Mandate Single-Payer

The Clinton and Obama campaigns have been tossing brickbats at each other over the details of their attempts to make health insurance affordable for the 47 million Americans — mainly the working poor — who do not have coverage. In brief, Hillary Clinton would mandate individuals and employers to buy insurance while Barack Obama would only mandate employers to contribute to insurance coverage.

Both Democrats are better than John McCain, who only recently put up a health policy page on his Web site that basically parroted the Bush administration’s proposal of tax credits to help individuals buy insurance with high deductibles, which would cover catastrophic illness but would discourage people from seeing a doctor for routine ailments.

The US spends about twice as much for health care as the average among industrialized nations, said Dr. Steffi Woolhandler, an associate professor at Harvard Medical School. But those other developed countries provide comprehensive coverage for their entire populations, while the US leaves more than 47 million uninsured and millions more inadequately covered. The US performs poorly on major health indicators such as life expectancy, infant mortality and immunization rates, in comparison.

Woolhandler is a co-founder of Physicians for a National Health Program (pnhp.org), which advocates a single-payer universal health-care plan such as HR 676, the “Medicare For All Act” proposed by Rep. John Conyers (D-Mich.). In a Web conference hosted by BackboneCampaign.org, Woolhandler noted that a study by the Harvard Law School and the Harvard Medical School found that half of all bankruptcies are due to medical bills. That is virtually unknown in Canada, which has single-payer coverage that takes care of major medical expenses. And 76% of those medical-based bankruptcies in the US were families who had health insurance at the onset of their illness, Woolhandler noted. People either lost their jobs and their insurance as a result of their illness or, if they held onto their insurance, they were undone by required co-payments, deductibles and gaps in coverage.

We’re already paying enough to cover everybody, she noted. One-third of health care dollars are eaten up in administrative costs, she said, as resources are squandered on paperwork and accounting. A single-payer plan that expands Medicare would result in savings estimated at $350 billion a year — which would pay for the coverage of the uninsured as well as fill in the gaps for the underinsured and those at risk of being put out of a job in the coming recession.

HR 676, which has 78 co-sponsors (including former presidential candidate Rep. Dennis Kucinich, D-Ohio), has yet to get a hearing in the health subcommittee, despite polls that show that two-thirds of Americans support the idea of universal health care paid through taxes. The reason is that, in the absence of a grassroots pressure, Congress members listen to insurance and pharmaceutical industry lobbyists who are willing to pay to keep the system just the way it is. When Republicans controlled Congress, they got two-thirds of the $31.2 million the insurance industry donated in 2006. Democrats are just now getting their share and they hate to alienate those donors.

While the American Medical Association has tended to support the status quo, Woolhandler said many physicians support single-payer as a way to simplify their practices. “We have excellent technology, but if folks can’t afford to get into our offices or, if they get into our offices, can’t afford to pay for the treatments, we can’t do our jobs,” she said.

As we’ve said before, instead of trying to patch our substandard private-insurance dominated health system, the best thing Democrats could do for working people as well as businesses in the US would be to expand Medicare to provide full-service health care for every American regardless of employment.

Any serious reform of health care will require a public groundswell to prod Congress to go to war with the health insurance and pharmaceutical industries that are determined to protect the status quo. If we’re heading into that fight, we might as well push for real reform.

“When the public gets mobilized, we’re able to beat back the lobbyists and the private interests,” Woolhandler said, “but if this is a backroom deal, the insurance industry and the pharmaceutical industry will have a field day.”

Massachusetts passed a state mandate in 2006, ordering individuals to buy coverage, but without effective cost controls insurance is still too expensive and provides too little coverage. Woolhandler said the cheapest policy in Massachusetts costs $4,100 a year with $2,000 deductible.

The good news is that both Clinton and Obama have said they are not opposed to a single-payer program — they just think it is not feasible to get such a program through Congress. “It’s important to have someone in the White House who’s not ideologically opposed [to single-payer),” she added.

So progressives should turn their attention to getting things moving in Congress. “It’s election season and that’s a tremendous opportunity to get active and bird-dog all the candidates — particularly congressional candidates,” she said. She recommended going to debates and town-hall meetings and asking candidates for the House and Senate variations of this question: “Since decades of experience have shown that private health insurance can’t control health costs or assure universal coverage, are you ready to support the single-payer bill, HR 676, Medicare for All?”

Woolhandler added that Obama’s mobilization of youth and independent voters might help move the Democrats to more progressive positions. “He’s getting people’s hopes up and when that happens it’s hard to get that genie back in the bottle,” she said.

(See health-care links at populist.com/healthcare.html/.)

Nader’s Back

Ralph Nader once again is running for president. That is his inalienable right. It is your right to decide whether or not you wish to support him, but neither you nor I can stop him from running. That’s the way democracy works.

Nader believes he can organize citizens and raise progressive issues via a political campaign — and he got widespread coverage of his announcement on NBC’s Meet The Press on Feb. 24. Nader sees Democrats and Republicans as too beholden to corporate lobbyists. He said he wants to elaborate on issues that he thinks the two remaining Democratic candidates, Barack Obama and Hillary Clinton, are not talking about, such as the need for single-payer medical coverage, reform of labor laws, cracking down on corporate crime, corporate welfare and Pentagon waste, reversing the US Middle-East policy regarding Israel/Palestine, Iraq and Iran, defense of civil liberties and supporting solar energy instead of nuclear energy. “Dissent is the mother of ascent,” Nader said. “And in that context, I have decided to run for president.” For more information, see votenader.org.

We support much of what Nader believes in, but we don’t believe he will be a significant factor in this election, particularly if Obama is the party’s nominee. If anything, Nader’s candidacy might blunt far-fetched Republican claims that Obama represents the “far left.” (Of course, we don’t think Nader is that “far left,” but that’s another editorial ...) Obama has the right attitude toward Nader’s challenge — and one with which we think Nader would agree: “I think the job of the Democratic Party is to be so compelling that a few percentage [points] of the vote going to another candidate is not going to make any difference,” the Illinois Democrat said.

During his campaign, in order to remove the appearance of a conflict of interest, Nader’s column will be on hiatus. The column in this issue, which was written before he declared his candidacy, will be his last in The Progressive Populist, at least until he concludes his campaign. — JMC

From The Progressive Populist, March 15, 2008

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