If Democrat Barack Obama wins election this year, the stage would be set for a major debate on health care in 2009 and 2010. Democrats would control the House, Senate and White House, breaking the partisan deadlock that has prevented serious reform.

On July 8, a coalition of 119 labor and civic groups announced a campaign to make sure major health reform is on the agenda. The group, Health Care for America NOW, will spend $40 million on TV, print and online ads between now and November, and deploy 100 organizers to 45 congressional swing districts. The group’s major backers include the AFL-CIO, AFSCME, the National Education Association, Service Employees International Union, and United Food and Commercial Workers, as well as MoveOn.org.

Health Care for America NOW proposes that Americans be given a choice: “A private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.”

Thus far, the ads target insurance companies.

The group doesn’t commit to any specific proposal, but calls on the government to guarantee quality affordable health care for everyone in America.

Several existing health care reform proposals could compete next year for support, including one that Obama has outlined, and one being proposed by U.S. Senator Ron Wyden, (D-Oregon). Both of those would move piecemeal toward universal coverage, preserving the role of private insurance companies in the health care system. Wyden’s proposal would require individuals to purchase private insurance. Obama’s proposal would include a public insurance alternative that individuals could buy into.

The proposal that may have the broadest support would do away with the insurance middleman altogether. Backed broadly by organized labor, House Resolution 676 would improve Medicare and expand it to cover all Americans, thereby creating a “single payer” health care system like those most other countries have.

HR 676 would set up the U.S. National Health Insurance Program, which would provide all individuals in United States free access to all medically necessary care — including primary care and prevention, prescription drugs, emergency care, and mental health services. Patients could choose their doctor. Only non-profit providers could participate. It would be paid for by a 3.3 percent payroll tax, plus an increase in the personal income taxes of the top 5 percent of income earners, plus a small tax on stock and bond transactions, and by using existing sources of government revenues for health care, such as the 1.45 percent Medicare payroll tax. HR 676 contains many measures to contain health care costs and, above all, would be expected to reduce the cost of health care by eliminating the enormous expense associated with billing and insurance company profits and administrative costs.

But the bill also provides that the estimated 470,000 workers whose jobs could be eliminated — clerical, administrative, and billing personnel in insurance companies, doctors offices, hospitals, nursing facilities — would be eligible to receive two years of unemployment benefits and would have first priority for retraining and job placement in the new system.

HR 676 is sponsored by Congressman John Conyers, (D-Michigan), and it has 91 co-sponsors in the 435-member House. [From Oregon and Washington, only Seattle Congressman Jim McDermott is a co-sponsor.] Conyers, now in his 21st term, is one of Congress’ most senior members, and chairs the House Judiciary Committee. He has begun speaking about the bill on the House floor outside of formal sessions, and plans to campaign heavily for it next year.

Over 400 labor organizations in 48 states have endorsed HR 676. Among them are 34 state labor federations (including Oregon and Washington), 110 central labor councils, and nine international unions — including the Machinists, Plumbers and Fitters, Letter Carriers, and Longshore Workers.

Thus far, labor support has been mostly symbolic, but the California Nurses Association, which has been making a bid to become a national nurses organization, has made passing single payer universal health care a top priority. Filmmaker Michael Moore, whose film Sicko documents the flaws of the U.S. health care system, is also a big supporter of the bill.

Like Senator Wyden’s proposal, HR 676 would also relieve employers of the burden of providing employee health coverage. That responsibility sometimes puts American companies at a disadvantage with foreign competitors, which have government-funded universal health care systems. HR 676 would mean an end to the jointly-managed union-management health plans (so-called Taft-Hartley trusts) that are the hallmark of many union contracts. But it could also put unions in a position to bargain back some of that employer contribution in the form of raises.

© Oregon Labor Press Publishing Co. Inc.