NOTE: This is a crosspost from Daily Kos, and so "this site" refers to Daily Kos and its blogs.

Since Sen. Ron Wyden (D-OR) unveiled his plan to universal health care coverage at the side of Andy Stern, the President of the Service Employees International Union, the largest union representing health care workers, and Safeway President Steve Burd, there has been a fair amount of debate on this site and most of it in unified outrage that Ron Wyden dares consider a plan that is not single payer.

Well, I think it's time to set aside our pre-conceived ideas, as right and moral as they are, and consider the facts for some practicality. First of all, let me get the niceties out of the way. I would love it if a single payer health care plan could pass. The private sector is incredibly inefficient in delivering health care, and also the current system rations care based on monetary might.

However, here is the hard, cold, fact: A single payer health care bill is not going to pass Congress, and will certainly not be signed by the President. There is all sorts of argument why it can pass. Maybe it can, maybe it can't. But it won't. Not in this Congress. And not the next one. And the one after that.

And it's fine to have a big huge debate about how to fix and reform our current health care system. For those of us who have the luxury of having health care. There are 47 million Americans for whom every day is another day too late and who cannot afford to sit there and watch us armchair warriors debate policy when they can't even take their kids to the doctor if she catches a fever. So let's get serious. We have a health care system. It's broken, but it's the only one we got. Every time those of us in that system moan about the precise ways of reforming it and spend 12 years doing absolutely nothing, those 47 million from outside it keep adding to their ranks. It's a damn shame. We have got a system, and the first thing we must do is bring every single American into that system. And then once everyone is part of the system, we can have a big debate about how to reform it. But as Howard Dean warned, if we don't concentrate first on bringing everyone in the system first, we will get nothing but another 12 years of doing nothing, exploding costs, and more uninsured. I WILL MAKE IT CLEAR: WE NEED TO COVER EVERYBODY FIRST.

Now, there is something significant going on in DC about health care, and we would be fools not to recognize it. It is the fact that labor, a Democratic Congressman, and business are coming together to at least propose a possible solution. And it's Sen. Ron Wyden's plan, based on the recommendations of the Citizens for Health Care Working Group. So let's talk about the plan, see how the SEIU feels about it, and see if the SEIU is the enemy of Americans looking for healthcare.


It's called the Healthy Americans Act. It's a program set up through every state's newly created "Health Help Agency" that provides information to consumers and matches individuals with the health insurance plans. Wyden explains what it provides, affordability, and quality:

... Government will in turn ensure that every American can afford health care by working through the Health Help Agencies to lower premiums and by providing standard health care tax deductions for individuals and families.

A good starting point on cracking down on insurance company greed:

The Healthy Americans Act creates a system of tax benefits and premium reductions that will ensure every American can afford a high‐quality, private health plan that is comparable to what Members of Congress enjoy now. Previous and existing health problems, occupation, genetic information, gender and age will no longer be allowed to impact eligibility or the price paid for insurance. Rather, insurance companies will be required to cover every individual who chooses to enroll and can not raise prices or deny coverage if individuals are sick.

So how does it happen and how do they make sure it's affordable? Wyden's office says:

One of the ways The Healthy Americans Act guarantees affordable health care is by putting more money in people’s pockets. For the first two years of the new system, employers who currently provide employee health benefits will be required to convert their health care premiums into higher wages that employees will use to purchase their own private health insurance.

Employers who do not currently provide health benefits will be required to begin making phased‐ in "Employer Shared Responsibility Payments." These payments will be used to ensure that everyone can afford their health plans by funding premium reductions.

After two years, all employers will be making ʺEmployer Shared Responsibility Payments.ʺ These payments will reflect the relative ability to pay of small and large employers and low‐ and high‐wage industries and will have no impact on the insurance coverage of their individual employees.

What's more, information about the plans, what they cover, and their rates of success in preventative care and other areas will be available to all consumers. And since the insurance pool is now all Americans, insurance companies are forced to compete for everyone's business instead of them being able to tell us what to do.

Now, let's look at the how many people are going to be covered and how. The Lewin Group's Staff Working Paper for Ron Wyden discusses coverage, and its ins and outs. Some highlights:

  • The plan will cover 246.8 million people
  • The plan and Medicare together will cover 99.2% of Americans
  • Encourages wellness by offering discounts
  • IMPORTANT: People are required to have a benefit package that is at least as comprehensive as the Blue Cross/Blue Shield standard option plan offered to federal employees (the full chart of these benefits are available in the document). This includes 100% payment of any out of pocket expenses over $4000
  • Participating plans must offer this minimum.
  • The estimated national average monthly premium will be $357 for single persons, $714 for married couples, $883 for two-parent families and $663 for one parent families.
  • Plans with costs below national average will be subsidized (later discussed) but if you choose a plan with higher cost, you pay the incremental cost. This both encourages consumers to find less expensive plans and forces insurance companies to lower prices to get customers.

Okay, now the fun part. How it's paid for, who pays, and what not. Again, a few highlights.

  • You've already learned above that part of the cost comes from employers who pay you in higher salaries or directly into the insurance pool.
  • Subsidized for people below 400% of Federal Poverty Level (that's currently $40K for single individuals, and $80K for a family of with 2 adults and 2 children); and people below FPL do not pay a premium at all but are covered.
  • Tax deduction of national average premium amount for your plan + 43.5%
  • Additional family deductible of $2000 per child
  • No tax deduction if you make more than $250,000 a year. You pay your premium and don't get a deduction.
  • Federal government health spending actually go down by $4.5 billion. (saving on administration by moving much of it to state Health Help Agencies from insurance companies) and competition.

You can read the actual full text of the bill Wyden will introduce on his site also.


Their recommendations, in summarized form, were:

Recommendation 1: Establish Public Policy that All Americans Have Affordable Health Care

Recommendation 2: Guarantee Financial Protection Against Very High Health Care Costs

Recommendation 3: Foster Innovative Integrated Community Health Networks

Recommendation 4: Define Core Benefits and Services for All Americans

Recommendation 5: Promote Efforts to Improve Quality of Care and Efficiency

Recommendation 6: Fundamentally Restructure the Way End-of-Life Services are Financed and Provided

It is important to note that the recommendation, while contained examples, did not actually propose policy measures with numbers. They recommended broad based ideas like:

  • community rated premiums
  • benefit standardization
  • guaranteed reissue provisions
  • government subsidies for those with limited abilities to pay.
  • protect against high out-of-pocket costs (the $30,000 meme was but an illustrative point)
  • focus on healthy living and prevention
  • ensure everyone can keep coverage and don't get denied (or jacked) based on their prior health, gender, age, etc.

Wyden's plan meets the goals, and does a smart job of it by cost controls, competition, and insurance industry regulations.


At the press conference where Wyden announced his plans, the President of SEIU, Andy Stern, was present and supportive. Here is some of what he said:

"It is time for fundamental, not incremental change, and Senator Wyden has a plan that is practical and principled, and sets down a moral test: Why doesn’t every American have the right to the same health care as the President, the Vice President, 535 members of Congress, and 3 million Federal workers?

"On behalf of the 1.9 million members of SEIU and their families, and as the largest union of health care workers, we believe Senator Wyden has made a critical contribution to the debate that Congress must attend to next year. Americans are sick and tired, and cannot afford to wait any longer for change."

Exactly. We can't afford to wait till this huge debate about how to reform the system is settled before we actually start covering everyone. We can't wait until the debate dust settles before we bring everyone in the system. Especially not when you can get the Safeway President and SEIU president to join hands and try to concentrate on one solution.

Andy Stern and SEIU were one of the only employees that showed real loyalty to grassroots Democrats by standing by Howard Dean after his Iowa loss when unions AFSCME jumped the gun. So I am going to give Andy Stern the benefit of the doubt that he is not out to destroy the progressive vision, grassroots movement. Nor is he a mouthpiece of big business. More importantly, SEIU is the largest union representing health care workers in America. And they know, as Ron Wyden does, as Safeway's President does, as I know, that we will never solve America's health care problem until we get everyone coverage first. That may well mean that we will end up with a bill that isn't the best way to do it. But coverage first, and then we can debate about reform when 47 million Americans don't have to sit outside the fences and can join this debate too.

I know it's been a long diary, and thank you for reading it. All emphases in quoations added and mine.

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Howard Dean for President

Nov 7: NOT A Mandate for Compromise