Let’s Make It Happen.
Well, you may be thinking that we’re on our way to hell in a handbasket but there’s a glimmer of a chance we can actually create significant change during the deranged reign of Donald Trump. Yes, the time may have finally come for health care for all in these United States.
Barack Obama stuck a band-aid on a system that needed a major heart transplant. Right-wing Republicans spent six years or more trying to rip the band-aid off and, when they finally got the opportunity, they had nothing to offer to replace it.
Oh yes, our Wisconsin resident-wonk, Paul Ryan, had a proposal. It proved to be even more unpopular than Obamacare. Ryan had a plan back in 2009 too, when Obamacare was first being crafted. He called it The Patient’s Choice Act, in which he generously offered Americans the choice between a casket and an urn. He followed this up two years later with an equally unpopular campaign to gut Medicare and Medicaid.
But all along there’s been a better option. In wonk-speak it’s called “single-payer.” Some people call it Medicare for All. Whatever you choose to call it, it’s a common sense approach that guarantees quality, fair and cost effective healthcare for everyone.
Congressman John Conyers (D-MI) has been introducing this legislation in every session of Congress since 2003. U.S. Senator Bernie Sanders (I-VT), you may have heard of him, has been presenting similar legislation in the Senate since 2010, influenced by single-payer legislation introduced by the late Paul Wellstone (D-MN) in the early 1990s. Congressman Jim McDermott (D-WA), now retired, had worked with Wellstone, Conyers, Sanders and others in introducing universal healthcare legislation since 1994.
So is this just a case of a few politicians on the loony left jousting with windmills? Not quite. Conyer’s bill, the Expanded & Improved Medicare for All Act (H.R. 676), was introduced early this year and already has 93 co-sponsors. Even Obama, before he became beholden to the powers-that-be, was in favor of universal healthcare. Speaking to an audience of union leaders in 2003, while running for the U.S. Senate, he had this to say:
I happen to be a proponent of a single-payer, universal health-care plan. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody.
As Ralph Nader wrote this past month, politicians on the left and right, from Harry Truman in the 1940s to Hillary Clinton and Minority Leader Nancy Pelosi in our time, have expressed their support for universal healthcare. According to Nader, Pelosi defended herself to young protesters at a recent town hall meeting by saying: “I’ve been for single-payer since before you were born.”
And what about that Tweety Bird in the White House? Back in 2000, he wrote: “The Canadian plan also helps Canadians live longer and healthier than Americans … We need, as a nation, to re-examine the single-payer plan, as many individual states are doing.”
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The Indictment
Let’s back up a little bit and revisit that time around 2006-2009, just before Obama’s Affordable Care Act was cooked up. The Obama reform bill was a political process that fit the adage about law-making: a messy, repugnant business akin to making sausage, not fit for the squeamish to watch.
So what was happening then, and what were the media, politicians and the grassroots doing and thinking? First of all, there was a deluge of articles in newspapers, magazines and online about the healthcare crisis. Yes! Magazine dedicated an entire issue to it in the fall of 2006. Everyone seemed to concur that the system was broken and almost everyone had a somewhat different theory on what it would take to fix it.
Lately, Republicans have been bellowing about sharply rising healthcare costs, citing this fact to support their assertion that Obamacare has failed. But news reports a decade ago revealed that this trend did not begin with the Affordable Care Act. Statistics from the Department of Health and Human Services indicated that U.S. health care costs climbed from 7.2 percent of Gross Domestic Product (GDP) in 1970 to 17.6 percent by 2009. The World Health Organization (WHO) reported that the U.S. spent more on healthcare as a percentage of GDP and more per person ($8,608) than any other country. At 17 percent of GDP, the U.S. spent twice as much in 2013 as France, the second highest country.
Back in 2008, the Centers for Medicare and Medicaid Services (CMS) predicted that total healthcare spending would double to more than $4 trillion by 2017, accounting for one of every five dollars the country spends. (At the time, healthcare spending was increasing at nearly three times the rate of inflation.) When I consulted the latest CMS fact sheet, it showed that national health spending reached $3.2 trillion in 2015.
Americans like to say that “you get what you pay for” but study after study in those pre-Obamacare years revealed that the U.S. health care system was not just the most expensive in the world but also one of the worst performing. The system was not just costly but also inefficient, wasteful, inequitable and faulted for poor outcomes. If report cards were issued to the industrialized nations of the world based on health indicators, the USA would have flunked out of school years ago.
Yes! Magazine’s 2006 issue on American health care noted that the World Health Organization (WHO) ranked the U.S. health system 37th, well below most of Europe and even trailing some Latin American countries. On “level of health,” how efficiently a system translates spending into overall health, (i.e. “bang for the buck”), WHO ranked the USA 72nd.
The U.S. has a higher infant mortality rate than most of the world’s industrialized nations. The number of women here who die during or due to childbirth is now double the maternal mortality rate of Saudi Arabia or Canada, and triple that of the United Kingdom. Our life expectancy ranks 50th in the world, below most developed nations and some of the developing ones.
Back when Democrats were beginning to craft their healthcare reform bill, about 47 million Americans lacked health insurance and nearly 45,000 were dying annually due to lack of health insurance. It was estimated that 50 to 60 percent of all filings for bankruptcy were due, at least in part, to medical expenses. And 68 percent or more of those who went bankrupt had some form of health insurance.
A Harris poll in 2005 indicated that three-fourths of U.S. citizens wanted what all other industrialized countries already had, universal healthcare. So what happened? What went wrong?
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Obamacare: A Necessary Compromise or Kiss of Death?
It was not as if no one was watching and no one cared. Healthcare reform was the biggest story in the news—locally and nationally. It was estimated that at least 800 organizations were actively working on the issue. In Wisconsin alone there were probably close to 100.
I was involved, as a community organizer, with a local group that was part of the national, faith-based network that Obama had also worked for as a community organizer. Wisconsin physicians Linda and Gene Farley, who dedicated decades of their lives advocating for single-payer healthcare, spoke at our meetings. Both are now deceased. Three different bills, all of them calling for comprehensive healthcare reform, vied for support in the Wisconsin State Legislature. One of them, the Wisconsin Health Security Act, would have created a single-payer, “Medicare for All” system in the state. None of the bills got much traction in the legislature, despite referenda in various counties and cities in 2006 indicating 82 percent support for affordable, universal healthcare and a 2008 poll that showed 61 percent of Wisconsin residents favored a state-run health system. Nonetheless, a number of significant reforms to the local health system were enacted.
But getting involved and getting to the table where the decisions are made proved to be two very different things. I could be wrong but I doubt that anyone from the multitude of local and national citizen coalitions (or labor unions or other progressive groups, for that matter), was ever invited to the table.
How about Dr. Quentin Young, a physician and native of Obama’s Hyde Park neighborhood in Chicago? Young, who died just a year ago, was an ardent advocate of single-payer healthcare, a national coordinator of Physicians for a National Health Program (PNHP), and the leader of many other local and national health organizations. When Martin Luther King, Jr. visited Chicago, Young was his personal physician.
Other notables he treated in more than 50 years of private practice included former Chicago mayor Harold Washington, former Illinois governor Pat Quinn, writer Studs Terkel and newspaper columnist Mike Royko. Oh, and Barack Obama too. Young once commented that the legendary Royko “was always very sarcastic and never liked my leftist ideas. Studs would at least listen to me.” Did Obama listen to him, or invite him to the table where the decisions were being made and the deals cut? Apparently not.
So who did Obama and the Democratic power-brokers listen to back in 2009 and early 2010? A case could be made that they were listening to money.
Those who had the money just happened to be the same ones who make their money off healthcare: the drug industry and the insurance industry. As Mark Weisbrot of the Center for Economic and Policy Research wrote early in 2009: “Our system of private insurance and powerful monopolies is vastly more wasteful and inefficient than the healthcare systems of other developed countries. Insurance companies spend tens of billions trying to insure the healthy, avoid the sick, and deny payment for claims. Pharmaceutical companies take $350 billion of our healthcare dollars for drugs that cost a small fraction of that sum to produce.”
During the first half of 2009, Big PhRMA (the Pharmaceutical Research and Manufacturers of America) spent $13.1 million in lobbying and the drug company Pfizer reported $11.7 million in lobbying expenses. “The pharmaceutical industry, which President Barack Obama promised to ‘take on’ during his campaign, is winning most of what it wants in the health-care overhaul,” wrote two reporters in the Wall Street Journal. This booty for the industry included no cost-cutting measures, no cheaper drugs allowed across the Canadian border, and no direct government negotiations with the pharmaceutical companies to lower Medicare drug prices.
At the same time, Bernie Sanders was pointing out that the combined profits of the nation’s major health insurance companies had increased by 170 percent from 2003 to 2007. The former head of UnitedHealth Group had accumulated stock options worth an estimated $1.6 billion and the Cigna CEO had reaped over $120 million in the past five years, Sanders wrote.
The Washington Post was scheduled to host a $25,000 per person “salon” to bring lobbyists and health care CEOs together with the policy-makers drafting the healthcare bill, until heat from the public forced the newspaper to cancel the event.
At the center of the national health care debate, as it dragged on in late 2009, was Max Baucus, chair of the powerful Senate Finance Committee. Who was Baucus listening to? Probably not any of the millions of Americans lacking adequate healthcare or coverage, or those going bankrupt due to healthcare expenses.
Baucus not only had his own taxpayer-subsidized health coverage but also scored $3.9 million in contributions from the healthcare industry over a six-year period, the most among all members of Congress according to the Center for Responsive Politics. Citing data compiled by the Center, the Washington Post reported that the healthcare lobby donated nearly $170 million to federal lawmakers in 2007 and 2008. During the first quarter of 2009, the Dems, who controlled Congress, collected 60 percent of $5.4 million in contributions from the healthcare industry.
When doctors and nurses advocating single-payer healthcare were banned from Senate hearings on healthcare, they stood in silent protest and Baucus had them arrested.
Many liberal Democrats and some of the grassroots organizations had drawn a line in the sand. The line was what was euphemistically called the “public option.” But the political winds were blowing and sand would soon bury the line.
The public option was a proposal to create a government-run insurance agency to compete with private health insurance companies. It would provide an “option” for uninsured citizens who couldn’t afford the rates or were rejected by private health insurers. Obama promoted the public option concept while running for election in 2008 but downplayed it when he got in office.
The public option was included in three bills considered by the House of Representatives in 2009, one of which was passed by the House. But Baucus and other powerful congressional leaders were against it.
In August, 2009, a group of five dozen House progressives wrote to Rep. Nancy Pelosi (D-CA) ruling out support for any bill without a public option. In early September, two leaders of the progressive caucus wrote directly to Obama, drawing their line in the sand. “Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Medicare rates–not negotiated rates–is unacceptable,” they wrote. “A health reform bill without a robust public option will not achieve the health reform this country so desperately needs,” they continued. “We won’t vote for anything less.”
In their brief letter, they used the word robust five times. The dictionary says it means to exhibit sound health or great strength and vigor, but the progressive wing of the Democratic Party proved to be somewhat lacking in these attributes. Late the following month, Joe Lieberman, the man without a party, threatened a filibuster and that was enough to bust the robust demand of the Dems, who began to cave.
Representative Dennis Kucinich (D-OH) voted against an early version of the Affordable Care Act in the House. In a public statement explaining his position, he charged: “Clearly the insurance companies are the problem, not the solution. They are driving up the cost of health care … But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers.”
In mid-March of 2010, Kucinich was a guest on Amy Goodman’s show, Democracy Now!, along with another former presidential candidate, Ralph Nader, the consumer advocate. The House was about to vote on the Senate healthcare bill, Obama had just met with Kucinich on Air Force One on their way to a political rally, and all of the other 77 Democrats who had vowed not to vote for a bill without a public option had already relented. Now it was Kucinich’s turn to toss in the towel.
“It would be impossible to start a serious discussion in Washington if this bill goes down, despite the fact that I don’t like it at all. And every criticism I made still stands,” Kucinich said. “I want to see this as a step. It’s not the step I wanted to take, so that, after it passes, we can continue the discussion about comprehensive health care reform.”
“I think the President could really be instrumental in bringing about just about any kind of change that he wants,” Kucinich added. “For whatever reason, he decided to carefully construct a plan that would admit no chance for any real challenge to the market structure of private, for-profit insurance companies. He’s worked very tightly within that system. That’s a choice that he made. And during the campaign, you know, he made it very clear that he was looking at reforms within the context of the for-profit system.”
Nader, who was not subject to arm-twisting by the President, had this to say: “This bill does not provide universal, comprehensive or affordable care to the American people. It shovels hundreds and billions of dollars of taxpayer money into the worst corporations who’ve created this problem: the Aetnas, the Cignas, the health insurance companies. And it doesn’t require many contractual accountabilities and other accountabilities for people who are denied healthcare in this continuing pay-or-die system that is the disgrace of the Western world.
“For the drug companies, it’s a bonanza. It doesn’t require Uncle Sam to negotiate volume discounts. It allows these new biologic drugs, under patent, to fight off generic competition–that’s a terrible provision. And it doesn’t allow reimportation from counties like Canada to keep prices down.”
But Nader was rather mild in his remarks compared to commentator Keith Olbermann, who used his MSNBC soapbox, just before Christmas 2009, to rant about the legislative conflict and to berate those lawmakers who had fashioned the healthcare bill. Howard Dean had been on his show the night before and had announced he could not support the proposed legislation.
Olbermann began by quoting Winston Churchill: “We have sustained a total and unmitigated defeat, without a war.” He castigated Senator Harry Reid (D-NV) for “seeking the least common denominator. This is not health, this is not care, this is certainly not reform.”
Olbermann urged the Dems not to make the defeat worse “by passing a hollow shell of a bill” that had been “slowly bled to death by the political equivalent of the leeches that were once thought state-of-the-art medicine, is now little more than a series of microscopically minor tweaks of a system which is the real-life, here-and-now version of the malarkey of the Town Hallers.
“The American Insurance Cartel is the Death Panel, and this Senate bill does nothing to destroy it. Nor even to satiate it. It merely decrees that our underprivileged, our sick, our elderly, our middle class, can be fed into it, as human sacrifices to the great maw of corporate voraciousness.”
“Mr. (Chuck) Grassley of Iowa has lied, and fomented panic and fear,” he said, and “Mr. Baucus of Montana has operated as a virtual agent for the industry he is charged with regulating.” Olbermann reserved his most scathing criticism for Lieberman, “the one man at the center of this farcical perversion of what a government is supposed to be … he has sold untold hundreds of thousands of us into pain and fear and privation and slavery–for money. He has been bought and sold by the insurance lobby. He has become a Senatorial prostitute. And sadly, the President has not provided the leadership his office demands.”
Olbermann argued that the provision in the bill requiring people to buy insurance had to be stripped out. “The bill now is little more than a legally mandated delivery of the middle class (and those whose dreams of joining it slip even further away) into a kind of Chicago stockyards of insurance,” he said.
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The game plan: How do we get from here to there?
So here we are, seven years later. Obama got his healthcare program and “cemented his legacy.” He spent the rest of his administration making war and defending his bad health program against rabid Republicans. Instead of the national security of a healthcare system that works, he gave us the national security state. But who was paying attention?
What are our chances now, if Obama couldn’t or wouldn’t do it then? Accuse me of being delusional, if you will, but I think our chances might be a little better now. Here are a few reasons:
One: The cost of healthcare continues to escalate out of control. In another seven years, nearly half of all healthcare spending is expected to be shouldered by the government, at all levels. So, if government is going to be involved anyway, why not have government take a robust position and save everyone lots of money, by eliminating the middle men (private insurers) and reining in the drug companies?
If the present system is allowed to continue, the government is likely to go bankrupt, along with many of its citizens. We can appeal to free-market Republicans on the basis of cost and appeal to everyone else on the basis of justice.
Two: The present system is wasteful and doesn’t do what it’s supposed to do, making it doubly wasteful. And who likes waste?
Every other industrialized country in the world provides healthcare for its entire population at half the cost and has much better outcomes. In Canada, only 1.5 percent of healthcare costs are devoted to administration of the single-payer system. In the United States, 31 percent of healthcare expenditures go to the insurance industry.
According to Steffie Woolhandler, a physician and co-founder of Physicians for a National Health Program, our hospitals are spending 25 percent of their total budgets on billing and administration, while those in Canada and Scotland are spending only 12 percent. In our bloated system, the number of administrative personnel has grown by 25 times the number of physicians, according to Bernie Sanders.
Trump expressed his admiration for the single-payer system in his book, The America We Deserve, and raved about the Scottish healthcare system on the David Letterman show just two years ago. We, as a nation, need to remind Trump that we do deserve a better system and we want it now!
Three: People’s attitudes are changing. More and more people view healthcare as a human right, not a privilege. Bernie Sanders, supposedly the most popular politician in the country, probably deserves a lot of credit for this. Sanders made a publicly-funded, single-payer, universal healthcare program the central tenet of his presidential campaign. Public opinion polls continue to show that the majority of people prefer a government-guaranteed healthcare program. In a LinkedIn survey just last month, nearly half of physicians said they would support a single-payer healthcare system.
Yes, there were people that thought some of Sanders’ proposals extreme, but today proposals of his such as free college tuition are being considered and even tested at the state level.
Four: We’ve tried the other options. They haven’t worked. Now it’s time to try something that will.
There were good progressive people, back in 2008 and 2009, who argued that we needed to “begin where people are at” or that we needed to “get to single-payer by another route.” Well, we’ve been there, done that. We underestimated the people. They were ready all along.
Even the corporate Wall Street Journal, just prior to the implosion of the Ryan healthcare plan, had this to say:
The Healthcare Market is at a crossroads. Either it heads in a more market-based direction step by step or it moves toward single-payer step by step. If Republicans blow this chance and default to Democrats, they might as well endorse single-payer because that is where the politics will end up.
Seven years ago, Dennis Kucinich said he hoped to use the Obama bill as a “step” toward real healthcare reform. Then the Republicans redistricted him out of office. Let’s get him back in the game and take the next step toward health care for all.
Bernie Sanders, who has not stopped campaigning and organizing, recently announced that he plans to soon introduce new healthcare legislation in Congress. Let’s get behind his bill and the Conyer’s bill. Let’s get our unions and faith communities and grassroots organizations and local Democratic groups and all the young people that Bernie brought into the political process to come together and organize another big push. Let’s demand that Trump help “make America great again” by providing a healthcare system that puts people before profits.
The time is now.
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