Years ago, at a summit of nonprofit health care advocates convened by charitable foundations in Monterey California, I remember a fierce debate over how best to get health care reform. The question: If we aren’t powerful enough to beat health insurers and HMOs by regulating them, why not just join up with them to take taxpayer money and pay for more private insurance?

Clearly, the same question has shaped the limited range and ambition of today’s panel in the United States Senate Finance Committee over the future of national health care reform, and the debate in general.
Today’s panel on "expanding coverage" is the second of three convened by Senator Max Baucus, who has emerged as the architect of health care reform given Senate Kennedy’s illness, despite the fact he is the #3 recipient of HMO and drug company campaign cash on the hill.

Today’s 14 panelists are largely a collection of groups who have already met behind closed doors with Baucus and Senate leaders — the so called "work horse group" — to arrive at a lowest common denominator consensus of what they believe "stakeholders" will accept in health care reform. That is let private health insurers run the show, make the taxpayers and consumers pick up the bill, and don’t shake up the health care pie too much. In other words, we cannot beat the HMOs and drug companies, so why piss them off by regulating them, let’s just focus on employers, taxpayers and individuals paying for private insurance coverage. Needless to say it’s the same old Washington politics that public opinion loathes.

The problem is private insurance coverage is not health care. That’s why my consumer group got an email complaint last week from an insured patient who landed in the emergency room and, after his insurance covered its share, was left with over $100,000 in bills he is responsible for. This insured patient is now contemplating bankruptcy.

Such junk insurance, with high out-of-pocket costs, is not real insurance, yet it’s bound to be the type of insurance that will be billed as affordable if every American is required to buy a private insurance policy. Unless HMOs are strictly regulated, either the premiums for policies will be too high or the benefits in the policy too little to really protect Americans. Without a true public health plan option to compete with the private sector, which Senator Baucus now says he can do without, the private market will never come in line with such regulation.

Back in Monterey and today my answer to the question of beating the HMOs or joining them is clear. Our consumer group beat the property casualty insurers at the California ballot in 1988 with insurance reform Prop 103, which overcame $60 million in opposition, so I know public opinion can prevail over insurance bucks. The same is true in the late 1990s when 41 states adopted a plank of HMO reforms despite industry opposition.
Public opinion runs strongly against HMOs and drug companies, the president needs merely to mobilize it for what he believes in. Our job as reformers should be to put the Senate on the hot seat with the most ambitious plan possible, not trot out a dog and pony show that caters to where the votes in the Senate are today.

A public debate with more ambition can change those votes tomorrow or ruin political careers.
The economy, business, taxpayers, consumers, and the uninsured themselves need a sustainable solution to the crisis in the lack of insurance and increasing prevalence of under-insurance. The answer cannot be simply to require HMOs to sell policies to everyone and have Americans show proof on their taxes that they have paid for coverage.

As President Obama said on the campaign trail, the problem isn’t that Americans don’t want health care, it’s that they cannot afford it. A false promise with a huge financial bill or insufficient benefits for consumers will fall apart after the next budget crisis. That’s what happened to some of my colleagues from Monterey when government revenues shrunk, the programs they wanted to create with the HMOs couldn’t be funded.

Nonprofit groups like AARP and Families USA are supposed to hold up the consumer end of the panel in the Senate Finance committee today, but they appear to agree — along their brethren at the nonprofit New America Foundation, funded by a corporate who’s who — that all Americans should be required to buy private insurance policies and the details of regulation are less important, as is the public insurance option. That’s why Families USA, which is supposedly the "consumer voice" in the debate, held a conference call briefing last week with the head of the health insurance lobby, Karen Ignani, who has been working closely with Families USA. If you cannot beat ’em… create a coalition with them.

The underlying wisdom here by the Washington "stakeholders," Senator Max Baucus and my colleagues in Monterey is that we need to be united for national health care reform and show a united front, regardless of the details, or it will all fall apart.

The problem is if Washington gets the details wrong the public will cast its own judgment with far greater consequences. The debate needs to be real. The president needs to mobilize the public for the most ambitious proposal possible, and now. It’s time to spend some of the campaign capital or the debate will become no debate at all.
Senator Kennedy, for his part, says he is holding tight to the need for a public option to the private market. Recently Consumer Watchdog wrote Kennedy asking him to keep his ambitions strong. The Boston Globe reported on Kennedy’s response today as well as the state of the "debate" as it is:

Nancy-Ann DeParle, his [Obama’s] top healthcare adviser, continues to emphasize the administration’s support for the public option, but recently raised eyebrows by saying the president is "open to talking about" alternatives.
Meanwhile, Senate Finance Committee chairman Max Baucus has suggested a healthcare bill could go through Congress without the public option, and activists worry that even Health Committee chairman Edward M. Kennedy, their longtime advocate, is considering trading away the public option.
"The right to healthcare you have championed is not the same as the requirement to buy private insurance," declared the liberal group Consumer Watchdog in a pleading letter to Kennedy.
Kennedy spokesman Anthony Coley responded: "No wavering. He will keep pushing for it."