This past week the House released its version of the national health care legislation. It is no longer the America's Affordable Health Choices Act of 2009 (H.R. 3200); it's now the Affordable Health Care Choices Act of 2009 (H.R. 3962). There are many changes, some of them are responses to the peoples' health movement. Now we await the Senate version to be finalized. When those bills are passed in each house, they will go to a joint conference committee to be merged together. The legislation that comes out of that conference will no doubt be the result of additional changes. That is where the power of the peoples' health movement will be felt.

No time to give up

The health insurance, drug makers and medical device companies distortion of the health care legislative debate in Congress has reached its crucial point. After extending their hands in friendship to the Democratic Party leadership, they quickly reverted back to their deceitful, lying ways.

What was once seen as a positive effort to bring health care services to everyone in our country at minimum out of pocket costs has been reduced to a scrambling for the crumbs that are left to fight over. It has driven many activists to the sidelines of the struggle. Too many have given up any hope for a decent national health program. Skepticism and cynicism is clouding the goal for which we must continue to struggle. The first goal of the monopolies effort is to discourage and defeat those in its opposition.

This isn't first time that the peoples' movement has had to piece together the crumbs to make a nice cupcake that makes sense and benefits all of us. Keeping our own goals ahead of us is crucial to the immediate struggle. It will also steel us for the upcoming struggles in the health and jobs arena as well as for our anti-war, anti-nuclear, anti-climate change and working class agenda. The rallying cry of past struggles remains true today, 'dare to struggle; dare to win.'

Differing public options

Make no mistake about it: the most advanced public option in the world already exists in the United Kingdom. That's right, it is a National Health Service. There, the hospitals are all public, and the physicians and nurses are government employees. Federal and state workers in the UK hold jobs with dignity and respect. With some variations, this same public option is alive and well in France, Spain, Portugal, Italy, all of the Scandinavian countries and elsewhere. This is the mortal fear of Wall Street and international capital.

Here in the United States a national health service/public option program is alive and well in veterans hospitals. This program is protected by US veterans against the attacks of the profiteers; and, believe it, these profit thirsty corporations try every day to privatize the VA hospitals. Rep. Barbara Lee's, D-Calif., H.R. 3000, the Josephine Butler National Health Service Act is an important piece of legislation that can be considered at a later date.

The next level of public option down from this is Rep. John Conyers' bill, H.R. 676, a national 'single payer' system. In this public option, financing for universal health care coverage would be fully public, but hospitals would remain mostly non-profit or keep their existing public status. The 'global budgeting' proposal within this bill would bring the private hospitals into a more coherent, rational system of care. And, there would be strong incentives for physicians to work in this public option.

H.R. 676 closely mirrors the current Medicare program and is sometimes referred to as a 'Medicare for all' proposal. This is a public option that would cover everyone and be the cheapest national health care program. The Congressional Budget Office (CBO) was not asked to 'score' H.R. 676 for good reason. After all, a single payer program would have eliminated the insurance industry as a major player. That is where much of the high cost lies in the House and Senate reform bills.

The leadership of the Democratic Party determined that it could not or would not eliminate the insurance industry from running our national health system. Some argued that it would be too 'disruptive' to the insurance industry to do that. Left out of the reasoning is the fact that 50 million people have no health insurance and 60 million more have poor coverage and will continue to have their lives disrupted every minute of every day.

'Public program' within a private system

Senate Majority Leader Harry Reid, D-Nev., bowed to the demands by the peoples' health movement and by the White House, and included a public option in the final Senate version of the bill. It was a major victory. This victory is a foot in the door. To make sure the door doesn't smash our collective feet, the peoples' health movement must keep up the struggle.

Right now, it is hard to determine just how this public option would function along side private, for-profit health insurance companies. And, probably even when a bill is passed and signed by President Obama, there will be many rules and regulations that will need to be written to put the bill into action. That will become another arena of struggle.

Clearly, the best public option that would really serve the people would be a public option that mirrors Medicare. This option would be the least costly because it reduces the ability to profit in the system. This is still entirely possible, and it is that goal that the peoples' health movement is mobilizing around.

The final conference committee must be forced to consider that alternative even if it just for the money saving aspects.

Support and opposition

This is a crucial time. The forces of reaction are gathering against any form of public option. Their methods are the usual: stirring up confusion and promoting a significant number of outright lies. The full barrage of the Medical Industrial Complex has been mobilized. And, be sure that Wall Street financiers and other industries' Boards of Directors where corporate executives of health insurance companies jointly sit and conspire are also mobilized. The collusion between all sections of capital is at play. There is no question that they have the money and the power. And, it is an open fact that their millions of dollars are contributed to mostly Republican politicians but the sad fact is that they give millions to Democratic Party politicians as well. Former leaders of WellPoint Insurance Company actually wrote the US Senate Bill for its chair, Sen. Max Baucus, D-Mont. No one denied that fact. Baucus was actually proud of his corporate relations. He has no shame.

The October 28th, 2009 lead editorial in the Wall Street Journal, 'The WellPoint Revelation,' shows the strategy of Wall Street. Here they cite the same corrupt, self-serving studies released earlier, that is, the high cost of the Senate Finance Committee Health Proposal. WellPoint's own people wrote that bill for Baucus and probably ghost wrote the editorial. Get the picture?

WellPoint's former employees – who knows they could still be on the payroll – did the research and wrote the legislation for Senator Max Baucus, legislation that they now condemn as being too costly. You can be sure that the leadership of the Republican Party's 2010 congressional strategy program will soon weigh in with their condemnation. These are the same forces that Baucus courted and used as his excuse to devise his legislation, legislation that keeps the insurance carriers in charge. With these carriers in charge, the price tag must be exorbitant.

Is Baucus party to the cynical policymaking? Who knows? One thing for sure, the industry is in charge.

One key politician is Sen. Joseph Lieberman, I-Conn. When asked if his opposition to any public option have to do with the power of the insurance industry in his state, he denied it. A second editorial in the Oct. 28th WSJ was titled, 'Lieberman Steps Up.' He is opposed to any form of national health that isn't controlled by the insurance carriers. His opposition for any public option flows from that. Yes, WSJ editors love him. The facts speak for themselves. Lieberman is pro-war, pro-industry, and, anti worker. He has no shame. The voters of Connecticut should recall him.

Surely, HR 3962's size will be a main feature of the attack from the right wing. It is one foot tall, 1,990 pages and 400,000 words. And, it weighs 20 lbs. This is all according to the New York Daily News, which often publishes copied Republican Party diatribes from their fax machine.

But, given all of that corporate and right-wing political power and their millions, the power of the peoples' health movement won the insertion of a public option in the Senate bill. The Senate version of this plan reportedly contains an 'opt-out' feature that would allow states to refuse to participate in the public insurance program.

In his opposition to this proposal, Sen. Lamar Alexander, R-Tenn., described it as being similar to an earlier Senate proposal and not unlike the opt out provision in the 1965 Medicaid bill. Alexander recalled that at that time only one state opted out of the new Medicaid program: Arizona.

Not only did Arizona refuse to join Medicaid until 1983, but when it did join it only allowed families with incomes less than one-third of the federal poverty level to benefit from the program. In 2008 right-wing groups in Arizona pushed a ballot initiative to keep that state out of any federal health care plan, which failed.

Alexander's analysis and cynical comments, if true, would be good news for supporters of a public insurance program. But if that opt-out provision stays in the final version, close attention must be paid to the language so that it cannot be used to undermine the full intent of universal access to health care services.

Financing the bill

While we fight to get the best public option we must make sure that the working class isn't burdened with the cost of health reform. The House bills create a new tax on the wealthiest incomes to pay for reform. Initially, the House bill would have taxed incomes of $250,000 and higher, but the new version puts the surcharge at about $500,000. We should demand that the tax go back to the $250,000 level. The House has chosen rightly to tax the wealthy and to reject taxes on the health benefits of working-class people. Meanwhile, the Senate bill creates a new tax on high-priced insurance plans, many of which are held by working-class union members.

Procedural maneuvering

To be sure, the leaders of the Senate and to a less extent the House must overcome many procedural issues to get a bill that will be acceptable to the peoples' health movement. The mass media is filled with filibuster and anti-filibuster noise, plus other confusing rhetoric. All of these voting issues will fade into the back if the movement is large enough and loud enough. That is the job ahead.

Immigrant's and women's rights issues

Two major peoples' rights issues remain before the Congress and White House. The first one is making sure that everyone residing in the country will receive his or her full health rights. This means that the health bill must not be limited to legal citizens or legal immigrants.

Labor unions, religious organization and civil rights groups should continue to sound the alarm for the rights of every man, woman and child to health services. Immigrants, regardless of their status, work hard at jobs where they pay the same taxes we all pay. That's right. They pay taxes that fund Social Security, Medicaid and Medicare and sundry other programs. But, they are prohibited from accessing the same benefits.

Public health professionals must raise a similar cry. They should raise the practical public health danger of infections and diseases when a significant portion of the population is refused basic public health vaccines, immunizations and primary health are services. The H1N1 threat is an obvious reason for total inclusion. A fully inclusive public health insurance program would do better than any ad hoc national vaccine program.

Health reform should also protect a woman's right to all reproductive services. All groups, not just women must fight for full health services relating to reproductive services. The House version only allows for these rights in the case of rape, incest and a direct threat to a woman's life. This is barbaric thinking. These decisions belong to the physician and woman; third parties should not be involved at all.

Reproductive planning should all be considered in the same package. For example, vasectomies. Planned Parenthood reports: 'Private health insurance policies may pay some or most of the cost. In nearly all states, Medicaid covers vasectomy.' Republicans want reproductive issues excluded from coverage under any new public program or from receiving federal subsidies. The question is why are women discriminated against?

Local action – national impact

What has been clear over the past weeks and months is that the actions of tens of thousands of angry people are being heard in Washington, DC. That local rage must be galvanized under clear and understandable themes such as: 'Public Option: Medicare.' That is becoming a rallying cry that makes sense. Get in touch with your local health care activists and join in.