In an interview with the New York Times, GOP wordsmith Frank Luntz — who recently penned a health care messaging memo instructing Republicans to attack President Obama’s health reform efforts by criticizing the deficiencies in foreign health care systems — concedes that Republicans will label Obama’s reform effort a “government takeover” of health care, regardless of the actual proposal:

Is it a correct description of the president’s plans for reform?
We don’t know what he is proposing. We want to avoid “a Washington takeover.”

But that’s not at issue. What the Democrats want is for everyone to be able to choose between their old, private health-insurance plan and an all-new, public health-insurance option.
I’m not a policy person. I’m a language person.

Indeed, “rather than challenging the tenets of American reform proposals, Luntz establishes a straw man argument against a non-existent health plan.” As Democratic strategist Paul Begala observes in a recent retort to the Luntz memo, “Because they know they cannot win the argument honestly, Republicans are resorting to mendacity.”

Opponents of reform sometimes claim that we can’t afford reform. The truth is, we can’t afford the status quo.

A new study from the Urban Institute shows that, absent serious health reform, fewer and fewer Americans will have health insurance, employers will drop coverage, and health care costs will eat up an ever-greater share of household and government budgets.

They find that, absent reform, individual and family spending on health care (the sum of insurance premiums and out-of-pocket costs) will rise approximately 40% per capita under a best case scenario of low unemployment and economic growth.

Under an intermediate or worst case scenario (in which fewer workers have jobs and comprehensive insurance, more uninsured burden the system, and health care costs continue to spiral upwards), they project individual and family spending on health care to increase 50% in an intermediate case scenario or almost 60% in their worst case scenario.

Read the study here.

This growth would increase health care spending as a share of income from 2009 to 2019 by 13% in the best case scenario to 40% in the worst case scenario.

The study also finds that, under the best case scenario without health reform, by 2019, 20.1% of non-elderly Americans would be uninsured (approximately 57 million people). In a worst case scenario, 23.2% of non-elderly Americans, approximately 66 million people, would be uninsured.

Effective health reform would ensure affordable accessible coverage for all Americans while working to rein in health care costs, saving families, businesses and the federal government money.

Rumors are circulating that the Senate Health, Education, Labor & Pensions Committee (HELP) will release its bipartisan health care legislation this Friday. Insiders tell the Wonk Room that the proposal will 1) include a robust health insurance exchange that prohibits insurers from denying coverage of preexisting conditions 2) offer subsidies for individuals and small businesses to offset the costs of insurance, 3) invest in prevention and chronic disease management and 4) and may expand eligibility for the Medicaid program.

The fate of the most controversial aspect of health care reform — the public option — remains a mystery, however. Over at The Nation, Lester Feder lays out the principles of a public health option, arguing, quite convincingly, that the public option must be designed in such a way that it 1) reduces health care spending 2) restores competition to health care markets 3) leads the way in improving health quality. In other words, the public option should be designed in such a way that it scores savings with the Congressional Budget Office.

But several Senators have recently endorsed a watered-down version of the public option that builds on existing state employee plans or creates a trigger (a.k.a. “fall-back public option”) that would only establish a public plan if “an arbitrary measure of market concentration were hit in a state” (the White House has also suggested that it is open to such alternatives):

Sen. Olympia Snowe, R-Maine, talked at length Thursday in a private meeting between members and staffers about the possibility of creating a fallback public option that only would kick in several years down the road if insurance companies are not doing their part to bring down healthcare costs and expand coverage, a Republican committee aide said. Snowe has had conversations with Senate Finance ranking member Charles Grassley and Sen. Orrin Hatch, R-Utah, about the proposal. From the Democratic side, Sens. Ron Wyden of Oregon and Thomas Carper of Delaware expressed interest in the idea Thursday, aides said.

State employer pools don’t have a record of lowering health care cost and as Tim Foley notes, “The problem with a trigger like this is the gun has already fired.” In other words, if a health care plan is supposed to break up concentrated health insurance markets and force insurers to negotiate the lowest prices for its beneficiaries, then what are we still waiting for? As a recent Health Care For American NOW report points out, “94 percent of insurance markets in the United States are now highly concentrated,” while premiums “have skyrocketed, increasing more than 87 percent on average over six years”:

If policy makers decide to include a public option, then they should design it in such a way that would enable it lower the nation’s health care spending. A watered-down alternative will undermine the argument of many progressives and ultimately hurt the cause of health care reform.

The debate surrounding a robust public option is one we can win, but first we must be willing to engage in it.

The New Health Dialogue is rolling out a series of posts analyzing the history of health reform. The first installment reviews the efforts of reformers during the Progressive Era. “A combination of poor timing, organized and fierce opposition, and dissension within the ranks of the reformers all prevented health insurance from becoming part of the New Deal,” the blog quotes author Paul Starr as saying:

Roosevelt was apparently so enthused about a national health care program that he intended to campaign on it during the 1938 midterms. However, he chose not to, preferring to defer until the 1940 presidential campaign. Unfortunately, by 1938 and 1940, it was too late. It’s no accident that the vast majority of the New Deal—creation of Fannie Mae, Social Security, the Civilian Conservation Corps, and the Tennessee Valley Authority—came into being during Roosevelt’s first term. The landslide election of 1932 swept giant pro-Roosevelt majorities into Congress and left the conservative opposition neutered, easing the way for an enormous burst of legislative activity. But by 1936, and especially 1938, the opponents of the New Deal—conservative southern Democrats and Republicans supported by the business community—had gathered enough strength to stop the New Deal in its tracks. But that period, Roosevelt’s second term, was when the New Dealers who had agreed to leave health insurance out of Social Security finally made their push.

Obama has certainly learned from the mistakes of his predecessor. As New Health Dialogue observes, Obama “is striking while the iron is hot, making comprehensive health reform an immediate top priority in a way it never was during the New Deal…President Obama has explicitly and repeatedly linked health reform to economic recovery, rather than viewing them as separate challenges [and] he is forcefully committing his political capital to the issue in a way that Roosevelt did not.”

Moreover, despite all of the sabre rattling we’ll hear about the Democrats’ ‘unprecedented’ plan to allow government to “take over” health care, the history of past efforts to reform the health care system or even a review of the government’s role in regulating the economy (or providing health care) strips today’s reforms of any grand originality or conspiracy. The precedent of providing ‘Social Security’ to every American senior, paved the way for Medicare and Medicaid; what was once described as ‘socialized medicine’ — the government providing health insurance — became part of the American experience.

And so it is today. Obama’s hybrid approach builds on the employer based system and strengthens public health programs. It recognizes that the fault lines in the health care debate and the current health care system were born from a long and complicated history. Obama and the Democrats will introduce a plan that is not a product of ideology. Rather, it will be cognizant of the history of the present system. It will be as radical as Medicare, Medicaid, and the VA.