With both the House and Senate looking to pass health care bills priorto the summer recess which begins August 8, now is the moment of truth forDemocrats: will they offer a real public plan option to compete withprivate plans and drive down costs? Or will they cater to thehealthcare industry which is now spending $1.4 million per day on lobbyists to protect their profits?

Throughout this debate, one Senator who has been willing to tell it likeit is, with the people’s interest at heart, is Bernie Sanders. Thisweek he will publish The Health Care Crisis: Letters from Vermont andAmerica–a collection of healthcare stories sent to him from across the nation.

“In early June we sent out a letter to our email list–and we said twothings,” Sen. Sanders told me in an interview this week. “Number one,please sign a petition calling for a single-payer system; and two, giveus some of your experiences with the private health insurance and yourexperience in terms of health care in general. Well, in a few weeks, wegot 40,000 signatures on a single-payer petition. But, as important, wereceived well over 4,000 responses–from Vermont and all over the country–people telling us what’sgoing on in their lives with regard to healthcare.”

These stories remind us of the powerful, personal experiences that toooften get lost in the abstract and arcane arguments over healthcarereform. I spoke with the Senator about these stories and the battle forreal reform as it enters the stretch run. Here is our conversation, andsome excerpts from the healthcare stories as well:

Sen. Sanders: If you read the responses–they’re justunbelievable. It really makes you believe that in this area [of healthcare] you’re living in a Third World country. You know, people dyingbecause they don’t have access to healthcare. People getting muchsicker than they should have because they can’t find a doctor. Peoplegoing bankrupt. I mean, all of the stories we read about but it reallyis mind-blowing just to read it in the words straight from people’smouths. It’s very emotional, I think it’s a good piece.

Q: It sounds similar in impact to the other booklet you did lastyear–The Collapse of the Middle Class.

Sen. Sanders: Exactly. And that’s what we have to continuedoing. I think it’s important to hear what’s going on in people’slives, and with regard to healthcare–this is an issue of life anddeath, where people are describing friends of theirs dying because theydidn’t have access to a doctor. It’s very traumatic.

Excerpt from The Health Care Crisis: “My younger brother, a combatdecorated veteran of the Vietnam conflict, died three weeks after beingdiagnosed with colon cancer. He was laid off from his job and could notafford COBRA coverage. When he was in enough pain to see a doctor, itwas too late. He left a wife and two teenage sons in the prime of hislife at 50 years old. The attending doctor said that if he had onlysought treatment earlier he would still be alive.” —Jim,Swanton, VT

Q: Talk about where things stand now with the health care bill.

Sen. Sanders: I’m on the HELP Committee. What I’m worried about, is you have at least four different groups working on this bill. You have the House–and you got three committees there. Then you have in the Senate–the Finance Committee and the HELP Committee, Kennedy’s committee. And you got the WhiteHouse involved in this. You got a lot of different forces comingtogether. I think the first area that we should be very concerned about–and I say this not from an ideological point of view, but just from astraight, factual observation–if one is serious about providingcomprehensive, universal, cost-effective health care for the Americanpeople, the only way to do it is single-payer. That’s just a fact. We are wasting about $400 billion a year inexcessive administrative costs…and it should be disturbing to theAmerican people that single-payer has not gotten the kind of due that itdeserves. And I think just given the enormous power of the insurancecompanies, the drug companies, the medical equipment suppliers–andthe fact that they’re now spending I guess over $1 million a daylobbying against any real healthcare reform should tell people about the power that these people have [to] prevent even a serious discussion of single-payer. So that’s issue number one.

Excerpt from The Health Care Crisis: “I am originally from Canada andsee the effects of the American system’s failures every day…. I can’tstress enough how the worries about health care in the U.S. shape theeveryday lives of Americans and American business in ways that Canadianscan’t even truly comprehend. Not having to worry about the financialcosts of getting sick or going to your doctor or whether or not you can”afford” to change jobs or start your own business is somethingCanadians experience without even knowing it….” —Paul,South Burlington, VT

Sen. Sanders: Number two, I am distressed at what’s happening onthe Finance Committee. I think the bill that they are bringing forth isextremely weak, and will rely for its funding on regressive funding. [The Committee] is not prepared to take on the drug companies or theinsurance companies in any meaningful way. And I think people should dowhatever they can at the grassroots level to make sure that nothing resembling a FinanceCommittee bill –as we hear it [described] today–gets passed. I ampersonally disturbed to read that Sen. Baucus… has formed what hecalls the “Coalition of the Willing.” And his Coalition of the Willing–and this is really kind ofunbelievable–consists of four Republicans on his committee and threeDemocrats. So, at a time when you have a Democratic President, you havea strong Democratic House…the healthcare policy of the US Senate[might] be developed by this Coalition of the Willing which has majorityRepublican support. It’s Senators Grassley, Enzi, Snowe and Hatch. Sothose are the four who are in Majority position who–according to somesources–will develop the policy of the US Senate. And I think forthe average American, for the average activist, for the averageprogressive it is literally beyond comprehension how–when theDemocrats now have 60 votes in the Senate, a strong majority in theHouse, and a Democratic President–a group made up of a majority ofRepublicans could determine an important part of what the healthcarelegislation will look like.

Excerpt from The Health Care Crisis: “…I am fascinated by thecontrast between the public debate… and the private anguishexperienced by our patients…. When medical care is desired, there isno line for our elected officials, our regulatory bodies, and ourwell-insured pundits. I wonder how much this affects the public debateon health care reform. If they felt only a small portion of thedesperation we see every day in the hearts of our patients, the debateon health care reform would have long ago been finished and put tosleep.” —Dr. Asa, Saint James, NY

Sen. Sanders: What I have been arguing and feel very strongly isthat–now that we have 60 votes, 58 Democrats and Senator Liebermanand myself–I think that at the very least what has got to happen isthat the fallback position, and it’s a significant fallback away fromsingle-payer, is a strong Medicare-type public option. And that to me means that anyone in America would have the right tohave a Medicare-type set of health benefits administered at the federallevel, and subsidized for low- and moderate-income people. And I thinkthat that has got to be at least a minimal demand ofprogressives. What we are seeing now is that certainly in the FinanceCommittee–unless things change very rapidly–that is not going tobe the case. In the HELP Committee we are going to have a halfwaydecent public plan, it could be better, but we’re gonna have something. And I’m going to be working with other people to try to strengthen that.

But I think the main point that I would make is that it should beunthinkable that the Senate does not have a strong public plan. And myview is that now that there are 60 people in the Democratic Caucus atthe very least every one of those people should be prepared to voteagainst a Republican filibuster and allow us to go forward with a strongpublic plan. If, at the end of the day, there are members of theDemocratic caucus who for whatever reason choose not to vote for astrong health care reform piece of legislation, they can vote no. But Ithink we should stand together to defeat a Republican filibuster. Andif passing a strong bill means with 51 votes, 53 votes, 54 votes,whatever, that’s what we should do. It’s much, much better to pass astrong bill with 53 votes, then a very, very weak bill that primarily benefits the insurance companies, and the drug companies, in a bipartisan vote with 70 votes.

Excerpt from The Health Care Crisis: “The sister in law of one of myco-workers is a 42-year-old single mom who was just diagnosed withbreast cancer which has spread to her brain. She has two young kids andwas given 3-6 months to live. She is insured, but the co-pays anddeductibles are so enormous that she is being forced to file forbankruptcy. Imagine facing death knowing you have 2 young kids. That isbad enough, but add to that financial troubles which have magnified thisalready horrendous situation. It is a national disgrace.” —Deb,Montpelier, VT

Q: Which makes me think of reconciliation needing just 51 votes. Can you get a strong bill done through that process?

Sen. Sanders: We’re looking at that. The preferred option wouldbe to have 60 people in the Democratic caucus who would vote forcloture…. Reconciliation is a complicated procedural process. It is not saying that underreconciliation you can pass a strong, comprehensive plan with 51 votes,because there are many, many elements to it, which means that you mayhave to deal with this legislation on a piecemeal basis. So, thestronger option would be to say, ‘Okay, we’re gonna be united. We have60 votes now. The American people expect us to deliver something real. We’re gonna defeat a Republican filibuster and then we’re gonna do thebest that we can which at a minimum will include a strong publicoption.’ Reconciliation is another approach but I think that it’s amore difficult, more complicated, less positive approach than having 60votes for cloture.

Q: The President has sent a lot of mixed signals in terms of how willing he is to fight for this–

Sen. Sanders: Yes.

Q: He said something almost opposite what you said. I’mparaphrasing, but he said, “I’d rather get some of what I want with 70votes, then all of what I want with 52.”

Sen. Sanders: I think in that regard–and I have a lot ofaffection and respect for President Obama–I think if we came up witha weak bill, I think it’s all together likely that in four or five yearswe’d have to come back and start all over again. Because a weak billsimply is not going to solve our problem of universal, good quality,comprehensive–and that’s a key word–coverage. You canhave universal coverage [that] doesn’t mean a whole lot, because you’llhave tens of millions of people who will have very high deductibles,high co-payments. They will still not be able to get to the doctor whenthey want to. And it will not be particularly effective. So, to passlegislation which doesn’t accomplish those goals–of universality, ofcomprehensiveness, of high quality, and cost-effectiveness–is, Ithink, a mistake. Because what happens if it’s not cost-effective–ifwe’re not beginning to address the $400 billion in waste that takesplace because we have a private insurance dominated system, with 1300private companies and thousands and thousands of plans, which require ahuge amount of money to administer…? If we don’t deal with theprofiteering of the drug companies, the high CEO salaries, the fraudactually being committed by many of these people–then the cost willbe so high that in a few years the government will have to cut back onit and we’ll be back to where we are again. So, to my mind…if youare serious about real healthcare reform, the only way to go issingle-payer, because that addresses the fact as to why we spend almosttwice as much per capita on healthcare as any other nation. If we don’thave the political will to do that, at the very least you need a strongpublic plan which will force competition with the private insurancecompanies–they will have to cut back on their administrative costs,on their profiteering–and there will be some benefit to be gainedfrom that. But if you don’t do that–if you end up with getting 10,15 Republicans who are very conservative on this issue, who are there toprotect the insurance companies and the drug companies, [then] I’m 100percent sure you’ll have to come back five years from now because whatyou will have done will not be meaningful for the average American.

Excerpt from The Health Care Crisis: “It is inexcusable that over 30percent of our health care dollar is wasted on bureaucracy. It is tragicand wrong that over 20,000 Americans die each year and many more areinjured and bankrupted because they lack insurance. It is infuriating tohave our hands tied by insurance companies, to have to jump throughhoops to get what we know our patients need. No wonder the number of newprimary care physicians is plummeting…!” —Dr. Susan, Colchester,VT

Q: How does the process work to arrive at the final Senate bill? Say the Finance Committee has a weak bill, and HELP has a decent bill–is there a conference?

Sen. Sanders: We don’t know exactly–you know, I just askedthat question today. It is not quite clear how the two committees cometogether. But I would hope that every activist in America, everyprogressive in America, will stand firm and say that if we’re not gonnado single-payer, at least you need a strong public plan, and that wecannot go forward without that…. As to the exact process of how thetwo committees come together, I don’t think anyone knows that at thismoment. But we’re gonna need a lot of grassroots activism to oppose aweak bill.

Q: So people should be contacting their Senators and Baucus? [editor’s note: and Sen. Harry Reid–tell him to get the Democratic Caucus united to stop a GOPfilibuster]

Sen. Sanders: That’s right. Absolutely. If we can’t pass astrong bill, with a good President, with a strong majority in the House,60 votes in the Senate–when are we gonna do it? When are we gonna doit?

And it’s not just a public policy issue…but from a political point ofview I think the Democrats will be hurt if they do not come up withsomething strong and meaningful because people will say, ‘Hey, we gaveyou the power and you couldn’t do it. And we didn’t give you the powerto start negotiating with conservative Republicans. We gave you thepower to produce something meaningful and real.’ And the other thingthat bothers me, I worry very much that what the Finance Committee islooking at is taxing health care benefits. You know, workers havefought for decades for strong health care benefits. They have given upwage increases. And now to adopt John McCain’s plan to tax those healthcare benefits–again, it’s not only very bad public policy, it’s aregressive way of raising revenue–but it is also bad politics. Whydo you want to step on the people who put you in office? They’re oursupporters. Now as you know, Obama came up with a pretty progressiveapproach where he thought he could raise $300 billion by cutting back onthe charitable exemptions for the very wealthy. That would haveimpacted only the top 2 percent. But my understanding is the FinanceCommittee doesn’t like that. They would prefer to tax the middle-classon their health care benefits. So I think that is clearlyunacceptable…. So, we want to take a look at whether this thing isgonna be funded on the backs of lower-income people and themiddle-class, or whether it’s gonna be funded in a progressive way asObama first suggested…. This is complicated stuff, the bills are gonnabe hundreds and hundreds of pages. But our bottom line should be not tosupport anything that is not strong, that is not meaningful, that is notreally gonna help the millions of people who absolutely need help, anddo that in a way which doesn’t break the budget of the United Statesgovernment.