WASHINGTON — California Democratic Sen. Dianne Feinstein says she's open to the idea of having the government compete with private companies as a way to help provide health insurance to the nearly 50 million people who lack it.
Rep. Tom McClintock, a freshman Republican from California's 4th Congressional District, says that would be a mistake, driving insurance companies out of business.
Once again, members of Congress are deeply divided as they ponder how to solve the 60-year-old riddle of insuring every American's health. And while President Barack Obama is pushing Congress hard to approve a plan, its projected cost of $1 trillion is proving to be a major sticking point on Capitol Hill.
"Clearly, the individual mandate -- and how it is funded -- is the critical, and as yet unanswered, question," said Feinstein.
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As the debate heated up this week, Californians jumped in, eager to shape the landmark legislation.
Democratic Rep. Doris Matsui said she wants to focus on prevention efforts by creating a national wellness trust fund.
Without prevention, she said, "we will never drive down health costs, nor will we move our society from one focused on treating sickness to one that promotes wellness and healthy living."
And Democratic Sen. Barbara Boxer said she wants Congress to strengthen patients' rights and to expand the healthcare workforce dealing with the elderly.
"The fact is, if we don't act, soaring healthcare costs are unsustainable for our families," Boxer said in a speech on the Senate floor. "In this great nation, we pay twice as much as any other nation for our healthcare. The fact is we must turn this around."
McClintock shudders at the thought of government involvement.
"I think the notion that the same government that invented $500 hammers and thousand-dollar toilet seats is going to hold down our healthcare costs is absurd on its face," McClintock said.
Feinstein was feeling the heat this week as unions accused her of trying to slow the debate. She angered unions and liberal activists when she went on CNN on Sunday to say that "there's a lot of concern in the Democratic caucus" about the healthcare plan, that it may lack the votes to pass and that its cost is "a very major and difficult subject."
On Thursday, the liberal group MoveOn.org unveiled a television advertisement attacking Feinstein, saying she had chosen to "drag her heels."
And Andy Stern, president of the Service Employees International Union, said Feinstein's comments "minimize the urgency of the healthcare crisis" and were out of character with her record on behalf of workers.
"With California's economy being crushed by out-of-control healthcare costs, Senator Feinstein should understand that fixing healthcare is an economic imperative for our country and states," Stern said.
Feinstein did not comment on the criticisms leveled against her, but she released a statement outlining her principles. She said she wants to prohibit the denial of insurance because of pre-existing conditions and make sure that Medicaid costs aren't transferred to the states, which could cost California billions of dollars. She said she also wants to create a system where patients are charged on their ability to pay for prescription drugs under Medicare.
Obama pressed for changes at a nationally televised town-hall meeting and dispatched Health and Human Services Secretary Kathleen Sebelius to argue the case on Capitol Hill, where hearings took place all week. Advocates, including doctors and nurses, rallied outside the Capitol and in locations across California, knocking on the doors of individual members as part of a massive lobbying campaign.
As part of the campaign, Sebelius on Friday released state-by-state reports showing why Congress needs to act. In California, she said, 19 percent of the population is uninsured, and the number of people with employer coverage has declined from 58 percent to 54 percent between 2000 and 2007. Roughly 20 million people in the state get health insurance on the job, where family premiums average $13,297. And average family premiums have increased by 114 percent since 2000, according to the report.
So far, much of the debate has focused on whether Congress should adopt the so-called public option, which would allow the uninsured to participate in an insurance plan sponsored by the federal government.
Democratic Sen. Jay Rockefeller of West Virginia introduced a bill to create the public option, saying, "It is time to end our days of private health insurance charging too much for too little, at the expense of the American people."
Obama, who backs a public option, said the cost of a healthcare plan would be paid for with efficiencies and savings that would result from an overhaul. He said he gets two to three letters a day from Americans telling them they lack health insurance and are going bankrupt from medical bills.
"I think about the woman ... in Green Bay, 36 years old, double mastectomy, breast cancer has now moved to her bones and she's got two little kids, a husband with a job," Obama said at a press conference this week. "They had health insurance, but they're still $50,000 in debt.
Critics said the president was taking the first step toward a government takeover of healthcare.
"When President Obama says public option, he means government-run healthcare," said Michael Steele, chairman of the Republican National Committee. "Without question, the government takeover of healthcare will diminish individual freedom and quality in our healthcare system."
Like the president, Boxer said that a public insurance plan would put pressure on insurance companies to keep costs down and provide quality coverage. She said Republican opponents of healthcare reform come from "the party of no" and are only interested in maintaining the status quo. She said the government already has public health plans: Medicare and veterans' health care.
"Let the Republicans introduce a bill to repeal Medicare -- that is a public plan," Boxer said. "The Republicans fought it in the 1960s. The Democrats passed it under Lyndon Johnson. Why don't they come here and say they want to repeal Medicare? Another public plan is veterans' health care. It is a government plan. Why don't they come here and put forward a proposal to completely do away with veterans' healthcare?"
HEALTHCARE OBAMA STYLE:
As Congress prepares to overhaul the nation's healthcare system, President Barack Obama has laid out a set of principles that he says should govern the change:
QUOTE: "We are still early in this process, so we have not drawn lines in the sand, other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are uninsured. Those are the broad parameters that we've discussed."