A public alternative to private health insurance is not likely to make the final health care reform bill Alaskan Democratic Sen. Mark Begich told 45 Kodiakans Monday at a virtual town hall at the Gerald C. Wilson Auditorium.

“Some people call it a public option, some people call it an exchange, some people call it a co-op,” he said. “Right now, to be honest, there are not 60 votes for any of those three.”

Contrasting anti-government sentiment expressed during August town hall meetings in much of the country, Kodiak’s town-hall meeting was dominated by supporters of public or nonprofit plans. Four Kodiakans asked Begich if he would support public or nonprofit health care plans.

Begich said he supported some of the public-option proposals, and promised an exciting finish to the health care debate:

“I wish I had a simple answer on the public option. The fact is, what we’re struggling (with) is trying to figure where we are going to get enough votes to get it on the floor to vote on and pass,” he said.

“Sometimes I like to watch Thursday night fights in Anchorage. Well you’ll be able to watch Monday through Thursday night fights on the Senate floor on this issue. It will be as exciting if not more because there will be emotions at levels you have never seen before from senators.”

Public/private

As at the town hall with Alaskan Republican Sen. Lisa Murkowski last month, Monday’s meeting sparked questions about the appropriate role of government in health care.

The single-payer heath care system used in Canada came up more than once, as well as the precedent of U.S. government-run organizations as diverse as Medicare, the Coast Guard and the Postal Service.

In the first question of the afternoon, Joe Floyd asked why an expansion of Medicare is not a public option on the table:

“I’m 100 percent in favor of a single-payers system,” Floyd said. “I happened to be in Canada with a friend and with my wife one time, and we were treated first hand to Canadian health care. And I’ll tell you, right now it’s the best thing I’ve ever seen. I can’t see why we can’t we extend the Medicare system to the 35-million people who are uninsured.”

Mike Rostad meanwhile questioned an expanding government role:

“I believe that everyone here is concerned about heath care here, and we do need to make some changes,” he said. “I think the dividing line is that there are some who fear a greater intrusion by the government. It wasn’t too long ago that our president said, ‘UPS and FedEx are doing just fine. It’s the post office that’s always having problems.”’

The pace of legislation

The intense Senate-floor debate promised by Begich could be just a few weeks away.

Three versions of the bill currently exist in the House of Representatives, while in the Senate there are versions of the bill in the Finance Committee and the Health, Education Labor and Pensions Committee.

Under Senate rules, a bill needs at least 60 votes to overcome the threat of a filibuster in the Senate.

Repeating a question asked to Murkowski at a town hall last month, an audience member asked Begich about his campaign funding contributions from the health care industry. The senator referred the audience to opensecrets.com, the Web site of the nonprofit, nonpartisan Center for Responsive Politics.

According to the organization, Begich received $95,000 from the health care industry between 2005 and 2010. Begich’s health care donations were dwarfed by $722,000 in funding from ideological or single-issue organizations like moveon.org. Begich also received $485,000 from lawyers and lobbyists.

Cost and quality

While the subject of affordability dominated the meeting, a Kodiak nurse asked how the current bill addresses health care quality.

Begich referred the audience to a Kaiser Family Foundation report available on his Web site, and highlighted two elements: increasing the use of technology, and paying doctors based on the health of their patients instead of for the number of tests and operations they perform.

Begich said it is possible to get better quality while cutting costs, and used his own experience as the mayor of Anchorage as example. He said the key is paying doctors based on the health of their patients. He also recommended cutting co-pays for preventive services so that people stay healthier and cost the system less money.

“When I took over the mayor’s office we had 11, 12 percent increases in our heath care costs. What we did is we took control of it,” he said. “We paid people to get their blood-pressure checked. We paid people to stay on a regimented course, to live a healthier lifestyle. The net result? The last year I was in office, the increase (in health care costs) was less than 1 percent. So you get better quality for your money. “

Mirror Writer Sam Friedman can be reached via email at sfriedman@kodiakdailymirror.com.