Sunday, May 31, 2009

On the Single-payer Universal Healthcare Crisis

Moyers' Preface to the Second Part of His 22 May 2009 Broadcast in Essay Form:

In 2003, a young Illinois state senator named Barack Obama told an AFL-CIO meeting, "I am a proponent of a single-payer universal healthcare program."

Single payer. Universal. That's health coverage, like Medicare, but for everyone who wants it. Single payer eliminates insurance companies as pricey middlemen. The government pays care providers directly. It's a system that polls consistently have shown the American people favoring by as much as 2-to-1.

There was only one thing standing in the way, Obama said six years ago: "All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House."

Fast-forward six years. President Obama has everything he said was needed -- Democrats in control of the executive branch and both chambers of Congress. So what's happened to single payer?

A woman at his town hall meeting in New Mexico last week asked him exactly that. "If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense," the president replied. "That's the kind of system that you have in most industrialized countries around the world.

"The only problem is that we're not starting from scratch. We have historically a tradition of employer-based healthcare. And although there are a lot of people who are not satisfied with their healthcare, the truth is, is that the vast majority of people currently get healthcare from their employers and you've got this system that's already in place. We don't want a huge disruption as we go into healthcare reform where suddenly we're trying to completely reinvent one-sixth of the economy."

So the banks were too big to fail and now, apparently, healthcare is too big to fix, at least the way a majority of people indicate they would like it to be fixed, with a single-payer option. President Obama favors a public health plan competing with the medical cartel that he hopes will create a real market that would bring down costs. But single payer has vanished from his radar.


Moyers Talks to Donna Smith [Video and Transcript]

BILL MOYERS: What is it you would like those folks to know, those regular citizens to know about this issue, about single-payer and why it's important to them?

DONNA SMITH: I tell people, I always ask them to tell me if they understand single-payer and what it's all about. It's a great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery. And you put it together in one system that takes out the waste and the abuse that's really happening, which is where all the money goes into the health insurance. Up to 30 percent of the costs have nothing to do with health care at all and everything to do with fueling the health insurance needs.


BILL MOYERS: When we did a report on the Journal 12 or 15 months ago on the California nurses and the fight out there for single-payer, we were inundated with mail saying they're socialists and you're a fellow traveler. What do you say to people like that, who read into what you're doing a call for state government-run socialistic medical care?

DONNA SMITH: I laugh a little bit in light of the last six months on how much money we've thrown into Wall Street and how much money we've thrown in keeping financial markets stable in this country. In three days, we were able to come up with three quarters of a trillion dollars to throw into Wall Street. So the argument about socializing things and making things government-run seems a little bit yesterday to me, just intellectually.

But I tell people, you know, look, don't fear this. This is not - you're not turning into a Communist red nation. Please don't be afraid. Even in polling data where the words "socialized medicine" is used, even in that polling data, almost 50 percent of the American public say, "Okay. Do it." And data where we just ask about a national health insurance system, and that's through "The New York Times" and CNN and Yahoo! and a number of polls, 60 percent of the American public say we've got to have a national health program. We just have to do it. It's the only way we fix this mess. It's spun out of control. It's going to bury us financially. It's going to mortgage our children, and it kills people. It just is not working.


Moyers Talks to David Himmelstein & Sidney Wolfe [Video and Transcript]

BILL MOYERS: Dr. Wolfe, I am puzzled as a journalist as to why this subject of single-payer, whether one is for it or against it, seems totally out of the debate in Washington. It's just not on the table. And it's not in the- on the radar screen of the press. Why do you think that is?

DR. SIDNEY WOLFE: I think the reason is, unfortunately, simple and frightening. Which is the power of the health insurance industry.


DR. DAVID HIMMELSTEIN: That's the big problem here is people want to find a solution that they can get through without a big fight with the insurance industry. Unfortunately it's economically and medically nonsensical - you can't actually have a health care program that works, if you keep the insurance industry alive.

BILL MOYERS: Well, then how do you account for the fact that so many people in other polls say, "We're satisfied with what we have for health care, and we don't want it taken away from us"?

DR. DAVID HIMMELSTEIN: Well, people are satisfied many times with their doctor and with the hospitals they go to. And most Americans aren't sick and don't actually have experience of their health insurance. But when you get sick, and actually have to use your insurance, that's when people find out the dark side of the policies they have. Huge co-payments, huge deductibles.

We did a survey of people filing for bankruptcy in courts around the country. Half of the bankruptcies are medical bankruptcies in this country. And of those medical bankruptcies, three quarters of those people had insurance, at least when they first got sick. But people have insurance that goes away after they actually need it.

BILL MOYERS: But why in the dozen or so hearings that I've tracked in Washington recently on health care reform have there been so few advocates of the single-payer?

DR. SIDNEY WOLFE: The seats at the table, or the witnesses at the hearing are, in a sense, controlled by the health insurance industry. They don't want someone essentially saying, "We don't need a health insurance industry. We can do what most other countries in the world have done. Have the government collect the money and pay the bills and get rid of all these people who are wasting $400 billion a year on excessive administrative costs."

So, we have got a fragmented health insurance industry. And it thrives on being fragmented. The drug countries make much more money with the fragmentation, because there's no price control. The insurance companies make much more money, 'cause they can push away people who aren't going to be profitable. The only people that suffer are the patients.

It's- 1968, I was one of a group of physicians that disrupted the American Medical Association's convention, because they were saying then, and in, for all practical purposes it's still true, "Health care is not a right. It's a privilege." And we said, quietly, as we took over the microphone, "That's wrong." We're now 41 years later, and it's still a privilege. And too many people in this country don't have that privilege. It's resulting in huge numbers of people being ill, sick, and almost 20 thousand people dying a year because they don't have health insurance.


BILL MOYERS: I've heard you say that several times. I've read you're saying it. We can do away with the health industry. I mean, them's fightin' words, a very powerful part of the economy, and they're a powerful part of the political statute, as David said.

DR. SIDNEY WOLFE: It absolutely is. And in Canada, back in 1970 or so, they were spending the same percentage of their gross national product as we were on health. They had huge numbers of uninsured people. They had the same insurance companies. Blue Cross Blue Shield. They decided to just get rid of the health insurance industry. That it was the only way to go. They had experimented with it in Saskatchewan ten years earlier. It worked so well, they couldn't wait to do it nationally. So, where there's a will, there's a way. There is no way we are ever going to get to having good health insurance for everyone, as long as there's a health insurance industry, in the way, obstructing care.

BILL MOYERS: What do you say to the argument, though, of people who've gone to Canada, and looked at that system. "Well, there are long waiting lines. You can't choose your doctor." In fact, conservative critics say that this will lead to what they dread which is socialized medicine. Would single-payer in fact mean I could not choose my doctor?

DR. DAVID HIMMELSTEIN: Well, in Canada, actually, you can go to any doctor, any hospital in the country.

DR. SIDNEY WOLFE: Much more choice than here.

DR. DAVID HIMMELSTEIN: Yeah, Canadians have better choice than we do. They spend half as much per person on health care as we do. And if you're going to cut our budget by 50 percent, we'd have to have some waiting lines. But if we're willing to keep spending at our current levels, we could cover everybody with first dollar coverage with terrific access to care.

BILL MOYERS: What do you mean first dollar coverage?

DR. DAVID HIMMELSTEIN: No co-payment, no deductible. You go to the doctor. The whole bill is paid. Any doctor, any hospital in the country. That's the model. And that's not just me who says that. The Congressional Budget Office has said that in the past. The Government Accountability Office says we're spending enough to do that. And we're really talking about social insurance, like Medicare is social insurance. But doctors and hospitals remaining privately owned.


BILL MOYERS: Am I correct in thinking on the basis of what I've read that with single-payer, the benefits would be publicly financed, as you just said, but that the health care providers would, for the most part, remain private?

DR. DAVID HIMMELSTEIN: They certainly would. As would the hospitals.

BILL MOYERS: They wouldn't work for the state.


BILL MOYERS: They wouldn't get their salaries some...

DR. DAVID HIMMELSTEIN: In fact, private practice is more common in Canada than it is here in the U.S. And in the U.S., we're seeing more practices being taken over by big corporations. And people, basically, doctors becoming employees of large bureaucracies. In Canada, private practices remain the norm. And that's what we're saying ought to continue in the U.S.

DR. SIDNEY WOLFE: I mean, essentially it's socializing the financing. So, I mean, when people use this scare word "socialized medicine" I don't know what they mean. We have socialized libraries. We collect taxes, and we have libraries, we have socialized police. The financing is socialized. In those cases, they are working for a city. In this case, the doctors are in private practice. The hospitals are operating privately. And any patient- it's interesting the system is called Medicare, and so, everyone in the country has a Medicare card and that allows them to go wherever they want. They don't have this limited number of providers, which is getting more and more limited, as everyone who has health insurance in this country knows.


BILL MOYERS: You are both doctors, but are there many doctors like you in support of single-payer? Is there any evidence of their numbers?

DR. DAVID HIMMELSTEIN: Well, we actually started our group, Physicians for a National Health Program with just a few of us. But we now have 16 thousand members. So, there are a lot of doctors who are activists on this issue. But more than that, surveys are showing that most doctors support national health insurance-


DR. DAVID HIMMELSTEIN: this point. Because our lives every day taking care of patients drive us to it. The paperwork, the bureaucracy, the game of mother may I we play with the insurance companies. All of those are not what we went into medicine for. We went into medicine, most of us, 'cause we wanted to take care of people. This system doesn't let us do that. And even my conservative colleagues, our organization has Republicans in it. There, at this point, single-payer supporters, 'cause they say "Let me practice medicine."

BILL MOYERS: I want to get your thoughts on President Obama's plan. As I read it, it's very difficult, at this moment, to know the details of it.

DR. SIDNEY WOLFE: 'Cause there aren't any details.

BILL MOYERS: There aren't any details. But he seems to be advocating a public option that would compete with the private insurance-driven sector, as a way of lowering the cost. What do you think about it? Is that- am I reading his plan correctly?

DR. DAVID HIMMELSTEIN: Well, most of the cost savings he's talking about are really illusory, I think. And my research group has done most of the research work on administrative costs in health care. And the administrative costs he's talking about saving are a tiny fraction of the potential savings under single-payer. 'Cause hospitals have to keep their bureaucracy, if you're dealing with hundreds of different plans. And doctors have to keep the bureaucracy in our office. You don't actually get the streamlining that you get from having one payer that has one set of rules and can pay lump sum budgets to hospitals. But more than that, we're worried that the public plan actually becomes a dumping ground for the unprofitable patients. As it's happening in Medicare.


BILL MOYERS: So, what would you like to see in Obama's plan?

DR. SIDNEY WOLFE: Well, we'd like to see Obama remember where he came from. And not only say, "If we were starting now from scratch, we would have a single-payer, but it's too disruptive." Instead of saying, "We are starting out from scratch, because we need to start out from scratch. There are too many people dying, being sick, ill, because they don't have insurance." And so, we would like Obama to espouse a single-payer program. The majority of people in the Congress would vote for it, if there were some leadership. Instead of saying, "It's politically impossible." It's politically impossible if everyone agrees that it's not possible, it won't happen.

If instead they say, "It's not only politically possible, politically feasible, and it's the only practical way it would happen." Anything short of that is essentially throwing billions of dollars at the insurance industry. And if you're afraid of the insurance industry, then you're afraid of doing the right thing.


Obama for Single-Payer Before He Was Against It.

...let me just echo Ta-Neishi Coates who recently wrote that "while a good politician accomplishes what is possible, a great one expands the realm of possibility - he doesn't simply accept the lines of argument as they're drawn and hew to the side with the most soldiers, he tries to redraw those lines to benefit his ideals."

The whole idea that single payer is the best option but politically "impossible" is simply unacceptable. Last I checked, electing an African American president was politically "impossible"...until Barack Obama went ahead and got himself elected president. The entire notion of "politically possible" and "politically impossible" is a canard that justifies the status quo. So while it's certainly terrific that Obama is fighting for some sort of universal health care system, and one with a public option (which could ultimately become a single-payer system), let's just remember: Nothing has been politically "possible" until it actually happened - and so if that's the major argument against single payer, it's not just a poor argument, it's a fraud.


Obama: Health Care Reform This Year -- Or Never
(two sites for the comments)

President Barack Obama warned on Thursday that if health care reform didn't take place this year, it won't be completed during his presidency.


*Special Note* Do see the Moyers video segments if at all possible. They are golden.


Obama hasn't floated a plan of his own and despite his previous support for a single-payer plan he has refused to allow any such plan to be discussed at recent healthcare reform negotiations. His claimed deadline may reflect the political realities of congressional elections in 2010, but it is also defeatist and melodramatic. Where was the forewarning on this? Now everyone is supposed to immediately jump in support of whatever Obama decides his plan will be even though he has refused to state just what in the hell it is? And the single-payer option is off the table? And it's now or never? By 1 August 2009?

He doesn't seem very hopeful, does he?

Obama is carefully orchestrating all of the reasons why any healthcare reform will prove impossible. And despite whatever Obama or any other Democrat may say of it in the future - they are intentionally dropping the ball on this reform issue because they lack both the leadership and the courage to do the right thing. Cowards all!

Let me float some ideas of my own with you...

Access to healthcare when you need it is a right and not a privilege. No one should be bankrupted by the vagaries of fate or accidental misfortunes concerning their health.

There is no reason to include the health insurance industry in any negotiations about healthcare reform. Why not? Because the health insurance industry is the problem and the source of waste that needs to be corrected.

Any plan that mandates that citizens must buy insurance from private insurers is a giveaway just like mandatory auto liability insurance. And the waste and enormous expense of healthcare will continue to escalate under such a reworked version of the status quo.

Our political representatives aren't going to do what's right because they fear the health insurance industry more than they fear you, the electorate. You are going to have to make them fear your displeasure more instead.

Obama hasn't really succeeded at anything so far. If he screws up healthcare reform as well, I know I am not voting for him a second time. And I won't be wasting my votes on other Democrats any longer either. I am tired of pretending to myself that Democrats represent any kind of meaningful alternative to the Republicans that will also not get my votes. If we don't pass single-payer during Obama's presidency I am never voting for either party again. Not ever.

Now is the time to contact your political representatives and make them understand what is at stake. I hope that you will make them understand that their political survival hangs on this issue.

People are dying while our representatives kowtow to the health insurance industry instead of us, their rightful masters.