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The Rise of Single-Payer Health Care

Friday, 12 June 2009 14:54 By David Swanson, t r u t h o u t | Report | name.

The Rise of Single-Payer Health Care
Single-payer health care supporters rally in Los Angeles in April. (Photo: Getty Images)

    Health care reform plans are being drafted and passed around on both sides of Capitol Hill, but the plan with the greatest number of Congress members behind it was first introduced as a bill six years ago. With two new co-sponsors having just signed on, Congressman John Conyers's single-payer health care plan, HR 676, now has 80 Congress members supporting it.

    A House committee held a hearing on single-payer health coverage on Wednesday, and a Senate committee included single payer in a hearing on Thursday. Many opponents of single payer, including President Barack Obama and House Speaker Nancy Pelosi, say it would be the ideal solution if it were possible.

    A single-payer or "Medicare for all" system that eliminates for-profit health insurance and simply pays for everyone's treatment by private doctors and hospitals of their choosing is also the only solution consistently favored by a majority of Americans in polls. The proposal, already in place in most of the world's wealthy nations, is raised at every health care town-hall forum that Congress members or President Obama speak at, including the one Obama held on Thursday in Green Bay, Wisconsin.

    The president always rejects single payer on the grounds that some Americans are too fond of their health insurance companies to part with them. A report by Fairness and Accuracy in Reporting last week found that the corporate media still virtually bans coverage of single payer. A Senate bill being championed by Sen. Chris Dodd in place of ailing Sen. Edward Kennedy, does not include single payer (which is supported by only one US senator, Bernie Sanders). The Kennedy-Dodd bill, at least in its initial draft, does not even include a "public option," that is a Medicare-like program to exist alongside the private insurance companies. The House bill is being drafted by one current and two former co-sponsors of HR 676, Congressmen George Miller, Henry Waxman and Charles Rangel, but it avoids single payer, championing a public option instead. Other competing Senate bills are expected to complicate things further.

    The approach taken by the Kennedy-Dodd bill and considered for the House bill is, rather than eliminating health insurance companies, expanding them by making insurance mandatory and subsidizing its purchase. While this approach is favored by the insurance companies, which have been among the primary participants in White House and Congressional health care forums this year, it is not supported by other corporations that would rather not be required to provide health insurance to employees. If anything has emerged on Capitol Hill this week, it is a chaotic lack of consensus except around the idea that something must be done to address a health care system that is damaging Americans' health and economy. Whether the growing chaos opens the door to single payer remains to be seen, and that possibility appears much more real in the House than in the Senate.

    In the House, the progressive Caucus has declared that, while it would prefer single payer, it will back no bill without a public option; the Black, Hispanic and Asian caucuses have also backed a public option; and Speaker Nancy Pelosi has said that no bill without a public option will pass. This should mean that, as the debate advances, the House will be more likely to back single payer than any other solution. Or, rather, it would be if it could create laws without having to get them through the Senate as well.

    Sen. Max Baucus has taken the lead in Kennedy's absence and chaired hearings last month to which he refused to invite any supporters of single payer. Baucus had 13 people arrested for speaking up at his hearings uninvited, an action that generated more media coverage of single payer than any poll or study ever could have. One of those arrested, Dr. Margaret Flowers, is the Maryland co-chair of Physicians for a National Health Program. She was interviewed by Ed Schultz on "MSNBC," who began covering single payer in a major way. "Bill Moyer's Journal" on PBS also focused on single payer and aired interviews with three leading advocates, including Donna Smith of the California Nurses Association (CNA). Tim Carpenter of Progressive Democrats of America (PDA) was interviewed on Fox News. Even the Washington Post took note.

    Over the past few weeks, the relatively serious media attention has inspired more activism and vice versa. Senator Baucus has been surrounded by demands for single payer at town-hall forums in Montana and questioned by activists with video cameras in Washington, DC, as have health insurance executives and lobbyists.

    Congress members John Conyers, Raul Grijalva, Donna Edwards, Steve Cohen and Emanuel Cleaver, along with Carpenter of PDA and Smith and Michael Lighty of CNA met with Majority Leader Steny Hoyer to lobby for single payer. Conyers has become increasingly outspoken, and on Wednesday evening, complained of being shut out by the president and by Waxman and Rangel, promising not to let up. On June 3, Senator Baucus met with advocates of single payer and told them he was wrong to have excluded them. But he said he would continue to do so.

    However, on Wednesday, the Health, Employment, Labor and Pensions Subcommittee in the House, Chaired by Congressman Robert Andrews, held a serious hearing on the topic of single payer, with four of the five witnesses favoring a single-payer system, and Conyers was one of the four.

    After the hearing and a briefing, Stephen Spitz of PDA told me, "Some of us met with Congressman Conyers in his office when he suddenly said: 'Let's go to Nancy Pelosi's office.' Off we went and, after talking to an aide of the speaker, we talked with Speaker Pelosi in her office in the US Capitol. She said she is for single payer and encouraged us to keep on doing what we were doing. She said that single payer cannot pass this year in the Congress. She said she was fighting to get a meaningful public option. Congressman Conyers asked her to let him (and experts he would bring) conduct a briefing before the entire House Democratic caucus on HR 676."

    The next day, on Thursday, the Senate provided a stark contrast. The Senate Committee on Health, Education, Labor and Pensions held a hearing with possibly a record number of panelists, one of whom, Dr. Flowers, favored single payer. Senator Dodd, chairing in place of the absent Kennedy, opened by remarking that he'd never seen a panel so large and that he at first thought the panel was the audience. While hearings often include as many as six witnesses, this one included two panels with a total of 24 speakers. The first panel, with 15 speakers, began with Flowers's very brief statement, followed by 14 other prepared statements, none of them responding to Flowers.

    Flowers began by indicating that she spoke for a majority of Americans. No one ever challenged that claim. Flowers criticized the idea of a uniquely American market solution as a delusion that has failed for 40 years. She said that health care in the United States is rationed right now ("rationing" being one of the dangers of "government health care" warned about by the sole witness against single payer on Wednesday). Congressman Dennis Kucinich had made the same point on Wednesday. The threats of wait time and denial of care are here under the current system. In what other industrialized nation, Flowers asked, do people hold bake sales to pay for their health care? In what other industrialized nation do millions of people go bankrupt because of medical bills? None of the following 14 speakers or any of the senators in the room answered these questions. In fact, they directed more criticism at the Kennedy-Dodd bill.

    Randel Johnson, vice president of the US Chamber of Commerce, warned that employer mandates could force companies to go out of business. William Dennis of the National Federation of Independent Business claimed to be concerned that employer mandates would hurt low-wage employees. There were no low-wage employees on the panel.

    Dr. Samantha Rosman of the American Medical Association (AMA) spoke against any public option. She did not provide arguments against it so much as announce that the AMA would not accept it. President Obama has said that a public option must be included. He is scheduled to speak to the AMA on Monday.

    Other panelists included right-wing think tankers and the CEO of a supermarket chain, who advocated urging employees to take better care of themselves. Two panelists other than Flowers were not from the usual crowd. They were Gerald Shea of the AFL-CIO and Dennis Rivera of SEIU, both leaders of labor unions that have backed HR 676 in the past and whose members overwhelmingly favor single payer. The AFL-CIO does not have a clear position now. Rose Ann DeMoro, vice president of the AFL-CIO, was part of the meeting with Baucus and advocates single payer. Shea mentioned that unions have always favored single payer, but he moved immediately to discussing the details of Dodd's plan, favoring a public option and employer mandates, but opposing taxing employees for health insurance payments made by employers. Rivera, too, favored a public option.

    The panel was followed by a lengthy question-and-answer period. For a long time no senators asked Flowers any questions. Finally, she grabbed a microphone and asked to speak. She responded to a discussion of preventive care by pointing out that when the goal of health coverage is not profit, an incentive is created to keep people healthy since doing so saves the public money.

    Sen. Barbara Mikulski later asked Flowers why a public option isn't good enough. Flowers said that one problem is that insurance companies will cherry-pick the healthiest patients and leave the sickest to the public program. More importantly, Flowers argued, much of the waste in the current arrangement is due to the fragmentation of the coverage system into 1,300 different companies, requiring hospitals to employ staff to interface with them. Adding a public option would only make this worse, Flowers said, not fix it.

    Sen. Jeff Bingaman tried to claim he had found a consensus among most of the panelists on various points, acknowledging that he was excluding Flowers. The fact that 14 of the 15 panelists represented a smaller portion of the public than the one panelist alone did not seem to matter.

    Sen. Bernie Sanders, who supports single payer, asked Flowers to expand on why single payer is the best plan and then proceeded to criticize another panelist, the CEO of Aetna, for denying people health care.

    While the Senate has a long way to go, even just to measure up to the House, single-payer advocates are encouraged by the progress this week. Katie Robbins of Healthcare-NOW! called Wednesday's and Thursday's hearings "measurable successes of the groundswell of support for a just, equitable system based on single-payer financing."

    "However," said Robbins, "the conversation is just beginning. We demand full hearings on single payer in the Senate, the House Ways and Means Committee, and the Energy and Commerce Committee. In addition, a fair scoring of single-payer legislation must be included in the Congressional Budget Office's report on health care reform."

    Kevin Zeese of Prosperity Agenda emailed me from Thursday's Senate hearing: "The multi-player advocates are divided. Bitterly so over mandates, paying for their plans and whether to have a public plan to compete. The senate is trying to fix the equivalent of a broken egg. It cannot be done. But they all have their heads in the sand and their hand in the till. Single payer is making progress. More people know single payer is right than admit it. It will win the day but they will pursue the wrong paths until they run into the dead end."

    A single-payer rally is planned for Friday, June 26, at 6:00 PM in front of Union Station in Washington, DC. Those likely to show up often speak about their struggle as one for basic human rights. Those who imagine the single-payer movement might go away often speak about health care reform in terms of "political feasibility" and "focus group message testing." Perhaps the growing success of the push for single payer is not so surprising.

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    David Swanson is the author of the upcoming book "Daybreak: Undoing the Imperial Presidency and Forming a More Perfect Union," by Seven Stories Press. You can preorder it at http://tinyurl.com/daybreakbook.

Last modified on Saturday, 13 June 2009 08:42