http://www.alternet.org/blogs/peek/141404/how_dennis_kucinich_may_save_the_health_reform_battle<edit>
But it also fails some of the basic criteria that most progressives have long said is a red-line that can't be crossed. First and foremost, it doesn't have a public option that can compete with private insurers and result in significant cost savings.
It has a public plan in which -- as far as the statute goes (it can be expanded in 2015 but there's no mandate to do so) -- only 9-10 million people will be eligible to enroll by 2019. Similarly, the publicly-administered exchanges are projected to cover about 30 million by that year. (These relatively small insurance pools will be able to bargain in concert with Medicare to some degree, so their power will be magnified, but still...)
That greatly limits the potential for cost containment. What it does is bend the curve of projected cost growth downwards, and cover about 2/3 of the uninsured. But we'll still have 3-6 % of the population uninsured and being treated at the ER. And while bending the upward curve down a few notches is a very good thing, it doesn't get us where we want to go -- not when you consider that we pay $2000 more for every American than the OECD average each and every year.
But it's more than just the costs or the people left out. Crucially important is that the public plan won't be big or effective enough to serve as a living example of the kind of large-pool public exchange models federal employees now enjoy. And that means it won't be a back-door to a European-style health care system. This is really key.
<edit>
The Kucinich amendment is really key. If it were to survive the legislative sausage-making and be enacted into law, the we could expect a progressive state to take advantage of the opportunity and enact a single-payer system in short order. And, if those of us who have been pushing such an arrangement are correct, the result will be greater access and better outcomes at a lower price tag for that state's residents.
And then we can move from an often ill-informed argument over the Canadian or British systems to a debate in which we can hold up a model in which millions of real Americans see very tangible benefits from an actual single-payer system in action.
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