If there's a point where single payer supporters in Congress should draw a line in the sand and say, "Beyond this we do not go," we've probably reached it with the refusal of the House Leadership to restore the Kucinich Amendment to the health care reform bill. The amendment, which guarantees states the power to create their own single-payer health care systems, passed the House Committee on Education and Labor by a 27-19 in July but was eliminated in the bill reported out to the House floor for a vote. Some will argue that even a small slice of the loaf is better than nothing and that single payer backers must vote for any bill that improves the situation, however modestly. But there does come a point for hardball in the legislative process.

If we want a model for how to play legislative hardball, the House conservative Democrat "Blue Dogs" will do just fine, their efforts having resulted in weakening the "public option" in the House Bill to the point where the Congressional Budget Office projects its cost to the consumer as "somewhat higher than the average premiums" of private health insurance plans. This, combined with the fact that only an estimated 10 percent of the non-Medicare population would be eligible for the program and estimates of those who would actually sign on run as low as 2 percent, would seem to dash any hope of its becoming a model program that might expand to something closer to a legitimate single payer system, or anything else that would actually achieve the dual goals of universal coverage and cost control.

The Blue Dogs did not get their way by saying, "Please." They did it by threatening to withhold support from the entire bill, even though they, too, do not want to go back to their constituents empty-handed on this issue. They do want a bill and they have very effectively maneuvered the current package in their direction. The time has come for the other side to get in the game.

The Kucinich Amendment should not, but inevitably will be confused with the Weiner Amendment. Anthony Weiner (D-NY) was very publicly promised a straight up or down vote on his amendment that would substitute a nationwide single payer system for the entire House bill, in exchange his for not pushing the amendment during the House Energy and Commerce Committee's deliberations on health care reform. Although the House Leadership subsequently indicated its intent to renege on that commitment, it has now announced that the vote will indeed occur. But while this vote will be historic in that a single payer bill has never before reached the floor of either branch of Congress, we will certainly not win the vote.

The amendment bearing the name of Dennis Kucinich (D-OH) is not, however, a dead issue, as its passage in committee demonstrates. For one thing, it is not without appeal to conservatives, in that it enhances the rights of the individual states to enact programs of their own choosing. In fact, the Republican members of the Education and Labor Committee backed it by a 13-5 margin. Whether they did so out of a belief in states' rights or simply to be obstructionist is hard to say. But the more interesting question is why the vote of Democratic members on the Committee broke 14-14 (with two not voting.) And here there is something of an answer - the House Leadership opposed it, as indicated by the "No" vote cast by Committee Chairman George Miller (D-CA).

Why would the House Leadership oppose the Kucinich Amendment? The best guess is probably their ties to the health insurance industry, combined with the fact that its passage might have real world implications, and real soon. The California Legislature has twice passed a state level single payer bill, only to see it vetoed by Republican Governor Arnold Schwarzenegger. Passage of a federal health care package that includes a state enabling amendment immediately throws the issue into next year's election to succeed Schwarzenegger who is out of the race due to term limits. As most long-time single payer-backers know, universal coverage was not achieved in Canada by federal action, but province by province. And given that a California single payer system would be the largest on the continent - as more people now live in our largest state than in all of our neighbor to the north - it would be hard to overstate its potential impact upon the country as a whole.

The argument will be made that the date by which the Kucinich Amendment had to be approved for possible inclusion in the House bill has passed (and it would have to wait for conference committee deliberations.) But as anyone who has been around a legislative body knows, where there is a legislative will there is always a legislative way. Rules are amendable and there are generally alternate routes. I have every confidence that the House Leadership can find one - but first it must have the desire to do so. And that desire will not come from within.

Maybe the Leadership has the 218 votes to pass its bill; maybe it doesn't. But it certainly doesn't have them without the 93 cosponsors of HR 676, the House Medicare for All bill. If your Representative is one of them, you might want to tell him or her that it's come time to push back at the House Leadership - hard: No state single payer option, no bill. No misguided fear of embarrassing a Democratic President should hold us back. The health of the nation is far more important than the political health of any man.