyday people in America get their health care denied by insurance company bureaucrats, directed by insurance company CEOs who make millions of dollars a year, flying around in their corporate jets, paid for by hiking your premiums, denying you the care you need and coming in-between you and your doctor.
The American people know that. We have to remind them.

Take a look at this exchange between me and John Roberts, the host of CNN's American Morning, last week (you can also watch it here):

In 1993, William Kristol wrote a now-famous memo advising Republicans that their ticket to power was blocking health care reform no matter what it looked like. Newt Gingrich followed that advice, and the rest - as they say - is history.

Taking a page from that history, Republican message maestro Frank Luntz told the Republican House conference this week - shrunk back to its 1993 size - that "You're not going to get what you want, but you can kill what they're trying to do."

Luntz's prescription for Republicans is to replay the 1993-1994 Republican playbook of attacking "government" health care: "government rationing care…Washington bureaucrats…government takeover…" You get the picture.

Only this time it won't work. And the reason that Luntz's recycled prescription won't cure Republican's political ailments is revealed in another one of Luntz's remarks to the Republican House members: "…because the American people blame the insurance companies more than almost anybody else for why health care is such a mess in this country right now."

The attack on government health care falls flat when confronted by the everyday experience of Americans with private health insurance. As New York Senator Charles Schumer said on Tuesday at the Senate Finance Committee roundtable, "Well, let me tell you, the American people have some problems with the government. But they have a lot more problems with private insurers."

HHS Secretary Kathleen Sebelius made the same point at a Ways and Means Committee hearing the following day: "I know there's a lot of talk about not having bureaucrats make health decisions, but I think it's equally important not to have private insurance companies make health decisions, overruling protocols recommended by health providers."

The Senator's and Secretary's observations should give some encouragement to those who worry that Democrats will be cowed by the retreaded, anti-government rhetoric from the right. This is a fight that we have prepared for and welcome. We at Health Care for America Now anticipated the fear-mongering attacks that Luntz is promoting and found that if we respond aggressively, we win the argument hands down.