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Health Care Reform On the Table
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July 10, 2009

Health care reform is coming. Both Congress and President Obama have made it a top priority. Now comes the tricky part — designing and funding a plan. Politicians are jockeying for the lead in structuring the final plan. And lobbyists and interest groups are spending lots of money making their case on the Hill and in the media.

Polls suggest that some 72% of all Americans want health care reform to include a public insurance option that competes with private plans. Recent news reports have Senator Baucus uncommitted, Representative Pelosi and Senator Reid strongly on board, and according to THE WALL STREET JOURNAL, Chief of Staff Rahm Emanuel "Open to Deal on Public Health Plan" even as President Obama reiterates his support for a public option.

BILL MOYERS JOURNAL has covered the public option that appears to be on the table and the idea of a single-payer plan which is not. Find out more about those plans and all the iterations under consideration below.

>>Compare the current plans.

The Public Option
The public option, according to Robert Reich, is a government-run non-profit insurance pool, that, by virtue of its size and bargaining power, could control costs and offer people who are either uncovered by, or unhappy with, private insurers an affordable alternative path to health care. Medicare is an example of a public option, notes Reich, with one important caveat the Medicare drug benefit bill passed during the Bush administration expressly forbids Medicare from using its size to negotiate for lower costs which would be an important strategy for keeping prices down.

Whence Single-Payer?
Dr. David Himmelstein and Dr. Sidney Wolfe told Bill Moyers on the JOURNAL that President Obama isn't considering a popular plan — single-payer. In a recent town-hall meeting in New Mexico, President Obama said switching to single-payer would be too disruptive.

The term "single-payer" generally means a system in which rather than having private, for-profit insurance companies, the government runs one large non-profit insurance organization. That organization pays all the doctor, drug and hospital bills — it is the "single-payer" of all medical bills. In most single-payer plans, every American would be enrolled and would pay into the fund through taxes.

Advocates argue that a single-payer system would pay for itself, saving huge amounts of money in administrative costs. The U.S. currently pays a higher percentage of health dollars for administration than any other nation.

The U.S. also ranks highest in total cost of care, but according to a recent report by the Commonwealth Fund, ranks last among industrialized countries "in preventing deaths through use of timely and effective medical care." In a recent FRONTLINE report comparing the health care systems of five other capitalist democracies, "Sick Around the World," WASHINGTON POST reporter T.R. Reid notes that, "The World Health Organization says the U.S. health care system rates 37th in the world in terms of quality and fairness. All the other rich countries do better than we do, and yet they spend a heck of a lot less."

>>Watch "Sick Around the World" to see how five other countries provide health care.

Published July 10, 2009.

Related Media:
Medical practitionersReforming Health Care
Washington's abuzz about health care, but why isn't a single-payer plan an option on the table? Public Citizen's Dr. Sidney Wolfe and Physicians for a National Health Program's Dr. David Himmelstein on the political and logistical feasibility of health care reform. (May 22, 2009)

Medical practitionersDonna Smith
Bill Moyers speaks with advocate Donna Smith about how our broken system is hurting ordinary Americans. (May 22, 2009)

Medical practitionersCalifornia Nurses Association
The California Nurses Association advocates a single payer national health insurance system. (May 5, 2008)

Melody Petersen, photo by Robin Holland Melody Petersen
Melody Petersen talks with Bill Moyers about her new book OUR DAILY MEDS, and how drug companies market medication. (May 16, 2008)

Rachel CarsonFRONTLINE: "Sick Around the World"
FRONTLINE travels to five other wealthy capitalist democracies — Great Britain, Japan, Germany, Taiwan, and Switzerland — to find out how they provide health care to all of their citizens far a fraction of the cost of the U.S. system.

References and Reading:
Public Citizen Health Research Group
"Public Citizen is a national, nonprofit consumer advocacy organization founded in 1971 to represent consumer interests in Congress, the executive branch and the courts"

Physicians for a National Health Program
"Physicians for a National Health Program is a non-profit research and education organization of 16,000 physicians, medical students and health professionals who support single-payer national health insurance."

Side-by-side comparison the major health care reform proposals.
Assembled by The Henry J. Kaiser Family Foundation.

"AMA president: Group open to government-funded insurance," CNN, July 1, 2009.

"Disputes put health care timetable in doubt," AP, David Espo, July 8, 2009.

"Harry Reid jumps into health negotiations,", Carrie Budoff Brown & Chris Frates, July 7, 2009.

"White House Open to Deal on Public Health Plan," THE WALL STREET JOURNAL, July 7, 2009.

"Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008"

Senate Finance Committee white paper on health care
White paper by Senator Max Baucus's committee discussed in the interview.

"Massachusetts Health Reform: The Myth of Uncontrollable Costs"
A report from the Massachusetts Taxpayers Foundation, May 2009.

"Obamacare to Come: Seven Bad Ideas for Health Care Reform"
By Michael D. Tanner, CATO INSTITUTE, May 21, 2009.

"The Moral-Hazard Myth"
By Malcolm Gladwell, THE NEW YORKER, August 29, 2005.

"TIMES TOPICS: Health Care Reform"

Also This Week:

With almost 20 years inside the health insurance industry, Wendell Potter saw for-profit insurers hijack our health care system and put profits before patients. Now, he speaks with Bill Moyers about how those companies are standing in the way of health care reform.


Trace campaign contributions, ad spending and the revolving door between industry and government.

Public option, single payer, free market — what are the options now under discussion?

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