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"I Prefer Single-Payer, But .... "

The Selling of Single-Payer Features

by HELEN REDMOND

“Start off on high ground but end up somehow crawling…”

–Bruce Springsteen, The Big Muddy

The farce in Washington DC called health care reform makes the blood of single-payer supporters boil. That the Obama administration has crafted and is trying to push through an unfathomable, over one-thousand page piece of shit legislation that in no way ends the health care crisis, and in fact, strengthens the power and position of the private insurance industry, should not be surprising. Obama sold out on the single-payer solution the moment he decided to run for the presidency and accepted campaign contributions from both the insurance and pharmaceutical industry.

That the voice of single-payer (SP) has been blacked out nationally (documented by Fairness and Accuracy in Reporting) also makes our blood boil. It’s as if our movement doesn’t exist. But it does. There are hundreds of grassroots SP organizations all across the country engaging in public activism and protest, we just don’t get press.

Only John Conyers single-payer legislation, HR 676, The United States National Health Care Act, fundamentally restructures health care, guarantees it to the entire population (the undocumented, too) and is fully funded. No other piece of legislation is as comprehensive. How many Americans know about this amazing, life-transforming bill that delinks employment from insurance and abolishes the despised health insurance industry? Has there been a front page story or major magazine interview with Congressman Conyers? There’s been virtually no stories about labor’s support for HR 676, despite the fact it’s been endorsed by 554 union organizations in 49 states and by 130 Central Labor Councils. But we heard plenty when Andy Stern, the president of the SEIU sat down with Lee Scott, the CEO of Wal-mart to discuss solutions to the nation’s health care crisis. Those two are experts on providing health care to workers? What about the nurses and doctors who support single-payer and got dragged out of, and arrested in Max Baucus’s senate hearings in Washington, DC? If doctors and nurses had been arrested for any other political issue it would have been the lead story in every newspaper and online edition. Doctors and nurses never deliberately get arrested — that’s news! 

The sea change in the public’s attitude toward government financed health care, however, has gotten press. A New York Times poll in June found that 72 percent supported a government-administered insurance plan – like Medicare for everyone under the age of 65. That poll also reported 64 percent believed the federal government should guarantee coverage to the entire population, i.e. health care should be a human right. Another interesting number: 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt. This is in stark contrast to President Obama’s position of tepid, incremental reform. Obama asserts if he was starting from scratch he might favor SP, but we aren’t so he can’t. He wants to build on the existing system and not “disrupt” the employment-based provision of health care. As if employment-based health coverage isn’t being massively “disrupted” by the economic depression that has laid off millions of workers and forced them down into the ranks of the 50 million uninsured.

But what is truly disgusting is how the “progressive” left has caved so quickly and cravenly, given up the fight for single-payer and support for HR 676. They have become the indignant foot soldiers, apologists and spinmeisters for Obama’s piece of shit legislation. They are betraying what they absolutely know to be true: the private insurance industry must be evicted in order to provide health care to everyone and end the fiscal crisis the multiple-payer system creates. Even the insurance companies know that according to revelations by Cigna whistleblower Wendell Potter. He reports the implementation of a single-payer health care system is what keeps the billionaire CEO’s of insurance companies and Karen Ignagni, the high priestess of America’s Health Insurance Plans (AHIP), awake at night cowering in fear and forced to spend 1.4 million dollars a day to make sure it doesn’t happen. They don’t fear a public option despite their protestations; they accept that due to the depth of the crisis, a few token compromises are in order to stay in business. It’s chump change and in exchange for perhaps losing a little market share, they’re going to get a mandate that legally obligates every person to buy their priced-to-make-profits “insurance products” or be financially penalized. If the Obama bill subsidizes the uninsured going into private plans, that’s millions of new customers to extract profits from and a transfer of taxpayer dollars into insurance industry coffers. The Massachusetts mandate madness gone nationwide.      

First the “progressive” Democratic Caucus jumped the single-payer ship arguing without even launching a fight that HR 676 was not “politically viable.” A senior research associate with Physicians for a National Health Program (PNHP) told the following story. He gave testimony to the caucus on why the public option was flawed and to continue robust support for HR 676. He was appalled to learn staffers for caucus members were claiming the public option was the same as single-payer or would lead to single-payer. The staffers banned him from handing out information comparing the public option to single-payer. They tried to censor his speech but he gave it anyway. When members of the caucus asked questions staffers continually interrupted him.

Health Care for American (HCAN), Katrina Vanden Heuvel of The Nation, Robert Reich, Joshua Holland of Alternet, and a raft of other progressive political pundits are pumping out article after article attempting to explain away or marginalize the myriad problems with the public option: the gaps in coverage, the millions that will be left uninsured, and how to fund it so that it’s “deficit neutral.”

They often begin by declaring, “I’d prefer a single-payer system but…” But what?

Joshua Holland’s article titled, “We Need Clear Thinking: There Should Be No Clash Between Public Option and Single-Payer,” is the most recent and best example of giving up and selling out single-payer. He too confesses in the piece (three times!) he really is an advocate of single-payer, but … But what? Holland argues, “The public insurance/single-payer rift is a false dichotomy and is distracting us from the real fight.” Dead wrong. The so-called public option and SP as embodied in HR 676 stand in direct opposition to one another. The “real fight” is to pass HR 676. The “distraction” is the public option. Holland then goes on to undercut his argument even further by maintaining, “The proposal before us today, if done right – and the devil is most certainly in the details – achieve a hybrid public-private system with “some single-payer features…” Huh? We already have that system, it’s not working. Holland thinks eventually the public option will “achieve something approaching a single-payer system – through the back door.” I’m gobsmacked by Joshua’s naiveté or is it stupidity? Single-payer health care systems always come in through the front door. They don’t evolve into existence over time.

Secretary of Health and Human Services Kathleen Sebelius was asked about the public option, “Can you say flat out that it’s just never going to be single-payer health insurance?” She replied, “Oh, I think that’s very much the case.” She then went on to make the case which I won’t repeat here. When President Obama addressed the American Medical Association (AMA) he asserted, “What are not legitimate concerns are those being put forward that claim a public option is somehow a Trojan horse for a single-payer system…So when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they’re not telling the truth.”
We would do well to believe Obama and his fellow Democrats when they straight up tell us they are opposed to single-payer.

But Holland’s noxious line of reasoning goes even further. He posits the false notion that single-payer systems don’t really exist in other countries, but instead are “multiple-payers but with some single-payer features.” He cites Germany, Holland, Belgium and France as examples. This is simply not true. Elimination of U.S.-style private insurance, if it existed in the first place, has been a prerequisite to implementing a universal health care system in every country that has socialized health care. In each country the government guarantees coverage and pays for the majority of it, even though it might be privately delivered. Moreover, in none of these countries does the private insurance industry have the power, profits or influence they do in the United States. In some, they are allowed to feed around the edges of the system which can lead to problems. Ireland is an example. The private health insurer BUPA recently left the Irish market after a judge determined the company had unfairly skimmed healthier patients from the public system and ordered the company to make adjustment payments. Can you imagine that ever happening in the United States?

Holland thinks progressives need to “refocus the debate toward how much private sector involvement we want, what structure we might adopt for health care financed through the private sector in order to keep the insurance industry’s predations in check.” He acts as if all sides in the health care debate were sitting down as equals and had equal input. Progressive don’t even have a seat at the damn table. Holland sounds like Obama who tells us we have to keep the insurance companies “honest.”

This is a debate over fundamentals and ideology, not tactics on how to get to a single-payer system, despite Holland’s insistence it’s the other way round. Single-payer supporters aren’t fighting for a health care system designed to keep corporate killers predations in check, ensuring their honesty or “fair competition.” Why would anyone want to do that? Our movement is fighting to get rid of an industry that puts profits over patients once and for all and we have the audacity to believe we can do it.

We haven’t given up and we haven’t sold out.   

It’s both better and honest to stand up and get arrested fighting for a piece of legislation you know will end unnecessary death and human suffering than to crawl and “advocate fiercely” as Holland is for a piece of shit legislation he knows will not. 

        

HELEN REDMOND is a member of Chicago Single-Payer Action Network (CSPAN) and a licensed clinical social worker at Cook County Hospital and Clinics. She can be reached at: redmondmadrid@yahoo.com