'Cantwell Favors "public option" on health care"--BUT WHICH ONE, MARIA?

Joel Connelly:

With local liberals making rumbles, Sen. Maria Cantwell, D-Wash., said Tuesday that a "public option" should be part of a package to reform the nation's health care system, but was vague about what form it should take.(BOLDING BY HOWIE)

Cantwell, who sits on the powerful Senate Finance Committee, said that Congress needs to develop a new system of health delivery to replace a status quo that "rewards inefficiency" and "rewards volume" in the form of unnecessary tests.

Cantwell and Gov. Chris Gregoire were headliners at a forum sponsored by the University of Washington Medical School.

The forum took place on a day of events underscoring the urgency of reform, the political pressure on lawmakers, and the political calculations of getting reform through the U.S. Senate.

Victims of state budget cuts, several centers providing nursing, health and rehabilitative care to senior citizens and the disabled closed their doors in Seattle and several other cities.

Seattle-area Democratic organizations, longtime champions of a Canadian-style single payer government health plan, convened in Renton to plot ways to put pressure on Cantwell.

And the Minnesota Supreme Court ruled in favor of Democrat Al Franken in the nation's longest-running U.S. Senate race. The victory by Franken gives Senate Democrats, if they can get their act together, a filibuster-proof 60 seat majority.

Cantwell and Gregoire argued that Washington is providing medical care efficiently and at lower cost. Supposedly conservative southern states such as Texas and Florida far exceed the national average in Medicare reimbursements.

"We are 11 percent less than the national average in the cost of delivering health care," Gregoire said.

The Tuesday forum focused on another key issue: While Congress needs to reform health care, the American people need to shape up.

Jonathan Hensley, president of Regence BlueShield, ticked off what he called "a dismal snapshot of the health of the population."

About 100 million Americans have cardiovascular problems. A third of the population is overweight. Twenty-six million Americans suffer from diabetes.

"Seventy percent of health care dollars are spent on conditions that can be prevented," said Hensley, who himself shed 80 pounds as part of a fitness effort for company employees.

In Cantwell's view, a key component to health care delivery must be "a focus on wellness, taking better care of ourselves and getting a system that rewards that . . . How do we get patients to do what they should? I don't know."

The American Association of Retired Persons voiced concern about millions of not-yet-retired Baby Boomers, Americans between the ages of 50 and 64 who are struggling to find an affordable health plan.

In Washington state alone, 120,000 middle and late-middle aged Boomers are "completely uninsured," said Ingrid McDonald, AARP's advocacy director, talking of what she called the "pre-Medicare" age group.

"We urge Congress to put an end to discrimination based on pre-existing conditions and age," McDonald argued. She noted that one plan, currently before the Finance Committee, would enable insurers to charge older people five times or more what they charge younger people."

Cantwell, Gregoire and experts on Tuesday's panel agreed that health care reform must encourage so-called private practitioners, family doctors involved with primary care of patients.

"The more specialists we train takes away from primary care," Cantwell said.

The University of Washington Medical School, the only multi-state med school in America, turns out more practitioners than any other facility in the country. Washington is also "a model for the world in how to deliver trauma care," said Dr. Paul Ramsey, dean of the UW Medical School, referring specifically to Harborview Hospital.

But even if aspects of medical care are working well - here - everybody on the panel agreed that the delivery system in America is not working.

"We do not have a health care system in America: We have a sick care system in America," said Gregoire.

Opinion polls have become the tail that wags the dog in American politics. On health care, politicians are confronted with two realities.

Surveys show that more than 70 percent of Americans feel that it is a major national priority to bring coverage to the estimated 46 million fellow citizens who lack health coverage.

The same polls, notably a recent Pew Research survey, show a majority of Americans do not feel they should pay more to underwrite health care reform.

Cantwell came out against one proposal at which the White House is nibbling, namely to tax health care benefits.

"Taxing health benefits when people have negotiated away salary to get more comprehensive health coverage, I have a problem with that," she said. The audience broke into applause.

Asked about a public option, Cantwell mentioned several alternatives, ranging from a government-run alternative to private insurance plans, to a nationwide network of Group Health-style co-ops.

She is clearly under pressure to back a government alternative.

"A public option is not going to go away: Insurance companies go away. Insurance companies come and go," said Jeff Johnson of the Washington State Labor Council.

Andrew Villeneuve, head of the Northwest Progressive Institute, added after the forum: "A lot of people are tired of half-way measures."

Cantwell made clear, however, that the key issue is finding a plan that can draw 60 votes in the Senate. A three-fifths majority will be needed to cut off any filibuster by Republican die hards venting old bromides about "socialized medicine."

When pressed by Villeneuve, she argued: "I do not want to see us take 46 or 47 million uninsured Americans, and put them down on top of an existing system that isn't working and controlling costs."

Cantwell is the first Washington senator to serve on the Finance Committee in more than 60 years. The panel is chaired by Montana's centerist Sen. Max Baucus, who has not yet tipped his hand as to a public option.

As soon as the committee has a draft health reform bill, Cantwell promises to put it on her Web site and invite public comment.