While the media are transfixed by all the screaming in town halls and on television, the real work of health care reform is being done in secret by congressional staff technocrats, government bureaucrats, health industry lobbyists and sometimes even a member of the Senate or House.

The controversy over the so-called public option is a prime example of what is happening. Under this arrangement, government health insurance plans are supposed to compete with those offered by private insurance companies, with the hope of forcing the private companies to lower prices and expand benefits. Advocates of this scheme offer it as an alternative to what’s known as universal medical care, Medicare for all or “single payer,” which would eliminate the role of insurance companies altogether in favor of a government-only plan. Many liberals say such far-reaching reform is unattainable. As a compromise, they support the public option.

The fight over the public option has occupied much of the media coverage, but left unsaid is the fact that weeks of behind-the-scenes negotiations have weakened the public option proposal to the point that it is hardly an option at all.

I discussed the matter with Rep. Dennis Kucinich, D-Ohio. Kucinich favors universal health insurance coverage, not the public option. So do I.

A health care reform bill was approved by the House Energy and Commerce Committee in July. Kucinich said that a final version — the real bill — is now being rewritten and will be presented to committee chairs and other leaders, who will bring the revised version to the House floor. “It’s happening now,” he said. “It’s being done by the leadership, and we [members of Congress] don’t know what’s going on.”

Kucinich is the author of an amendment to the House bill that would ease federal barriers to states wanting to enact universal care plans of their own. Legislators are engaged in such efforts in California, Colorado, Illinois, Minnesota, Montana, New Mexico, New York, Ohio, Pennsylvania and Washington. He told me it “was one of the few provisions in a badly flawed bill that could provide benefits.”

Kucinich suggested I read articles written by health insurance expert Kip Sullivan on the Web site of Physicians for a National Health Program, which advocates government-run universal health care. Sullivan, he said, has figured out the real story.

Sullivan writes that public option advocates once promised a program as far-reaching as Medicare but “now promote something entirely different. To make matters worse, they have not told the public they have backpedaled. The campaign for the ‘public option’ resembles the classic bait-and-switch scam: Tell your customers you’ve got one thing for sale, when in fact you are selling something very different.”

Sullivan documents how the public option has been watered down since Jacob Hacker, a political science professor now back at Yale after a stint at UC Berkeley, proposed it several years ago. Hacker first estimated that 129 million would be covered, drawn by its generous terms. But the public option plans now before Congress would cover no more than 10 million, Sullivan said. Reducing subsidies to low-income people has cut the number covered, while limits on private insurance benefits have been eased.

In addition, the public option would actually be run by insurance companies such as Blue Cross, acting as contractors for the federal government. What is everyone arguing over? Heads they win, tails they win.

Referring to a bill approved by the Senate Health, Education, Labor and Pension Committee, Sullivan writes that the language of these provisions is so complex “it requires at least two readings to understand it.” The language of this and the other bills is no doubt designed to be purposely incomprehensible to most lawmakers, who will receive the final bill only at the last moment. The bills certainly are not being written to be understood by the general public.

Another important issue being decided in private is what precisely will Americans get from the new plan. “What level of subsidies [will] be available to make coverage more affordable for people?” asked Drew Altman, president of the Henry J. Kaiser Family Foundation. “What kind of coverage will people receive, and will it meet the public’s expectations?”

Kucinich doesn’t like the secret process. Neither does a newspaper that seldom, if ever, agrees with him on anything: The Wall Street Journal. Noting that President Barack Obama has complained that critics have misrepresented him, the paper said, “Who’s to know what’s reality and what’s a myth when the public and Members of Congress aren’t able to read a bill that would restructure one-seventh of our economy.”

So far, the loser in this game of backroom politics is the consumer or, in this case, the patient. The winner is the medical care industry.

President Obama is scheduled to speak to Congress on Wednesday on the issue. He’ll have to assure the rest of us that we’ll be winners, too.

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