Does passage of a bill that funnels millions of additional Americans into the private insurance system, and the decision of House leaders to shut down debate on one single payer amendment and scuttle another, mean the end of the years of efforts by single payer activists to win the most comprehensive reform of all?

For the nation’s nurses and the many grassroots activists, the answer is clearly no.

In discussions and organizing, now occurring coast to coast, including a strategy conference this weekend in St. Louis hosted by Healthcare-NOW, many are charting a new course that turns next to the U.S. Senate, to the Senate-House Conference Committee, and then to state capitols from Sacramento to Harrisburg where vibrant single payer movements and campaigns continue to grow.

Most single payer advocates acknowledge some important reforms in the House bill, especially the expansion of Medicaid to millions of low income adults, increased regulation of the insurance industry, expanded public health funding for community programs for low income families, and a more progressive tax plan than the onerous tax on middle income health benefits proposed in the Senate.

But those who dismiss the weaknesses, coupled with the overhyped rhetoric comparing the bill to the civil rights legislation of the 1960s or passage of Social Security and Medicare, should be wary of the backlash when millions of Americans continue to face health insecurity and potential bankruptcy as their healthcare costs rise largely unabated and continue to experience denials of medical treatment insurance companies don’t want to pay for.

As California Nurses Association/National Nurses Organizing Committee Executive Director Rose Ann DeMoro has written

Social Security and Medicare were both federal programs guaranteeing respectively pensions and health care for our nation’s seniors, paid for and administered by the federal government with public oversight and public accountability

By contrast, the main provision of the House bill, and its Senate counterpart, is to expand health care coverage by requiring everyone to "have insurance" — mostly buying private insurance (since the public option is open to so few). Ultimately whether some want to admit it or not, a massive bailout worth tens of billions of dollars to the insurance industry.

Further, while Social Security and Medicare were both significant expansions of public protection, the House bill actually reduces public protection for a substantial segment of the population, women, with its unconscionable rollback of reproductive rights in the anti-abortion amendment.

To that end, tempering some of the triumphalism would be advisable. Equally unfathomable is the threat by some liberal groups to target single payer proponents Dennis Kucinich and Eric Massa who voted against the anti-choice amendment as well as the full bill. (Massa, in particular, was elected with active support from the single payer community and took a principled stand in a swing district.)

Those who start down this road would do well to remember the nurses, physicians, and thousands of single payer grassroots activists who have carried the flame of genuine healthcare reform for years, and will certainly continue to make their voices heard, especially as employers continue to shift skyrocketing healthcare costs to workers and out-of-pocket costs eat up, by some accounts, 15 percent to 19 percent of family incomes.

One of those suggesting that work must continue, even prior to the vote, was House Whip James Clyburn who told the Associated Press November 5:

“I didn’t want anyone to think that if you don’t get everything you want in this health care bill right now, that’s the end of the game. What we need to do is lay a foundation. Get passed what we can pass that will have a meaningful impact on people’s lives — not put too many of our people in jeopardy — and then build upon it later. It’s a long road."

For single payer proponents, the construction on that long road begins in the Senate now where Sen. Bernie Sanders plans to introduce single payer language. As he said on Vermont Public Radio this week:

"I believe that a single payer system is the most effective way to provide comprehensive, universal, cost-effective health care. … (Without single payer) that ain’t going to happen. The health insurance industry and the drug companies are too powerful."

Sanders is also proposing a federal exemption of legal barriers for states that opt to establish single payer systems, similar to the Kucinich amendment that was stripped out of the House bill by House leaders in the hours leading up to its final vote.

The reason for the amendment, Sanders notes:

"So that if states like Vermont or California or Pennsylvania – states that are strong in a single payer movement – want to move in that direction that they will be able to do so. And I think … what you will probably end up seeing is we will move toward a Medicare for all program when one state does it and does it well. And other states say, ‘You know what? That looks like the most cost effective, fairest way to provide quality care to all people.’"

You can help. Contact your Senator, (202) 224-312, and urge them to join Sanders in supporting this important amendment. That’s what a lot of us will be working on next.