Today’s meeting of the nation’s leading single payer activists with Sen. Max Baucus was historic, and a recognition of the power of the tens of thousands of nurses, doctors, and grassroots activists across the country who have been turning up the heat on the policy makers in Washington.

Make no mistake – your voices are being heard. And, the protests and pressure will continue.

As Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, told Baucus, “there is a groundswell” across the country that will continue to press for single payer reform, and Baucus and other policy makers in Washington “are going to get to know us very well.”  In a later press conference, DeMoro blasted the conventional wisdom that single payer is not politically viable. “Is it politically viable to let people die and suffer from a lack of political will?” Noting the fight for women’s suffrage and the civil rights movement, she emphasized, “we’re going to have to turn up the heat. Women did not get the right to vote by voting on it.”

Today’s gripping meeting was in itself an important part of that campaign, with leaders of the CNA/NNOC, Physicians for a National Health Program, and Sen. Bernie Sanders, author of a single payer bill in the Senate, S 703, making a forceful, unfiltered case to one of the top power brokers in the Senate, Max Baucus, for single payer as the only reform likely to actually fix our broken healthcare system and effectively control costs.  A couple of photos from the press conference afterwards are here.

For the first time, Baucus, who has been deluged with protests inside his Senate Finance Committee which has been in the forefront of drafting legislation and in town hall meetings at home in Montana, was apologetic. “I made a mistake,” he said, “I should have left it (single payer) on the table, front and center with everything else.”

Baucus talked about his own positive experiences in Canada where he inspected the Canadian healthcare system first hand, “I was very impressed,” during the healthcare debate in the early 1990s, noting the contrast between a Montana hospital which has an “entire floor” of people devoted to billing, and other administrative paper work, and a nearby Canadian hospital which does it all “in one room.”

He agreed to use the power of his office to have charges dropped against the Baucus 13, nurses, doctors, and activists arrested for raising their voices in the committee hearings.

While Baucus continued to aver that single payer can not pass the legislature, the nurses and doctors pressed him to:

•              Hold a hearing in which the merits of single payer can be contrasted with the plans now rapidly advancing in the Senate. While Baucus said the tight timeline made that very difficult, Sanders noted that Sen. Chris Dodd is considering a health committee hearing on single payer, which Baucus could co-sponsor. Baucus said, “let me think about it.”

•              Have the Congressional Budget Office score, do a financial analysis, of single payer legislation in addition to other health bills it scores.

•              Support legislation to allow federal waivers for individual states to enact single payer systems as national role models (another Sanders bill).

•              Assist in arranging a similar meeting between single payer leaders and President Obama.

Ultimately, Baucus threw the ball back to the President, citing the demand of the President to Congress to have a bill on his desk by October. “He wants a big win on healthcare reform,” Baucus said.

But the rush to adopt a flawed bill would hardly serve the Senate or the President well, DeMoro noted. “The President would be putting himself in a very bad position. We don’t want that to happen.”

One after one, the other participants made compelling cases for single payer. Dr. Marcia Angell, former editor of the New England Journal of Medicine, noted that only single payer can achieve effective cost controls. The alternatives being considered are “all unaffordable and unsustainable. Why pour more money into a dysfunctional system.”

PNHP co-founder Dr. David Himmelstein said  “the decision should be made on what’s going to work.” He cited the Massachusetts law, where he lives, which is considered a model for both the Baucus proposal and the pending Kennedy bill. The bill is rapidly “fraying,” said Himmelstein. Some 28,000 state residents are about to be cut off of subsidized coverage because the state can’t afford it, and new studies show conditions for many state residents back to where they were before the bill was passed with inadequate or no coverage, and medical bills they can’t pay.

Geri Jenkins, RN, Co-President of CNA/NNOC, said “we need evidence based policy,” and all the evidence shows that single payer is the best way to contain costs, improve quality, and achieve universality.

PNHP President Dr. Oliver Fein cited the study last year reported in the Annals of Internal Medicine that 59 percent of physicians support a single-payer type system, and a new study showing doctors waste three to four weeks a year on paperwork that could be spent caring for patients.

Sanders later praised the efforts of nurses, doctors and activists who have made single payer an inescapable part of the public discourse. “When you have the nurses and physicians saying the current system is not working,” scores of people saying health care is a right  and single payer the most cost effective approach, we’re seeing this grassroots movement growing and gaining momentum.

If you agree, why don’t you fax Max Baucus, maybe a couple times, and let him know that we need real healthcare reform, not lobbyist-driven pablum and nonsense statements.

Follow the national nurses blog and twitter feed!

"It would be nice if something made sense for a change." – Alice, from Alice in Wonderland.

Perhaps we live in an alternative universe.

One in which two thirds of Americans want the government to guarantee healthcare for everyone, while the policy makers in Washington labor to craft a reform plan that caters first to the threats and demands of the insurance industry and the minority voices on Capitol Hill.

One in which the Senate Finance Committee plays congenial host to the insurance industry, the drug companies, and right wing think tanks and it's chairman Max Baucus can proclaim all options are on the table while slamming the door on the nurses and doctors — and arresting them when they speak out.   Why? For advocating the most comprehensive, cost effective reform of all, a single-payer/Medicare for all approach.

One in which single payer is considered off the table inside the rarified airs of Congress, but when President Obama ventures into a town hall meeting with regular folks, the first question he is asked is:

"Why have they taken single-payer off the plate?" asked one woman in the audience to great applause. "And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn't it a conflict of interest?"

Watch here:

http://www.youtube.com/watch?v=Q6d45duX_WU

And one in which Drew Altman, CEO of the Kaiser Family Foundation can ponder today about how baffling it is that the "experts" — presumably people like him who was given a seat at the table by Baucus — sees the world so differently than the vast majority of Americans struggling to survive a cruel, inefficient, and inhumane healthcare system:

"Experts believe the health care system is full of unnecessary care and troubling variations in care, … The public has a very different world view: People think that underservice is a bigger problem than overservice. They want relief from the problems they are having now paying for health care and health insurance in very tough economic times. … And many are worried that they will not be able to afford their health insurance in the future or may lose it altogether."

The "experts" say the problem is too much "unnecessary" care. The public thinks too many people are being denied care they need.

The experts think costs are so high because consumers don't have enough "skin in the game" (i.e., we like to go to the doctor, get invasive tests, and endure long waits for care and high out of pocket costs). The public thinks the reason is "because drug and insurance companies make too much money."

The experts think health care information technology is a panacea to improve quality and cut costs. The public thinks it will probably increase costs (the Congressional Budget Office happens to agree) and are concerned about the privacy of their medical records.

The experts think we must have comparative research to limit future costs. The public thinks "insurers should pay even if their doctor recommends a treatment that has not been proven to be more effective than a cheaper one." (Imagine, getting the care you actually paid your insurance company to provide, what a concept)

Either we need to get more in tune with the self-appointed experts, or they ought to listen to what the people actually think. Or perhaps, as Marcia Angell, former editor of the New England Journal of Medicine told the Great Falls Tribune in Baucus' home state of Montana, "Single-payer is simply considered not realistic for a politician. The medical industrial complex just won't permit it."

But at a price, to our health, to the well being and financial security of American families, and to the cause of health care reform.

Or as Michael Lighty, national policy director for the California Nurses Association/National Nurses Organizing Committee put it:

"Hillary Clinton and President Clinton took single payer off the table much more dramatically than Baucus has, yet everyone draws the lesson that because of 1994 we can't do single-payer. They should draw a different lesson from the Clinton-era struggle. The lesson is we didn't fix the problem. We didn't offer a solution that works and so no one wanted it. That's the risk they run this time going down the road they're currently going. They won't solve the problem, it'll ruin their credibility even if it's enacted, and that's much greater risk."

With Max Baucus’ Senate Finance Committee continuing to shut out the voices of single payer advocates while rolling out the red carpet for the insurance giants and other health care corporations, five more were arrested today and dozens of other nurses stood before the committee in a dramatic silent protest.

Today’s action — the second in a week that led to 8 arrests — coincided with the anniversary of the birth of Nightingale. It also marked the kickoff of two days of actions by nurses from around the country who are pressing for a legislative agenda for quality nursing care and a single standard of quality care for all.

Here’s AP.  Here’s a link to a photo of the nurses being arrested.  The Wash Times covers it here and here’s Patricia Murphy.

Action!  Fax Mad Max and tell him single-payer deserves a voice in the debate!

All told, this is the most media coverage single-payer healthcare has received since SiCKO was released in 2007-ironic given that it comes from an attempt by Washington insiders to keep America’s caregivers out and stifle discussion of their healthcare plan.

“What a disgrace that RNs and physicians are shut out and arrested while the insurance industry is given a seat at the table. We would expect that from the Bush administration, not in the time the Obama administration,” said NNOC/CNA Executive Director Rose Ann DeMoro. “The Baucus Committee can arrest nurses, but they can not silence the voices of RNs who will continue to speak from their hearts on behalf of their patients who want and deserve real reform.”

Standing up in the audience and speaking before she was arrested, Sue Cannon RN, said, “don’t guarantee drug profits, guarantee health care. We’re entrusted to care for our patients, and we can’t do that without single payer, guaranteed healthcare. We need no more Blue Crosses and double crosses.”

“In honor of Florence Nightingale, patients need access to healthcare. We need to protect our patients, we need single payer now,” said NNOC/CNA Board member DeAnn McEwen, RN.

Also raising their voices and accepting arrest were Steve Fenichel and Judy Dasovich, two physician members of the Physicians for a National Health Program, and  Jerry Call of PNHP and Health Care Now.

Some 40 other RNs staged a silent protest — standing before the committee in red nursing scrubs and turning their backs to show signs reading “Nurses and Patients First. Stop AHIP. Pass Single Payer.” AHIP, America’s Health Insurance Plans, is the private insurance industry lobby arm that is given a regular voice by the Baucus Committee, which is in the forefront of discussion on a health plan.

The protests, before a sea of reporters and cameras marked a continuing escalation of voices of protest —  last week eight were arrested — in an ongoing spectacle in which the committee has bent over backwards to accommodate the insurers, the drug companies, the coalitions representing America’s largest corporate interests, even the rightwing Heritage Foundation and conservative think tanks. All while excluding the doctors and nurses who favor single payer and have the most direct, hands on experience with our failed insurance based healthcare system.

Noting the shut out, Call said to the committee, “60 percent of the chairs at the table should be for single payer advocates because 60 percent of the people want single payer” reform.

That’s a system in which choice of doctor and other providers is guaranteed, with comprehensive benefits, real cost controls, and an end to insurance industry denials of care.

And more pix here.

1. Karen Ignani, the president of the insurance industry trade lobby, America's Health Insurance Plans, offers to end the outrageous industry practice of charging women more than men for health coverage, and is widely praised for the concession.

Even though the reprehensible practice of institutionalized gender bias should have been considered out of bounds long ago. The industry was not even shamed by the report last fall by the National Women's Law Center that insurers charged 40-year-old women up to 48 percent more than men of the same age for the same coverage.

And even though the “offer” remains conditional. AHIP continues to demand conditions in health reform proposals now before Congress, including a requirement that all Americans currently without coverage be forced to buy private insurance, and that Congress block any inclusion of a public alternative to private insurance. Now they've increased the ante and want federal pre-emption of state-based public protection regulations on insurers, such as requirements in a number of states that private insurers must cover such critical basics as maternity care or preventive cancer screenings.

Instead of gushing over AHIP for being conciliatory, it's time to demand the insurance industry stop holding our health hostage and end all discriminatory practices, including all higher charges based on age, health status, where you live, or other factors that serve as a financial barrier to access to care.

There can be no more excuses, no more exceptions, no more impediments to care. If anything, the widespread disparities and offensive pricing practices that characterize the private system  are a major reason why so many Americans are fed up with the insurance based system and want real reform, such as a single payer/Medicare for all approach.

Which brings us to Ignani's other remarkable comment yesterday.

2. “We are not asking people to trust us, we are asking people to trust government.”

Yes, Ignani apparently actually said that. And it was presumably not just a Freudian slip. In other words, a tacit admission that the insurance industry has no credibility with the public — and given their legacy of practices such as charging women more because they are of childbearing age they don't deserve it — and have to rely on the government to give them any trust with the public.

Yes, that government. The same government the insurance industry regularly excoriates “government-run” healthcare and is doing its best to provoke fear and loathing of even a public option alternative to private insurance.

3. The very Republicans who the Democratic leadership is bending over backwards to accommodate on the final form of a health plan are making it increasingly clear that they will work to defeat the legislation no matter what it is.

As now reported, GOP strategist Frank Lutz has put together a 26-page memo for the

Republican leadership on how to revive the Harry and Louise ads from 1994 to campaign against the new bill, using almost identical language from that campaign.

So a bill is being crafted to please the Republicans who will oppose it anyway on the assumption that they can use the specter of “government-run” health care, the same government Karen Ignani admits the public trusts more than her insurance industry, to regain political power at the polls.

Which, finally brings us to:

4. The Senate Finance Committee and its chair Sen. Max Baucus held a hearing Tuesday shutting out doctors and nurses and community supporters of single payer while providing a red carpet to AHIP, the Chamber of Commerce, Blue Cross Blue Shield, America's Health Insurance Plans, Business Roundtable, and the rightwing Heritage Foundation.

No wonder that some finally turned to peaceful protest and subjecting themselves to arrest.

The irony or tragedy, if you prefer, is that by trying to silence the voices of doctors, nurses and advocates of broader reform the Democratic leaders have, as the Washington Times put it, “forfeit a crucial bargaining chip with Republicans, meaning that any compromise with Republicans would swing too far toward the center or right” and leave themselves in a position of crafting even more unworkable reform.

“That's why it looks like (Democrats) are moving so far to the Republican position because they're not even considering the advantages” of a single-payer system, said Michael Lighty, national policy director of the California Nurses Association/National Nurses Organizing Committee.

In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.

For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide — Tommy Douglas. 

While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders'  S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well.

It's worth recalling that Supreme Court Justice Louis Brandeis famously called states “the laboratories of democracy.” As columnist Froma Harrop has suggested, “being closer to the people and more attuned to the local culture, states are better equipped than the federal government to introduce new social policies. Innovations are usually first tried in the places most receptive to them.”

More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states.  Here's a roundup of some of the state bills:

California

The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.

In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that “nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars.”

UC Irvine medical student Parker Duncan said that he did not want to “be in a world not doing what I was trained to do,” referring to the paperwork that is one of the expensive burdens that undermine the ability of the current system to deliver health care.

Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.

Colorado

House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.

“Our current health-care system is not well,” Kefalas said. “Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically.”

Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.

Illinois

HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.

At an introductory press conference, Brenda Langford, Cook County RN, said that “Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage.  We see far too much of this at Cook County hospitals—and that’s why we support guaranteed healthcare through a single-payer system.”

Maine

LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.

The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.

As Cathy Herlihy of the Maine State Nurses Association put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the “the only solution,” she said. “We do not have time to wait. Our health should not be sacrificed for limited reforms.”

Pennsylvania

Two single payer bills are alive in the state, House Bill 1660, the “Family and Business Healthcare Security Act of 2009,” and Senate Bill 300.

Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.

The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters..

The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system. 

Other states

Single payer bills are also on the docket in Minnesota, Missouri, and Washington.

Hundreds of people, nurses, doctors, medical students, grassroots activists, and California School Employees Association members gathered in downtown Los Angeles Monday to deliver an unequivocal message about the nature of the healthcare reform Americans so desperately need.

For those inside the tightly scripted White House Forum or anyone watching the live feed on line, that message was blacked out. Inside the pre-selected speakers kept within the accepted framework: we need reform, costs are out of control, Americans are hurting, and preventive care will solve all our problems ('fraid not). Unfortunately nothing proposed in the forum is likely to cure this crisis.

The “official forum” was so short on content, the Los Angeles Times was moved to note, that “the presentation was light on details. Universal coverage — health insurance for all Americans — was widely touted, but there was no discussion of how to achieve that goal.” 

In other words, the public forums amount to little more than, “window dressing,” as the Times quoted Deborah Burger, co-president of the California Nurses Association/National Nurses Organizing Committee.

Indeed all the real work is being done by a handful of Congress members. Even the White House is largely AWOL, writes Trudy Lieberman in the Columbia Journalism Review:

It looks more like Congress’s overhaul, and the word “overhaul” might be a stretch. The private insurance system looks alive and well; it will just have more people in it. The danger of leaving the details of reform up to Congress is that the special interests cozy with members have a good shot at getting what they want.”

What they want is individual mandate — forcing everyone to buy private insurance, a massive bailout for the insurance industry.

What they don't want is anything that will disrupt their comfortable profit making machine, the real reason why discussion of single payer, as in the Medicare for all bill, HR 676,  has been shut out of the debate.

The failure to include single payer as an option, despite its broad popular support among the American public, majority support among doctors and nurses, and an army of grassroots activists, means that all the pressure inside the hallowed halls of Congress is coming from the right. Not surprisingly, it means all the compromises and concessions will go to appease that crowd — the insurance industry and the right — as well. The result is that even the cherished goal of the liberal establishment, the more limited public plan alternative to private insurance, is greatly imperiled. 

Fortunately, those on the outside are not going away.

“We know there is a conscious attempt to stifle our voices,” said CNA/NNOC co-president Geri Jenkins said at the Los Angeles rally. “As a nurse who still works at the beside I see up front and personal what this fractured and dysfunctional system has done to our patients and the public. We need to get for the for-profit insurance industry out of the delivery of care in this country, so we can have a just and equal system with a single standard of care that everyone is entitled to.”

While California Gov. Arnold Schwarzenegger was inside trying to sell the nation on the type of reform he proposed in California which was rejected because of its call for forced insurance and its failure to rein in the insurance industry, the state's Lieutenant Gov. and former state insurance commissioner John Garamendi was outside with a very different message:

“As a former insurance commissioner, I know the insurance industry very well. They have but one purpose, the bottom line… They will manipulate the system so they do not have to pay” and spend one-third of every health care dollar on administrative costs “so they can deny claims and push people aside. It has to end, and it will end.”

How? “41 years ago we figured out how to solve this problem. Americans created a single payer, universal health care system that covers everyone who is over 65, allows you to choose your doctor and have a comprehensive benefit package. We know how to do it. All we have to do is take the 65, erase it, write in 0, and you send your premium to Medicare. That's change we can believe in and the change America needs.”

“We're here to send a message to the President” and the Congress “to put HR 676 on the table,”, said Reggie Cervantes, a 9/11 rescue worker whose own fight for healthcare was so well chronicled in Michael Moore's “SiCKO“. “I will not go silently into that good night.” Nor should any of us.

With the final White House Forum on healthcare scheduled Monday, April 6 in downtown Los Angeles, advocates of single payer/guaranteed healthcare have one more opportunity to shake up what has become a dreary conventional wisdom about the presumed acceptable parameters of the debate.

Hundreds of nurses, doctors, healthcare and labor activists will rally at 9 a.m. outside the California Endowment, 1000 North Alameda St., Los Angeles.

It will mark the fifth time, at all five White House regional forums, that the single payer/Medicare for all message will come to the stage, outside and inside the forum.  You can extend that to the town hall meeting at the White House last week where the President was asked why we can't have a national healthcare system like they have in other industrialized nations.

But the scene is very different in the committee rooms where the top legislators, with their handpicked insiders, either from the healthcare industry or conventional players who won't upset the status quo, have determined the general framework of a legislative approach they deem acceptable — and dismissed as out of bounds the one reform most likely to work, a single payer approach.

While single payer is not on the table, accommodating the insurance industry and healthcare proposals by the party that was trounced in the polls in November apparently is.

That's why two of the biggest debates now are not over whether to adopt a national healthcare system, that has guaranteed access to care in every other industrialized nation, but whether to force people to buy private insurance and to tax their employer-funded health benefits.

Start with requiring everyone not covered to buy insurance, which amounts to a massive bailout for the insurance industry. The Democratic chairs of the key committees that are running the show on healthcare have all agreed that individual mandate, putting us all in hock to the insurance giants, will be part of the bill, the New York Times' Robert Pear reported this morning.

Their alleged premise, says Pear, “that if everyone had health insurance, it would be easier to control health costs.” 

Not to mention that it is the top priority for the insurance industry, which is salivating at the prospect of tens of millions of new customers marched into their offices under threat of federal penalties.

But it's not so popular with everyone else — a major reason why the individual mandate plan by Gov. Arnold Schwarzenegger, host of the LA forum, crashed and burned last year. And it hasn't worked so well in its prime model, Massachusetts, either.

Listen to the comments of Massachusetts State Sen. Jamie Eldridge, who voted for the law, but recently gave this assessment to a Congressional committee, as reported by healthcare writer extraordinaire, Trudy Lieberman at the Columbia Journalism Review:

The assumption was that, as more people—and, in particular, more young and relatively healthy people—joined the system, premiums would go down across the board. There was also the assumption that as more people became insured, the number of people going to the emergency room would drop dramatically, saving the Commonwealth money. Neither of those things have happened—at least not enough to produce the cost savings we were told we would see. In fact, health care reform has cost the Commonwealth much more than expected—-up to a record $1.3 billion this year. It is maddening that so many of our public health care dollars are diverted to HMOs and health insurance companies, under the current employer-based Massachusetts health care system.

As to taxing benefits, turn the page back to the fall campaign when that idea, the centerpiece of Sen. John McCain's healthcare plan, was widely denounced by soon-to-be President Obama and virtually every other Democrat running for office in stump speeches, election mail, and numerous TV ads.

It was considered so distasteful Sen. Joe Biden even found it to be a handy zinger to Gov. Palin in the vice-presidential debate, saying: “Taxing your healthcare benefit. I call that the ultimate Bridge to Nowhere.”

But, apparently that was then and this is now, as the Los Angeles Times affirmed this week:

Democrats and Republicans on Capitol Hill are expressing increasing openness to an idea that once seemed unthinkable: putting taxes on some healthcare benefits.

And Peter Orzag, the Obama administration's budget director, told the Washington Post that taxing benefits “should most definitely remain on the table.” Unlike real reform, apparently.

What changed? Lieberman has one idea:

What happened to Obama’s budget proposal of a $634 billion down payment (for health care reform) that was to be funded in part by making wealthier people pay higher income taxes? Or the $175 billion that was to be saved by cutting the excess payments to Medicare Advantage plans over ten years? … The Senate draft budget doesn’t contain any actual money for health care. Instead…there will be “space” for a health reform reserve fund. No taxing the rich—members of Congress beat up on that one. No trimming Medicare Advantage plans—insurers don’t like that.

The $634 billion figure was always too small to provide all the subsidies people will need if they are required to buy health insurance, which seems to be the direction the pols are going. But if Obama’s revenue source doesn’t survive the budget process, then where does the money come from? …  Bingo! The money might just come from taxing the health insurance benefits of …  everyone else who gets insurance from their boss.

Ironically, the main reason President Obama says single payer reform is not under consideration is because it would “scrap (the employer based system) everybody is accustomed to,” as he said in the town hall meeting last week in response to the question of why we can't have the system that works for everyone else:

But demolishing what we have now is almost exactly what would happen when you tax health care benefits.

Many if not most of the youngest and healthiest employees, especially in a recession, would drop their employer coverage to shop for cheaper, barebones plans in the private individual market.

Employers, left with the more expensive employees to cover and an unsustainable risk pool, would see their premium costs skyrocket even more, prompting many to sharply reduce coverage or eliminate benefits entirely.

As Texas employers and healthcare analysis succinctly told the Dallas Morning News' Jason Roberson during the campaign, “this could eventually lead to the death of company-provided health plans.”

Some seem to have forgotten that consequence. On April 6, come help us remind them.

Haven't we heard this song before? It sure looks like the people who already control our healthcare system are framing the biggest issues of the present healthcare reform debate.

From the back rooms to the committee hearings to the White House summits to the front pages of the newspapers, the demands of the insurance industry are given enormous deference and accommodation.

Is it fear of Harry and Louise, the insurance campaign that some believe torpedoed the muddled Clinton health proposal? Is it the considerable influence of insurance industry contributions in the pockets of many legislators?

Or perhaps it's the caution or lack of will of some liberal groups to press for more fundamental reform–such as a single payer/expanded Medicare for all approach–that permits the industry and its conservative champions in Congress to dominate the terrain.

There's two major indications of this trend.

First, who is in the room where the key decisions are being made. As Consumer Watchdog put it:

First we heard that consumer advocates had been left out of closed-door negotiations orchestrated by senate staffers to formulate health care reform legislation. Then, consumer advocates were left off the invite list to the White House summit on health care reform.  The third strike came when no consumer voices were heard at a U.S. Senate Heath, Education, Labor and Pensions committee round table discussion about insurance reforms in the forthcoming national health care reform effort.  Three of the seven panel members were from the insurance industry.  A forth panelist represents an insurer-friendly think tank.

The second key sign is what the chattering class defines as the contours of the debate.

In a telling piece earlier this week, the Washington Post's Ruth Marcus called the present moment “crunch time” in which only five major pieces remain to be resolved.

Piece One: Should there be a public insurance option?
Piece Two: How to pay for the program? Specifically, should employer-provided health insurance, no matter how generous, continue to be treated as tax-free income?
Piece Three: Should individuals be required to purchase insurance?
Piece Four: What mechanism should there be to control costs?
Piece Five: How much muscle should Democrats use to get health-care reform done? The temptation is to use special budget procedures known as reconciliation that would allow Senate Democrats to approve health reform with just 51 votes. House leaders, fed up with being held hostage by Senate gridlock, are pushing this approach.

On each of the policy points here, the insurance industry and its defenders are on the offensive. And on every point, major concessions that will appease the insurers, but do little to rein in skyrocketing costs or protect families, lurk.  

Imagine a scenario in which the bill that finally emerges includes a mandate that all individuals must buy private insurance, but there are no uniform standards, widely varying prices for coverage depending on where you live or your age, no real controls on what the insurance companies can charge in premiums, co-pays, deductibles and other out of pocket costs. If that sounds a lot like the badly flawed Massachusetts model, it should.

If you get health coverage at work, your benefits are now taxed, a clear incentive for your employer to reduce or drop coverage, pushing more people into the still poorly regulated cutthroat private market.

And even if proponents win on the much debated public plan option, don't expect it to solve the problem, as Physicians for a National Health Program leaders David Himmelstein and Steffi Woolhandler point out :

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

Yet only on the final piece identified by the Post's Marcus, process, does it look like the insurers and the right are being aggressively challenged. Perhaps what may be most telling is the gushing this week over the non-concession by the insurance industry that it will be willing to end its immoral practice of denying coverage to people with pre-existing conditions if it gets everything else it wants. 

In his town meeting yesterday in which the public got to ask the questions, President Obama was asked about single payer, and while demurring that we have “a legacy, a set of institutions that aren't that easily transformed” showed that he understands a central tenet of what is clearly right about single payer.

“A lot of people think that in order to get universal health care, it means that you have to have what's called a single-payer system of some sort. And so Canada is the classic example: Basically, everybody pays a lot of taxes into the health care system, but if you're a Canadian, you're automatically covered. And so you go in — England has a similar — a variation on this same type of system. You go in and you just say, “I'm sick,” and somebody treats you, and that's it.”

The challenge to the rest of us is to show that legacy has collapsed and no longer works for the uninsured or the insured, and move the debate beyond what the insurers want to what the rest of us need.