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Originally published Monday, March 22, 2010 at 4:27 PM

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Guest columnist

Reaching for best but settling for good on health care

Congressman Jim McDermott, D-Seattle, was among 60 House Democrats who signed a letter saying they wouldn't vote for a health-care bill that did not include a strong public option. Here he explains how he decided a pragmatic vote on Sunday's health-care reform was a good start.

Special to The Times

I HAVE been a keen advocate of a national single-payer system of health care for a very long time because it is incontestable that single payer — meaning absence of private health insurance companies in managing access to care — offers the most efficient and effective way to provide health coverage to every member of our society.

I have introduced single-payer legislation to the Congress no fewer than nine times. Last year, I signed a letter with about 60 of my colleagues saying I would not support a health-care bill that did not include a strong public option. But just yesterday, I proudly voted for a health-coverage-reform bill that neither establishes a single-payer system nor includes any kind of public option.

Why did I choose to support this less-than-ideal legislation? After 40 years of public service, I've learned that you should always reach for what is best while realizing you'll probably have to settle for something less. I have never been an ideologue, and have always considered myself a principled pragmatist. I'm reminded that the World Health Organization ranks France's health-care system the best in the world, and it is neither a single-payer system nor a system with a public option. (Incidentally, the U.S. health system is ranked 37th). France's system is based on tight regulation of its insurance industry, and the legislation we just passed is a huge step in that direction.

While this is not the bill I would have written, it will provide many significant gains for Americans soon after the president signs it. It will ensure that no child is denied coverage for a pre-existing condition. It will ban lifetime limits on coverage, meaning insurance companies no longer will be able to drop people with chronic illnesses that require expensive care. It will provide preventive care under Medicare to help older Americans get to the doctor before they become sick.

And then, over the next few years, we'll see some huge changes that will fundamentally strengthen our health-care system. We'll see the creation of state-based health-insurance exchanges, which will allow consumers to buy insurance in much the same way they book flights for travel, choosing from many coverage plans those that make the most sense for them and for their families. Subsidies will be available to make health insurance more affordable to middle-class families. In the Seattle area alone, this legislation will help nearly 30,000 uninsured people to obtain health coverage, and it will provide millions of dollars in new funding to community health centers.

We're still going to have to amend and improve this measure, just as we have done to Social Security in every year since its passage in 1935 and to Medicare since 1965. We often forget that when Social Security first went into effect, it didn't provide survivor benefits to the families of deceased workers and didn't provide benefits to many disabled workers. When Medicare was first enacted, it did not cover dialysis treatment or physical therapy and wouldn't pay for hospice services.

Over time, these important benefits have been added, as Congress has recognized shortcomings in these programs and improved and strengthened them. I foresee a similar pattern of improvements to this legislation, improvements that will continue to make our health-care system better and fairer.

One of the things I like best about this bill is symbolic: It reclaims the concept that government must protect the common good, and it reminds me that few things reflect our commitment to the common good more acutely than our health-care system. That system is in desperate need of reform and yesterday, finally, we started that journey.

U.S. Rep. Jim McDermott, D-Seattle, represents Washington's 7th Congressional District.

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