Dr. Rob Stone is fairly confident that Barack Obama, Harry Reid and Nancy Pelosi will produce healthcare reform legislation this year that will include a "public option." His concern is exactly what that government-administered alternative to corporate health care will actually be.

"My worst fear is that they are going to pass something that they're going to claim is something good, and it's perhaps going to be even worse than what we have now," said the Bloomington Hospital Emergency Room doctor and advocate for a single-payer healthcare system.

Specifically, Stone is worried the public option that is supposed to offer competition to private insurance companies -- "the people who are going to the trough and sucking money out of our health care system" -- will instead enable them to insure the "healthy and the wealthy" and dump the poor and sick onto the public plan.

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First of a series
Coming Aug. 23: "Blue dog obstacles to true health care reform"

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Eventually, such a system would inevitably fail, he said, and "the people will look at it and say, 'That was a failure. We're just going to dump the public option.'"

The other scenario, he said, which is corporate health care's worst nightmare, is a public option that is so good that "insurance companies start to wither, and it becomes a slippery slope to single payer."

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"The biggest problem is not the right and the left, it's the people versus the corporations."

Stone is director of Hoosiers for a Commonsense Health Plan (HCHP), which advocates for a publicly financed, privately delivered (single-payer) universal health plan at the state and national level, according to its Web site. He sat down over coffee at the Green Bean on West Fourth Street to discuss the state of health care reform in America, as Congress takes its August recess.

While congressional deliberations over the past several weeks have been discouraging on multiple levels, single-payer advocates do have two victories to celebrate, he said. House Speaker Pelosi, D-San Francisco, has said her chamber will have an opportunity to vote on a single-payer proposal. "I'm really excited about that," he said.

And one of the three health care bills to emerge from House committees includes a provision from U.S. Rep. Dennis Kucinich, D-Ohio, that would allow states to implement single payer-programs. "That would be great," he said. "I think that would be fabulous."

Even without such federal enabling legislation, California's State Assembly has twice passed single-payer bills, only to have them vetoed by Governor Arnold Schwarzenegger, Stone said.

The Lewin Group, an industry-owned consulting firm based in Falls Church, Va., performed two analyses of California's single-payer potential, one quite a few years ago and the other five or six years ago. "They worked out how California could cover everybody with a net savings of money and a small, affordable tax hike," he said. "They could do a state system there that would be a single-payer system at the state level."

While Stone said inclusion of federal enabling legislation wouldn't move single-payer any closer in Indiana, the Indiana House of Representatives did pass a single-payer bill in 1993. Sponsored by State Rep. Charlie Brown, D-Gary, the bill died in the Republican-controlled Indiana Senate. As in 1993, Democrats today control the Indiana House, and Republicans control the Senate, he noted.

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Despite these two nuggets of hope, most of the news out of Washington has not been encouraging for advocates of a truly affordable, universal-care plan, Stone said. Before congressional debate had even begun, the Obama administration bargained away major consumer protections to the pharmaceutical industry and American Medical Association.

"My worst fear is that they are going to pass something that they're going to claim is something good, and it's perhaps going to be even worse than what we have now."

To get pharmaceutical industries like Eli Lilly on board with its reform efforts, the administration agreed to continue impeding the flow of cheaper prescription drugs from Canada and Mexico to American consumers, he said. And Medicare will not be allowed to negotiate lower drug prices under the Obama plan, as is the case now with state-run Medicaid programs and the federal Veterans Administration (VA).

Medicare, Medicaid and VA are all federally run, single-payer programs, Stone added. Medicare serves the elderly, Medicaid the poor and the VA combat veterans. They all provide higher levels of care at lower costs than the private health insurance system. But they don't pay doctors and drug companies as much.

The White House deal also would grant the industry greater secrecy for data developed in drug development using public funds, which in effect will delay the availability of cheaper generic drugs by years.

Score it an economic victory for the pharmaceutical industry, Stone said. "My best source on all of this is the Wall Street Journal. They ran a piece in late June saying the pharmaceutical industry had basically gotten all that they wanted."

Administration officials struck the deal for purely political purposes, Stone said. "The White House decided right off that they had to divide and conquer, and if they were going to get anything from the health insurance industry they were going to have to have the pharmaceutical industry basically on board right from the start."

His assessment was reinforced in an Aug. 5 story in The New York Times, the day after Stone spoke those words. The paper quoted Billy Tauzin, the former Republican House member from Louisiana who now leads a pharmaceutical trade group: "We were assured: 'We need somebody to come in first. If you come in first, you will have a rock-solid deal.'"

Getting the AMA on board was accomplished by old-fashioned wheeling and dealing, by promising the doctors they'll make more money. Specifically, the administration agreed to jettison a Medicare provision called the Sustainable Growth Rate (SGR) that allowed the government to reduce physician reimbursements if overall Medicare payments rose too fast. "The whole SGR thing was thrown out," Stone said. "That was the big bone that the docs are really happy about. That's why they decided to come along."

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In the final analysis, the issue for Bloomington-area representatives -- Republican Senator Richard Lugar, Democratic Senator Evan Bayh and Ninth District U.S. Representative Baron Hill, D-Seymour -- will be whose interests they vote for, Stone said. Hill has a key leadership role in the Blue Dog Democrats, a House voting bloc whose resistance to single-payer is ardent.

"We're spending billions and billions, even a trillion, that is going to profit, greed, waste and inefficiency."

"The biggest problem is not the right and the left, it's the people versus the corporations," he said. "The reason we've got the most expensive health care in the world, and yet relatively poor health care compared to the rest of the world, is because we're spending billions and billions, even a trillion, that is going to profit, greed, waste and inefficiency."

Public filings for the first and second quarters of this year, he said, show corporate health care interests like the pharmaceutical industry are spending roughly $1.5 million a day lobbying. HCHP has an annual budget of about $4,000. Stone laughed out loud at the comparison.

"Ultimately, at the end of the day, are we going to do something that is good for people or are we going to protect the corporations, the insurance companies, the pharmaceutical companies, the medical device manufacturers?" he said. "That's what it's really about."

Steven Higgs can be reached at .

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For more information
Hoosiers for a Commonsense Health Plan

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