Why not Single-Payer?

[irishbobcat]

Why Not Single Payer?

Part 6: New "Health Care For America Now" Coalition May Reflect 
Divisions in the Movement for Universal Healthcare

By Miles Mogulescu
Huffington Post
July 10, 2008
http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-
part_b_111718.html

In the past two days, Huffington Post blogs by Roger
Hickey of the Campaign For America's Future and Gerald
McEntee of the American Federation of State, County and
Municipal Employees union have proclaimed the creation
of "Health Care for America Now!", a new coalition to
fight for universal healthcare.

On the face, this seems like an exciting new
development. It is certainly a good thing, to the
extent that it places universal healthcare at the top
of the agenda for the next president and Congress. Its
first proposed TV ad is a powerful critique of the
private insurance industry. (See
http://youtube.com/watch?v=tirU5qpmFK4)

However, if you scratch beneath the surface, the new
coalition reflects significant divisions among
progressives about how best to achieve universal
healthcare.

Many progressives support HR 676, the legislation
sponsored by Rep. John Conyers and co-sponsored by 90
House members to create a universal single payer
healthcare system in America similar to that in most
other advanced capitalist countries. That's not what
the "Health Care For America Now!" coalition supports.
According to its Statement of Common Purpose, its plan
will provide "a choice of a private insurance plan,
including keeping the insurance you have" along with "a
public insurance plan without a private insurer
middleman." HCAN's plan would also give government a
"watchdog role." Supporters of HR 676 want to abolish
the wasteful private insurance system under which
approximately 30% of every insurance dollar goes not to
providing health care, but to administrative costs,
executive salaries and shareholder profits; and replace
it with a single national system, similar to Medicare,
in which every American is covered from cradle to
grave, every patient can choose his or her own Doctor,
and treatment is determined between patient and doctor.
HCAN wants to reform the present private insurance
system, albeit with a strong commitment to providing a
public alternative that consumers and businesses can
buy into and which it hopes will compete in the
marketplace with private insurance.

Even the name of the new coalition, "Health Care For
America Now," is confusingly similar to an existing
coalition called "Healthcare-Now" which has been
working for several years to unite community
organizations, labor unions, churches and business
groups in support of HR 676. The single payer bill has
been endorsed by 394 Local Unions, 99 Central Labor
Councils, 33 state AFL-CIO's and 14 national and
international labor organizations including the United
Auto Workers, the National Education Association, the
United Electrical, Radio and Machine Workers, the
International Longshore and Warehouse Union, and the
California Nurses Association/National Nurses
Organizing Committee. HR 676 has also been endorsed by
hundreds of community organizations and such national
organizations as the NAACP, League of Independent
Voters, Physicians for National Health Care Program,
the United Church of Christ and the United Methodist
Board of Church and Society, and 32 City Councils
including Baltimore, Louisville, Indianapolis, Detroit
and Boston. (For more information on HR 676 and
Healthcare-Now see: http://www.healthcare-now.org and
http://www.pnhp.org)

So the new HCAN coalition in many ways represents the
division of the progressive movement for universal
healthcare into competing coalitions with competing
plans for healthcare reform, one supporting the reform
of the current private insurance system and the other
supporting the creation of a single universal public
system. Leaders of both coalitions are dedicated
progressives who truly believe their approach is best
-- indeed, although I'm an active supporter of single
payer, some of the founders of HCAN are close friends.
One wonders, however, if many of the organizational
sponsors of the new HCAN coalition, which includes such
prominent groups as MoveOn, AFSCME, NEA, Planned
Parenthood and the AFL-CIO, clearly understand the
differences. For example, the NEA is a sponsor of both
coalitions. The AFL-CIO is a sponsor of HCAN, but 33
State AFL-CIO's have endorsed HR 676. I'm a member of
Move On, but as far as I know, MoveOn has never polled
its members to determine whether they support universal
single payer health care or a reformed hybrid private
insurance/public system. If Mov On is going to throw
its support to one side or the other of this key
debate, it should ask its members' opinions, just as it
did in deciding which Democratic candidate to support
in the primaries.

This division in the progressive healthcare movement
into competing coalitions could endanger healthcare
reform, as was the case recently in California. Last
year the California Legislature, under pressure from a
progressive coalition of community organizations and
labor unions, passed a bill which would have created a
state single payer system, had it not been vetoed by
Gov. Schwarzenegger. This year some liberal Democratic
legislators, with support from the SEIU, tried to forge
a compromise with Schwarzenegger for a private health
insurance mandate. It was defeated in the State Senate
after being opposed by a majority of the progressive
health care movement in California who support a single
payer system.

Why is a single payer system more likely to bring
affordable universal healthcare than reforming the
current private insurance system? I've written about
this in great detail in this "Why Not Single Payer"
series on the Huffington Post and the links to the
other articles in this series are given at the bottom
of this post. To quote from Part 5, "Any healthcare
reform plan that's based on private insurance is
fatally flawed. The incentive of private insurance is
upside down. The less care a private insurance company
provides for the same premiums, the higher their
profits. Most of us saw the cases in Sicko of insurance
companies paying bonuses to employees who rejected
healthcare claims from the sick. With hundreds or
thousands of different private health insurance plans,
it's impossible to negotiate consistently lower costs
with health care providers and drug companies. A single
payer system has the market clout to reign in costs.
Most important, private insurance is a colossal waste
of money. Administrative costs for Medicare are 2-3%.
Approximately 30% of private insurance premiums go to
overhead, profits, and executive salaries...Overall the
administrative costs of private insurance exceed $400
billion a year. That's enough to cover all of the
uninsured without raising taxes." (For a more detailed
critique of HCAN's plan see:
http://www.pnhp.org/blog/2008/07/09/a-policy-response-to-health-care-
for-america-now/)

Most progressive supporters of incremental reform based
on a private/public hybrid will admit that in an ideal
world, they would prefer a single payer system. They
will argue, however, that the insurance and drug lobby
is so powerful that single payer would never pass -- a
compromise which maintains the private insurance system
but regulates it and provides a competing public
alternative is more "pragmatic." I think this argument
is misplaced. The private insurance industry will no
sooner accept intrusive government regulation which
limits its profits, and a public alternative which is
truly competitive, than it would a single payer system.
Incrementalists will also argue that most Americans
won't accept single payer because they want to keep
their present employer-based insurance, even though
most Americans are seeing their share of premiums rise,
their deductibles increase, their choice of doctors
reduced, and their insurance claims often denied. But
polls show that a majority of American voters will
support a single payer system, a majority that is only
likely to increase with a mass citizens' movement for
single payer and further public education on the
alternatives. A recent CBS News poll asked "Which do
you think would be better for the country: having one
health insurance program covering all Americans that
would be administered by the government and paid for by
taxpayers, or keeping the current system where many
people get their insurance from private employers and
some have no insurance?" 55% chose "One Program for
All" and only 29% chose "The Current System."

HCAN is right that the only thing that can overcome the
power of the insurance and drug lobby is a massive
citizens' movement for universal healthcare. Where
they're mistaken, in my opinion, is in trying to divert
that movement to a compromise that will never work,
rather than focusing that movement on forcing a
Democratic Congress and a President Obama to pass and
sign HR 676 and bring a truly universal healthcare
system to America.