Health Care Now
You can register online now for the August 22-24 super-conference that will bring together Healthcare-NOW!, the Labor Campaign for Single-Payer Health Care, and One Payer States in Oakland, CA!
For the same $60 registration fee we normally charge for our 2-day conference, you can now attend the entire One Payer States conference, workshops being organized jointly by Healthcare-NOW! and the Labor Campaign, as well as a reception and keynote speakers for all three groups. We expect over 300 activists to attend, giving attendees a chance to learn from the best organizing going on around the country, build bridges between labor and community groups, and energize the movements for both state and national single-payer reform.
Please register today, so that you will have time to make travel and housing arrangements!
If cost is a barrier, a limited number of scholarships will be available – just follow the instructions on the registration page for requesting a discount or solidarity housing.
We’re incredibly excited to be joining the Labor Campaign and One Payer States, and we will update you with keynotes, workshops, and panels when the full agenda becomes available!
July 30, 2014 will mark the 49th anniversary of Medicare, our only publicly financed, universal health plan, which lifted a generation of seniors out of poverty. Each year Healthcare-NOW! coordinates Medicare’s birthday as a national day of action for single payer healthcare.
Please email Ben to let us know if you would like to plan or are planning an action this year, so we can email you educational materials, help publicize your event to activists in the area, and put you in touch with others who are planning actions elsewhere in the country.
In years past Healthcare-NOW! has coordinated up to 50 actions on or around July 30th. We want this whole week to be filled with events across the country that will help the movement increase its visibility and outreach. This will be a great organizing opportunity for local and national organizations, and a way for even small actions to become part of a larger movement for the week!
From Unions for Single Payer –
Bryan Aldridge, Chairman, reports that the Brotherhood of Locomotive Engineers-Kentucky State Legislative Board, has endorsed HR 676, national single payer health care legislation introduced by Congressman John Conyers, Jr. The legislation is also known as “Expanded and Improved Medicare for All.”
The BLET-Kentucky State Legislative Board represents approximately 900 members and 12 divisions in the State of Kentucky.
The resolution affirms that BLET-KSLB “will work with other unions and community groups to build a groundswell of popular support and action for… HR 676 until we make what is morally right for our nation into what is also politically possible.”
In other news, Congresswoman Janice Hahn of California’s 44th District and Tim Ryan of Ohio’s 13th District have signed on to HR 676 bringing the total to 57 in addition to chief sponsor Conyers.
By Benjamin Day –
This past Monday melanoma finally took Tim Carpenter, who is best known as the founder and long-time Executive Director of Progressive Democrats of America. Tim was a fierce organizer for social justice. You will hear and read many amazing tributes to Tim, because he was one of those rare individuals who swoops into many people’s lives and leaves an indelible mark. Most of us open ourselves up to a few people, we change them (and they change us) forever, but to everyone else we are just friendly co-workers, neighbors, or friends.
Tim was different.
We spoke a couple days before he died and he was, of course, organizing. Tim only spoke and acted at 100 miles per hour. Whether he was on TV, at a rally, or asking about your family, he communicated on a sort of verbal autobahn that left friends and correspondents breathless and disoriented. His emails consisted of 90% cheer leading and morale boosting for those around him: “Teamwork!”, “Onward!”, “Thanks for stepping up!”, “Building the team!”. Tim always started with thanks, and ended with an exclamation mark.
But what will stay with me forever is how Tim approached organizing as a person. My most vivid memory is meeting with Tim and Russell Freedman a few months ago in downtown Boston, where Tim received specialty care, commuting from Western Mass. We met at Legal Seafoods, and after some brief updates on the campaigns we were working on together, Tim cut work discussion off (as he usually did), and asked how I was really doing. How are my parents? Am I seeing anyone, or am I one of those activists who sacrifices everything for the cause? How am I feeling about my job at Healthcare-NOW? How can he can support me?
Two hours pass, we pay our bill. Tim hugs me, and says “I love you,” as he always does. I tell him I love him, too. Only when I’m seated in my car, in the parking lot, do I realize that Tim is receiving end-of-life care for a terminal illness – his physicians gave him only a few months to live initially, over a year ago – and yet he spends most of our time together asking how I’m doing, trying to support me, and letting me know that he loves me. We were old friends but by no means close friends. This was just how Tim lived his life, and it deeply challenged me to become a better person.
I will miss Tim badly, but I have a feeling that he’ll continue to sit on many of our shoulders for years to come, shouting out encouragement.
It feels truly Orwellian that progressives are applauding the forced purchase of private health insurance — one of the most hated industries in the United States — while the right is opposing a model that originated from their political leaders. The Affordable Care Act (ACA) is a step farther on the path to total privatization of our health care system, not towards the health care system that most Americans support: single payer Medicare for all.
In the months leading up to the March 31 deadline to obtain health insurance, ACA supporters united around their mission to enroll people. Volunteers knocked on doors and tabled in their communities. Celebrities and athletes tweeted and labor unions ran robocalls. The media buzzed with speculation about whether the ACA would succeed or fail. March 31 felt like election night. And after it was over, ACA supporters clapped each other on the back and celebrated.
Obamacare survived. But now that the law is implemented and the dust is settling, it’s time to question what this actually means for health care and what we should do now.
Before President Obama was elected in 2008, Drs. David Himmelstein and Steffie Woolhandler, two of the co-founders of Physicians for a National Health Program, raised a crucial question in their report, “Our Health Care System at the Crossroads: Single Payer or Market Reform?” They outlined the health care crisis and how past reforms were taking us toward increasingly “threadbare insurance coverage.” Knowing that health care reform would be front and center for the next few years, they argued that as a nation, we had a choice to make. We could stay on the same path toward a market-based health care system or take an evidence-based approach and create national single payer health insurance.
With the ACA, we have now passed that crossroads and are headed down the road to a completely market-based system of privatized health care. This is not something to celebrate. Dr. Adam Gaffney recently wrote an excellent history in Jacobin on the turn we have taken away from the concepts of universal health care and economic justice to a neoliberal model. We are inundated with market rhetoric telling us how wonderful it is to have the choice of shiny silver insurance in the brand new marketplace. Insurance plans are called products and we are consumers of them.
The problem with these public relations messages is that having health insurance doesn’t guarantee access to health care and health care doesn’t belong in the marketplace. As patients, we do not have a choice of whether or not to purchase health care when we need it. Delaying or avoiding necessary care can and does have serious consequences. And we can’t predict how much health care we will need or when we’ll need it. In a market-based system, profits are the bottom line and people receive only the amount of health care they can afford, not what they need.
The ACA is transferring hundreds of billions of public dollars to the private insurance industry to subsidize plans that leave people underinsured, unable to afford care and at risk of financial ruin if they have a serious accident or illness. And even at its best, tens of millions of people will remain without insurance.
Most of the 7.5 million people who purchased health insurance on the exchanges were already insured. More than 80 percent bought the lower-tier silver, bronze or catastrophic plans with the hope that they would not get sick. These plans have the lowest premiums but require that patients pay thousands of dollars out of pocket before insurance kicks in, and then pay 30 to 40 percent of the cost of covered care. The result is that underinsured people will continue to self-ration, delay or avoid care due to cost, as 80 million of us did in 2012.
The ACA includes regulations, but as usual the insurance industry has ways to work around them. Many insurers had caps on out-of-pocket costs waived. Insurers also found a way to “cherry pick” the healthiest customers by leaving cancer centers and major medical centers out of their networks. In fact, most of the new plans have narrow and ultra-narrow networks that shift more of the cost of care onto patients because care outside of insurance networks isn’t covered. And while insurance companies cannot drop individuals when they get sick, they can stop selling their plans in areas that don’t make a profit. Some are already doing this, which means the competition that was supposed to emerge did not. Instead, in 515 of the poorest counties in 15 states, only one insurance company is available on the health exchange. And greater consolidation of the health care system is underway through mergers and acquisitions.
Our public insurances, Medicaid and Medicare, are being increasingly taken over by private insurances in the form of Managed Care Organizations and Medicare Advantage. They compete for the healthiest patients and siphon more of the health dollars for profit, salaries and administration than public insurances. Top advisors to the White House expect our public plans to be rolled into the health exchanges in the near future with subsidies, a plan similar to Congressman Paul Ryan’s voucher proposal.
Nations that treat health care as a public good and not a commodity have universal coverage that costs less and produces better health outcomes. And in polls, some two thirds of Americans support single payer. Now our tasks is to shift the national debate away from how many people have insurance to what type of health care system we support. Efforts to do this are taking place at both state and national levels.
State efforts to educate and organize for universal health systems are using a human rights framework. This started with the Health Care is a Human Right campaign in Vermont that is working to create universal coverage, and similar organizing is happening in Maine, Pennsylvania and Maryland. An essential component of this organizing model is to develop leadership within communities that are uninsured or underinsured. States such as Washington, Oregon, Colorado and New Mexico also use human rights messaging in their campaigns.
State health reform faces significant barriers because federal legislation is needed to allow the creation of a state single payer system. However, state campaigns are essential because they push state health policy to be the strongest it can be and build an informed and organized grassroots movement that can also push for solutions at the national level.
Legislation for single payer health systems exists in Congress. In the House, Congressman John Conyers (D-MI) has introduced HR 676, “The Expanded and Improved Medicare for All Act,” in every session since 2003. So far it has 56 co-sponsors. In late 2013, Senator Bernie Sanders (I-VT) introduced SB 1782, “The American Health Security Act,” in the Senate. National organizations are working together to encourage more members to sponsor them and a national lobby day is happening in Washington, D.C., on May 22.
On a personal level, I have chosen to be a conscientious objector to the ACA. I cannot in good conscience give my support to the very industry I am trying to eliminate. Being a conscientious objector is a decision that people have to make for themselves. So far nearly 500 people have joined me by signing a petition at PopularResistance.org.
Some people speculate that the ACA will bring us to single payer some day because it will fail. This will only happen if we fight for it. Every day that we delay, people suffer and die in this country unnecessarily. Neil H. Buchanan says it best, “The ACA is as good as it gets, when it comes to basing a health care system on private insurance, and it is simply not good enough. Even as the ACA takes effect, therefore, we need to start planning to make it disappear.”
Margaret Flowers is a pediatrician and co-chair of the Maryland chapter of Physicians for a National Health Plan. She serves on the board of Healthcare-Now and of the Maryland Health Care is a Human Right campaign. She is also an editor at popularresistance.org.
From Media Mobilizing Project –
Everyone gets sick, but not everyone can access healthcare when they need it. The Affordable Care Act has expanded access, but millions are still left out, and most people with insurance still struggle to afford the care they need. In Pennsylvania and in states across the country, a growing movement is demanding that healthcare become a human right that’s accessible for every person. What will it take to make this happen? Three leaders on the front lines of this struggle share their insights and experiences.
A conversation with Nijmie Dzurinko, a leader of Put People First PA, Mark Dudzic, national organizer with the Labor Campaign for Single Payer, and Marty Harrison, a nurse and member of the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP).
Some See Their Compensation Double
Chief executive officers at Fortune 500 health insurance companies, who have opposed new regulations under the Affordable Care Act, emerged this month as one of the ACA’s greatest beneficiaries. Recently filed financial reports show that average compensation for these top nine health insurance CEOs rose by more than 19 percent in 2013, while several of the nation’s largest insurers more than doubled CEO pay.
The biggest winner was Aetna CEO Mark Bertolini, who received a staggering $30.7 million compensation package in 2013. This marks the largest payout to any health insurance executive since passage of the ACA and exceeded the compensation of the next two highest paid health insurer CEOs combined. The Bertolini pay package, which included a large “special one-time performance-based retention award,” represented a 131 percent increase over his $13.3 million compensation in 2012.
Molina Healthcare and Centene, both Fortune 500 insurers that specialize in privately managed Medicaid plans, roughly doubled CEO compensation in 2013. J. Mario Molina received $11.9 million, up from $5 million in 2012, while Centene’s CEO Michael Neidorff made $14.5 million, up from $8.5 million. Overall, average CEO pay across Fortune 500 health insurers rose from $11.6 million in 2012 to $13.9 million in 2013.
The disclosures of higher CEO pay coincided with several of the same companies announcing better-than-expected earnings in the first quarter of 2014, even as they signaled that patients and businesses should prepare for increased insurance premiums in 2015.
“For far too long, private health insurance executives have received outsized compensation packages – subsidized by the ever-increasing premiums of hardworking Americans – while millions of low income individuals and those with pre-existing conditions went uninsured,” says Representative John Conyers, Jr. (D-Mich.). “The United States’ healthcare sector has been in need of repair for decades, and over-the-top executive compensation is emblematic of the failure of our private health insurance system. While the Affordable Care Act is a good first step, truly universal coverage and meaningful reform to our healthcare system can be provided only through a single- payer system. I have introduced H.R. 676 – the Expanded and Improved Medicare for All Act – since 2003 to live up to this aim of universal care and establish health insurance as a basic right rather than a for-profit industry,” he continued.
“Families and patients are being asked to tighten their belts in the face of rising healthcare costs, while our premiums are being used to subsidize even more astronomical compensation for the already wealthy,” said Benjamin Day, Director of Organizing at Healthcare-NOW!, a nonprofit group that advocates for a single-payer system, sometimes called “an improved Medicare for all.”
“In contrast, the top administrator of Medicare – our public, universal health plan for all seniors, which is more efficient, provides better financial protection, and receives higher marks from patients than private health insurers – is paid less than $200,000 per year. The culture of excess at these for-profit corporations is incompatible with the goals of an efficient, ethical health care system, where every dollar diverted from patient care represents a loss of access for real families.”
Day continued: “We face the highest healthcare costs and have among the worst health outcomes of any country in the developed world because we allow private health insurers and dozens of other intermediaries to act as for-profit middlemen in the health care system. Although many backers of the Affordable Care Act said it would rein in insurance company excesses, the law clearly hasn’t curtailed top executive pay.”
“Thirty-million-dollar CEO paychecks – millions that should be spent on saving lives, not making the rich richer – should be a stark reminder that a single-payer, Medicare-for-All program would lower costs by spending every available dollar on patient care, and making access to care an inalienable right for everyone in the United States,” Day said.
1. Securities and Exchange Commission, 10-K Annual Reports
2. Securities and Exchange Commission, DEF 14A Proxy Statements
(Both available at https://www.sec.gov/edgar/searchedgar/companysearch.html)
Aetna’s CEO Mark Bertolini received a 131% pay hike, bringing in $30.7 million: that’s 877 times the $35k that the average worker makes in a year.
Tell him that’s not okay.
Fortune 500 health insurers increased compensation for their CEOs 25% in 2013 over 2012! Aetna’s CEO Mark Bertolini received a 131% pay hike, bringing in $30.7 million: that’s 877 times the $35k that the average worker makes in a year. Centene and Molina Healthcare doubled pay for their CEOs as well.
Can you fathom that these tens of millions of dollars, which are taken from your health premiums and tax dollars, have been diverted towards making some of the wealthiest men in the world even wealthier?
At a time when we are facing sky-rocketing premiums and rising co-payments and deductibles, our healthcare dollars are paying for yachts and second mansions instead of saving lives.
Let’s make them pay for it by emailing Aetna CEO Mark Bertolini directly. Tell him it is immoral for the ultra-wealthy to be pocketing our limited healthcare resources. Each dollar they steal from patients will redouble our efforts to improve and expand Medicare for all.
Tim Carpenter never lost faith in the very real prospect of a very radical change for the better. And he never lost his organizer’s certainty that the tipping point that would make the change was just a few more phone calls, a few more rallies, a few more campaigns away.
So he kept on organizing.
To the last.
Carpenter, the lifelong social and economic justice campaigner who nurtured Progressive Democrats of America from its founding a decade ago into a national movement, died Monday at age 55 after a long battle with cancer.
Not many hours before I learned that he had passed, Tim was on the phone with me, running through the latest numbers from a national petition drive he and PDA had organized to urge Vermont Senator Bernie Sanders to seek the presidency. They were over 10,500. A few hours after the call, he emailed me, with more numbers. They were over 11,000. That was typical Tim. His enthusiasm for politics was immeasurable, and infectious.
But Tim’s was never a typical politics. He knew the drill: he had been at the side of presidential candidates, developed winning electoral strategies and helped to organize movements around every essential issue of the Carter, Reagan, Bush, Clinton, Bush (again) and Obama eras. But Tim was always about something more; he was never satisfied with an election victory, or a legislative success; he wanted to transform politics because he wanted to transform America into a land that realized what he believed was an irrevocable promise of liberty and justice for all.
To achieve that end, Tim knew it was necessary to transform a too-often centrist, too-frequently compromised Democratic party into a dramatically more militant and more meaningful organization than it has been for a very long time. Mixing memories of the New Deal with elements of the 1960s civil rights and anti-war movements, linking the vision of the Rainbow Coalition with the new energy of fast-food and retail workers demanding a $15 minimum wage, Tim sought to define and achieve what one of his heroes, author and Democratic Socialists of America chair Michael Harrington, described as “the left wing of the possible.”
Tim refused to compromise with politics as usual. Yet, he refused just as ardently to be pushed to the margins. He waded into the middle of every new fight, grabbed a stack of precinct lists, distributed them to the activists he’d brought along in that beat-up car with Bob Dylan blasting on the stereo, and headed for the doors shouting, “Teamwork!”
“The Progressive movement is driven by people, but it is only successful because of people like Tim Carpenter,” said Congressional Progressive Caucus co-chair Keith Ellison, D-Minnesota, a PDA board member who got it right when he said, “Tim showed the kind of determination and courage that was contagious. His passionate idealism was matched only by his inexhaustible commitment to making those dreams a reality.”
Combining his encyclopedic knowledge of movement history and electoral strategy with the knowing optimism of one who had actually bent the long arc of history toward justice, Tim embraced an “inside-outside strategy” that was designed to go around the party elites and link insurgent campaigns to grassroots movements.
“In the polling booth and in the streets” was his vision, and if that meant breaking with the party establishment and aligning with the demonstrators outside the party convention, or outside the White House of a Democratic president, so be it. The principles were the point, and while Tim could join a coalition with folks who might not share every one of his positions, he believed his mission was to pull that coalition to the left.
Tim was a Democrat—to the frustration of his Green, Socialist and social Libertarian friends—but he was never a member of the Democratic Party establishment. He was the thorn in its side, declaring, “I’m not satisfied with the party as it is. I want the party as it should be.”
Tim cut his teeth on campaigns that recognized the connection between transforming politics and transforming the country: as a kid working “behind the Orange Curtain” (in then hyper-conservative Orange County) for George McGovern in 1972 and for the remarkable radical intervention that was Tom Hayden’s 1976 US Senate bid. Tim was a trusted aide to the Rev. Jesse Jackson’s 1988 “Rainbow Coalition” run for the presidency, an inner-circle strategist for Jerry Brown’s 1992 presidential run (addressing that year’s Democratic National Convention and urging delegates to “Save Our Party” from ideological compromises and corporate influence), a key figure in Dennis Kucinich’s anti-war presidential campaign of 2004.
Tim worked on plenty of campaigns that lost—as well as winning campaigns such as those of Congresswoman Donna Edwards, D-Maryland, Massachusetts Governor Deval Patrick and, to his immense delight, Senator Elizabeth Warren, D-Massachusetts—but he didn’t count wins and losses. He was interested in movement building. Drawing together veterans of the 2004 Kucinich and Howard Dean campaigns, Progressive Democrats of America grew, with Tim as its national director, into a network of activists and elected officials on the left of the party.
At the core of the mission was Tim’s vision of a movement-guided politics.
It was the same vision that shaped Tim’s grassroots activism, as a Catholic Worker advocate for the homeless who slept on the streets of Santa Ana to challenge police harassment; as an organizer of the anti-nuclear Alliance for Survival who counted musician-activists Jackson Browne and Bonnie Raitt as friends and comrades; as an organizer and champion of groups that opposed not just wars but the overreach of a military-industrial complex—from United for Peace and Justice to Democrats for Peace Conversion. To begin to list Tim’s causes, his victories and his ongoing struggles would take days—or weeks if Tim was still telling the stories. But suffice it to say that, for more than four decades, he was there—behind the scenes, sleeping on the floor, risking arrest, flying in with the rock stars, counseling the presidential candidates, remembering the name of every son and daughter of every activist, making the money pitch, organizing, always organizing.
The Nation named Tim as its “Progressive Activist of the Year” some years back. And it was far from the only honor accorded him. When Congressman John Conyers, the Michigan Democrat who is the senior progressive in Congress and arguably in America politics, learned that Tim was sick, he told the US House, “Tim has been indefatigable in pressing forward progressive ideals to help strengthen our American democracy. He has been in the forefront of progressive causes, from promoting nuclear disarmament to fighting to abolish the death penalty to establishing health care as a human right, as well as securing voting rights and jobs for all.”
Around the same time, Tim’s daughter ran up to him with an envelope from the White House that had arrived in the mailbox of the family’s Florence, Massachusetts, home. When they opened it, there was a note from President Obama, wishing Tim well while celebrating his resilience.
That was how most of us took the news that Tim was ailing. Knowing he had beaten cancer before, we wanted to believe that Tim was unstoppable. When he warned “it’s pretty serious this time,” we paid attention to his actions, not his words. Because even as he made the rounds of doctors and hospitals, treatments and hospice preparations, he was still on the phone, still texting, still emailing, still organizing.
Tim was determined that Progressive Democrats of America, a group founded when Democrats were not doing enough to oppose the war in Iraq or to advance a “Medicare for All’ reform of a broken health-care system—PDA’s slogan: “Healthcare Not Warfare”—would keep embracing new issues: amending the US Constitution to end the buying of elections by billionaires and corporations, getting Washington to take seriously the threat of climate change, blocking “Fast Track” and the Trans-Pacific Partnership trade deal.
Tim believed every battle could be won, by building bigger coalitions, by getting more people engaged.
Tim had a remarkable gift for what actress and PDA advisory board chair Mimi Kennedy referred to as “radical inclusivity.” He was always welcoming young activists into the fold, flying off to meet with folks who might form a new PDA chapter, asking people to tell him what new issues they were working on—and then asking how he could help. He had a faith that the change was going to come: a faith born in having won and having lost but never having surrendered the organizer’s dream of a movement that would be unstoppable.
We were in California last year and Tim asked a crowd to:
Help us grow this movement. Help us to put 435 activists in every congressional office, and another 100 activists in every Senate office to say: not only is it time to end this war, not only is it time to bring about healthcare as a human right, but it’s time for our community to stop turning our back on those who so desperately need us. To stop talking just about the middle class… It’s time to talk about the 50 million Americans who are poor.
A politics that speaks not only for the middle class but for the poor—proudly, energetically, radically—jumps boundaries that many top Democrats still avoid. But that was what Tim Carpenter wanted.
“It’s our responsibility to build that movement, your responsibility, my responsibility,” Tim said, even as he warned, “I may not be with all of you when you are out there in those streets, in those struggles, but I will be with you in spirit.”
If we did not fully understand then, we do now.
Tim Carpenter was right. The building of the politics he wanted—more powerful than any party or politician—is now our responsibility. But Tim is with us in spirit, still telling us that the key is not money or television ads, not caution or compromise. It’s a passion for justice. It’s a belief that peace is possible. And, like Tim said, it’s “Teamwork!”
This year marks our 10th anniversary! Marilyn Clement founded Healthcare-NOW! in 2004 originally under the title “Campaign for a National Health Program NOW.”
We are doing something extraordinary for our National Strategy Conference to mark this occasion: we will be hosting a mega single-payer conference jointly with the Labor Campaign for Single-Payer Health Care and the One Payer States group, all of which will converge on Oakland, California the weekend of August 22-24. After ten years, this will be our first National Strategy Conference on the west coast!
The Healthcare-NOW! and Labor Campaign conferences will be hosted at the International Longshore & Warehouse Union Hall in Oakland, and One Payer States will be hosted a short distance away at the California Nurses Association. We expect over 300 activists to attend, and participants will have the option of attending all three conferences if they choose, along with joint plenaries, keynote speakers, and a Saturday night reception that will bring everyone together.
So mark your calendar for the weekend of August 22-24! We’ll have a call for workshop proposals and a registration page up shortly. We are incredibly excited to bring such a large group of inspiring activists together to learn from one another and energize this movement!
New System Would Boost Economy, Reduce Costs and Eliminate Unfair Burdens on Companies That Provide Health Insurance Benefits
WASHINGTON, D.C. – A publicly funded, universal health care system would aid businesses by engendering a more dynamic economy, taming costs and freeing businesses that provide health insurance of the costs of administering benefits and subsidizing the nation’s health care, a Public Citizen report released last week concludes.
“Small businesses have rated the cost of health insurance as their top concern for a quarter century, and large businesses struggle with health care obligations that their international competitors do not have to worry about,” said Taylor Lincoln, research director of Public Citizen’s Congress Watch division and author of the report. “If it weren’t for entrenched partisan alliances, business leaders would have demanded that Congress relieve them of health care burdens long ago.”
Publicly funded universal health care systems – such as the Canadian “single-payer” system, in which the government pays for all covered services – exist in nearly every developed country in the world. In the United States, universal care systems could be implemented either at the federal or state levels. The Affordable Care Act of 2010 includes language permitting states to apply for waivers that would enable them to institute universal care systems beginning in 2017. Vermont has passed legislation declaring an intention to do just that.
Public Citizen’s report, “Severing the Tie That Binds,” outlines three ways a universal health care system would benefit businesses.
First, it would end “job lock” and other economic distortions stemming from our health care financing system that hinder the freedom of individuals to pursue new ventures. Despite common perceptions that the United States is an entrepreneurial bastion, we have among the lowest rates of self-employment and small businesses among industrialized countries, researchers at the Center for Economic and Policy Research reported in 2009.
The researchers hypothesized that the dismal numbers in the United States were due to the high costs that individuals and small businesses here must pay for health care, which those in countries with universal access to health care do not face. By facilitating more entrepreneurship, a universal health care system here would likely boost economic growth, leaving businesses with a larger pool of potential customers.
Second, a universal care system would significantly dampen future increases to health care costs – and perhaps reduce costs – even as it greatly increased access to care. Numerous studies have concluded that the United States spends much more on administrative functions, such as billing and interactions with insurance companies, than other wealthy countries. Meanwhile, pharmaceuticals and procedures in the United States cost much more here than elsewhere.
A universal care system would reduce administrative costs by expanding economies of scale, streamlining processes and cutting insurance companies’ marketing costs and profits from our national health care bill. At the same time, costs for drugs and procedures would be kept in check by increased transparency, as well as increased governmental bargaining power and rate-setting authority.
Third, although a publicly funded, universal care system would likely rely on significant revenue from businesses (such as through a payroll tax), there is reason to believe that total health care-related costs for businesses now providing benefits would decline, in part because a new system would spread costs more fairly.
Businesses that provide health care benefits would no longer have to essentially subsidize those that do not by covering the unreimbursed cost for care provided to the uninsured. Businesses also would be spared the costs of administering health care benefit programs. Meanwhile, funding formulas for universal care may reduce the overall share of national health care costs borne by the business sector by garnering revenue from a broader array of sources.
Elements of the solutions laid out in Public Citizen’s report already exist at the state level or are under consideration. For 35 years, Maryland has set across-the-board rates for hospital care, including care funded by Medicare and Medicaid. This program has saved tens of billions of dollars. In 2014, the scope of Maryland’s program was broadened by establishing overall caps on hospital budgets to counter the economic incentive to provide a greater volume of care. Establishing rate-setting authority and capping overall hospital budgets are hallmarks of the cost-savings mechanisms in universal care systems.
Vermont in 2011 passed legislation that called for it to create a “universal and unified health system” that would take advantage of provisions in the Patient Protection and Affordable Care Act that permit states to apply for waivers to craft their own health care systems beginning in 2017.
“The states might be flying below the radar, but they have a chance to implement solutions that should have widespread appeal,” said Lisa Gilbert, director of the Congress Watch division of Public Citizen. “If businesses leaders allow common sense to guide them, we think they will join the campaign for universal care.”
Vermont wants to bring single payer to America
By Sarah Kliff for Vox –
Saskatchewan is a vast prairie province in the middle of Canada. It’s home to hockey great Gordie Howe and the world’s first curling museum. But Canadians know it for another reason: it’s the birthplace of the country’s single-payer health-care system.
In 1947, Saskatchewan began doing something very different from the rest of the country: it decided to pay the hospital bills for all residents. The system was popular and effective — and other provinces quickly took notice. Neighboring Alberta started a hospital insurance plan in 1950, and by 1961 all ten Canadian provinces provided hospital care. In 1966, Canada passed a national law that grew hospital insurance to a more comprehensive insurance plan like the one that exists today.
Saskatchewan showed that a single-payer health-care system can start small and scale big. And across the border, six decades later, Vermont wants to pull off something similar. The state is three years deep in the process of building a government-owned and -operated health insurance plan that, if it gets off the ground, will cover Vermont’s 620,000 residents — and maybe, eventually, all 300 million Americans.
“If Vermont gets single-payer health care right, which I believe we will, other states will follow,” Vermont Gov. Peter Shumlin predicted in a recent interview. “If we screw it up, it will set back this effort for a long time. So I know we have a tremendous amount of responsibility, not only to Vermonters.”
When Shumlin ran on a single-payer platform in 2010, it was unprecedented. No statewide candidate — not in Vermont, not anywhere — had campaigned on the issue, and with good political reason. Government-run health insurance is divisive. When the country began debating health reform in 2009, polls showed single-payer to be the least popular option.
Shumlin just barely sold Vermont voters on the plan (he beat his Republican opponent by less than one percentage point). Then, he got the Vermont legislature on board, too. On May 26, 2011, Shumlin signed Act 48, a law passed by the Vermont House and Senate that committed the state to building the country’s first single-payer system.
Now comes the big challenge: paying for it. Act 48 required Vermont to create a single-payer system by 2017. But the state hasn’t drafted a bill that spells out how to raise the approximately $2 billion a year Vermont needs to run the system. The state collects only $2.7 billion in tax revenue each year, so an additional $2 billion is a vexingly large sum to scrape together.
The failings of the Affordable Care Act are rooted in a long shift away from the idea of a truly universal health care.
Last year’s three-ring Congressional shutdown circus — for many little more than a desperate rearguard action by an isolated rightwing fringe to undo the fait accompli of Barack Obama’s health care reform — reinforced with each passing day the gaudy dysfunction of the American political system. But we miss something crucial if we construe the perseverance of Barack Obama’s 2010 Affordable Care Act (ACA) as nothing more than the overdue victory of commonsense health care reform over an irrelevant and intransigent right, or, even more, as the glorious culmination of a progressive dream for American universal health care long deferred.
For many commentators, though, this is precisely what the ACA represents. With the law’s passage in March 2010 and its survival in the face of a constitutional review by the Supreme Court, they have concluded that the battle “over universal health coverage,” as one writer for the Washington Post put it, “is basically over.” Unfortunately, the evidence does not permit such a sanguine conclusion.
Most plainly, when we consider the provisions and limitations of the law, it becomes clear that though it may help many, the ACA fails fundamentally to create what so many had hoped for: a system of universal health care. Leaving millions still uninsured and many more “underinsured” — a well-described and researched phenomenon in which the possession of health insurance still leaves individuals and families with dangerous financial liability when illness strikes — the ACA falls well short of the standard of universal health care as it is understood elsewhere in the social democratic world.
But more broadly, when we consider the ACA through the lens of political economy, an even more concerning narrative emerges, one that says even less about the triumph of social democracy and more about the sharp shift of the political center and the disintegration of the New Deal left. For the law fundamentally leaves intact a system of health care predicated, as we shall see, on key neoliberal health care beliefs, for instance the “moral hazard” of free care, the primacy of health consumerism, and the essentiality of the private health insurance industry.
As a single-payer advocate who is also a doctor, I was concerned after the Affordable Care Act was passed that it didn’t do enough to combat rising underinsurance. A recent study by the Commonwealth Fund, which used new data to demonstrate that in 2012 some 31.7 million Americans were underinsured (i.e. insured, but still with heavy additional out-of-pocket health care expenses), argued that the burden of underinsurance will likely lessen as the ACA fully unfolds. But is there really reason for such optimism?
This is a complicated issue with many moving parts, so one way to tackle it (before immersing ourselves in the exhilarating policy literature) is to pose a simpler question: if your family is insured, and someone gets seriously sick, can you not worry about going broke?
The short answer: it depends on how much you have in the bank, and on the “out-of-pocket maximum” established by the ACA for your particular plan. The out-of-pocket maximum is the most that you would have to pay (after premiums) on things like co-pays for medications or deductibles for hospitalizations, and it can go as high as $12,700 annually for exchange plans under the ACA. But doesn’t the law provide protection for lower-income individuals, for instance, in the form of reduced out-of-pocket limits? The answer is yes – but to a lesser extent than we initially thought, even though, somehow, no one informed us that things had changed.
Health Care for All – Texas’s Open Journal radio series on healthcare reform was today, Wednesday, April 9th on KPFT 90.1FM (Houston) at 9:30am. Their guest this month was Dr. Gerald Friedman.
Here’s a direct link to the mp3 file (right click to save).
Dr. Gerald Friedman, Professor of Economics at the University of Massachusetts at Amherst was their guest. He is the author of a new study that shows how a nonprofit single-payer system based on the principles of “The Expanded and Improved Medicare for All Act, H.R. 676, would save $1.8 Trillion dollars over the next ten years and still be able to provide high quality health care for everybody.
Email HCFAT your ideas at email@example.com or call in to 713-526-5738 during the next show. They will be on the air every 2nd Wednesday of the month at the same time.
When most liberals hear the words “third party,” they have nasty flashbacks to Ralph Nader’s spoiler campaign in 2000. The history buffs among them might think of the populist Greenback Party’s feckless protests against the gold standard in the 19th century or the five presidential campaigns of the Socialist Eugene V. Debs — the last of which, in 1920, he ran from prison.
Third parties seem out of touch with reality, the refuge of idealists with dreams too fragile for the trenches of major party politics. But Democratic skeptics, at least, shouldn’t be too quick to judge. One state is now on the way to single-payer health care, and a third party deserves much of the credit.
Three years ago, Peter Shumlin, the governor of Vermont, signed a bill creating Green Mountain Care: a single-payer system in which, if all goes according to plan, the state will regulate doctors’ fees and cover Vermonters’ medical bills. Mr. Shumlin is a Democrat, and the bill’s passage is a credit to his party. Yet a small upstart spent years building support for reform and nudging the Democrats left: the Vermont Progressive Party. The Progressives owe much of their success to the oddities of Vermont politics. But their example offers hope that the most frustrating dimensions of our political culture can change, despite obstacles with deep roots in American history.
Green Mountain Care won’t begin until at least 2017, but Vermont liberals are optimistic. “Americans want to see a model that works,” Senator Bernie Sanders told The Atlantic in December. (Mr. Sanders is an independent, but a longtime ally of the Progressives.) “If Vermont can be that model it will have a profound impact on discourse in this country.”
Before you dismiss that prospect as wishful thinking, consider: That’s how national health care happened in Canada. A third party’s provincial experiment paved the way for national reform. In 1946, the social-democratic government of Saskatchewan passed a law providing free hospital care to most residents. The model spread to other provinces, and in 1957 the federal government adopted a cost-sharing measure that evolved into today’s universal single-payer system.
It seems natural that America’s experiment in Canadian-style health care should begin in Vermont, a state with a long history of cross-border contact. In Derby Line, Vt., the border runs through the town library. Decades ago, pregnant women from Quebec often drove to Vermont to give birth, preferring American hospitals. Not anymore. When it comes to health care, two countries that share so much have diverged profoundly.
Between 1870 and the Great Depression, Americans and Canadians both worried about the growing gap between the mega-rich and the poor. Their disillusionment fueled the rise of dissenting parties. In Canada, the most successful of these, the social-democratic Cooperative Commonwealth Federation, won control of Saskatchewan in 1944. Canada never passed reforms to match the New Deal, and the C.C.F. capitalized on voters’ frustration with the federal government’s inaction — just as liberals in Vermont are now doing.
It’s risky to compare 1940s Saskatchewan to Vermont today, but “Vermont has some of the features that Saskatchewan had in the 1940s and 1950s. It’s a rural state in which voices from the left have been more legitimate than in other parts of the country,” said Antonia Maioni, a professor of political science at McGill University in Montreal. “Saskatchewan was the last place where you would have expected to have this bold innovation. It was the poorest, most rural, most sparsely populated province. And yet it was the mouse that roared.”
The Vermont Progressives have only eight seats in the State Legislature, but they played a decisive role in the 2010 gubernatorial election. They promised not to play spoiler if the Democratic candidate supported single-payer health care. “Shumlin was very clear on his stance, and it pulled him through a narrow primary — a lot of Progressives were volunteers on that — and then he narrowly won,” Chris Pearson, a Progressive state representative from Burlington, told me. “He kept his promise.”
What explains the success of the Progressive Party? Vermont is small, and “it was expected that I’d knock on every door in my district,” Mr. Pearson said. “Progressives are dedicated to that style of campaigning. It’s also affordable. You can run a House race for $5,000.”
Despite their urban origins in Burlington, the Progressives have won crucial support from rural, traditionally conservative parts of the state, where lifelong Republicans have responded to the same argument that the Populists once used: Without regulation and a public safety net, capitalism will grind the independent farmer into the ground.
The trouble is that the Progressives have no national colleagues pressuring President Obama from the left. The Saskatchewan social democrats and their national successor, the New Democratic Party, forced the ruling Liberals to move left in the 1950s and 1960s as other provincial governments came to favor national reform.
American third parties face many obstacles in national elections, not least financial disadvantages and the ability of the major parties to co-opt dissenters by forming factions (in Canada, rules requiring tight party discipline mean insurgents like the Tea Partiers would probably have to form their own organizations).
But there is a deeper ideological reason. Canada inherited something else from Britain besides the Westminster system. It retained the full spectrum of English politics. This includes the socialist left and the Tory right — both traditions that, despite their differences, call for a strong central government and the restraint of individual liberty in the interest of the community.
The United States, by contrast, is a revolutionary state. The founders feared both kingly tyranny and the rule of the mob, and they bequeathed to us a political spectrum that is the narrowest in the Western world. With few exceptions, even left-wing dissenters have preached some version of free market ideology. The Vermont Progressives’ promise to “promote cooperative, worker-owned and publicly owned enterprises” is a far cry from Debs’s demand that “the capitalist system must be overthrown.”
In times of crisis — during the Civil War, the Great Depression and World War II — Americans have tolerated a radical expansion of the role of government. Harry Truman tried to seize the moment in 1945 by pushing for universal health care, only to be stymied by conservative opponents and the American Medical Association.
American doctors succeeded where Canadian doctors failed (despite multiple doctors’ strikes) because the American political system left individual politicians vulnerable to lobbying. They capitalized on the rhetoric of the Cold War, insisting that “socialized medicine” was one step short of Soviet tyranny. There is also no denying the ugly role that race played in this story: Too many white Americans have rejected reforms for fear that their tax dollars would help black Americans.
Yet the main lesson that Americans can learn from Canada is that political cultures can change. In 1950 Canada was, in many respects, a more conservative country than America, and each step of reform was hard-won. But as Canadians watched new policies produce results, skeptics became supporters. “Many policies that emerged in postwar Canada have changed Canadians’ conception of their relationship to the state,” Professor Maioni told me. “Policies feed political culture.” If the Vermont experiment works, other states will follow. American pragmatism will trump ideology.