In the past two days, Huffington Post blogs by Roger Hickey of the Campaign For America's Future and Gerald McEntee of the American Federation of State, County and Municipal Employees union have proclaimed the creation of "Health Care for America Now!", a new coalition to fight for universal healthcare.
On the face, this seems like an exciting new development. It is certainly a good thing, to the extent that it places universal healthcare at the top of the agenda for the next president and Congress. Its first proposed TV ad is a powerful critique of the private insurance industry. (See http://youtube.com/watch?v=tirU5qpmFK4)
However, if you scratch beneath the surface, the new coalition reflects significant divisions among progressives about how best to achieve universal healthcare.
Many progressives support HR 676, the legislation sponsored by Rep. John Conyers and co-sponsored by 90 House members to create a universal single payer healthcare system in America similar to that in most other advanced capitalist countries. That's not what the "Health Care For America Now!" coalition supports. According to its Statement of Common Purpose, its plan will provide "a choice of a private insurance plan, including keeping the insurance you have" along with "a public insurance plan without a private insurer middleman." HCAN's plan would also give government a "watchdog role." Supporters of HR 676 want to abolish the wasteful private insurance system under which approximately 30% of every insurance dollar goes not to providing health care, but to administrative costs, executive salaries and shareholder profits; and replace it with a single national system, similar to Medicare, in which every American is covered from cradle to grave, every patient can choose his or her own Doctor, and treatment is determined between patient and doctor. HCAN wants to reform the present private insurance system, albeit with a strong commitment to providing a public alternative that consumers and businesses can buy into and which it hopes will compete in the marketplace with private insurance.
Even the name of the new coalition, "Health Care For America Now," is confusingly similar to an existing coalition called "Healthcare-Now" which has been working for several years to unite community organizations, labor unions, churches and business groups in support of HR 676. The single payer bill has been endorsed by 394 Local Unions, 99 Central Labor Councils, 33 state AFL-CIO's and 14 national and international labor organizations including the United Auto Workers, the National Education Association, the United Electrical, Radio and Machine Workers, the International Longshore and Warehouse Union, and the California Nurses Association/National Nurses Organizing Committee. HR 676 has also been endorsed by hundreds of community organizations and such national organizations as the NAACP, League of Independent Voters, Physicians for National Health Care Program, the United Church of Christ and the United Methodist Board of Church and Society, and 32 City Councils including Baltimore, Louisville, Indianapolis, Detroit and Boston. (For more information on HR 676 and Healthcare-Now see: http://www.healthcare-now.org and http://www.pnhp.org)
So the new HCAN coalition in many ways represents the division of the progressive movement for universal healthcare into competing coalitions with competing plans for healthcare reform, one supporting the reform of the current private insurance system and the other supporting the creation of a single universal public system. Leaders of both coalitions are dedicated progressives who truly believe their approach is best -- indeed, although I'm an active supporter of single payer, some of the founders of HCAN are close friends. One wonders, however, if many of the organizational sponsors of the new HCAN coalition, which includes such prominent groups as MoveOn, AFSCME, NEA, Planned Parenthood and the AFL-CIO, clearly understand the differences. For example, the NEA is a sponsor of both coalitions. The AFL-CIO is a sponsor of HCAN, but 33 State AFL-CIO's have endorsed HR 676. I'm a member of Move On, but as far as I know, MoveOn has never polled its members to determine whether they support universal single payer health care or a reformed hybrid private insurance/public system. If Mov On is going to throw its support to one side or the other of this key debate, it should ask its members' opinions, just as it did in deciding which Democratic candidate to support in the primaries.
This division in the progressive healthcare movement into competing coalitions could endanger healthcare reform, as was the case recently in California. Last year the California Legislature, under pressure from a progressive coalition of community organizations and labor unions, passed a bill which would have created a state single payer system, had it not been vetoed by Gov. Schwarzenegger. This year some liberal Democratic legislators, with support from the SEIU, tried to forge a compromise with Schwarzenegger for a private health insurance mandate. It was defeated in the State Senate after being opposed by a majority of the progressive health care movement in California who support a single payer system.
Why is a single payer system more likely to bring affordable universal healthcare than reforming the current private insurance system? I've written about this in great detail in this "Why Not Single Payer" series on the Huffington Post and the links to the other articles in this series are given at the bottom of this post. To quote from Part 5, "Any healthcare reform plan that's based on private insurance is fatally flawed. The incentive of private insurance is upside down. The less care a private insurance company provides for the same premiums, the higher their profits. Most of us saw the cases in Sicko of insurance companies paying bonuses to employees who rejected healthcare claims from the sick. With hundreds or thousands of different private health insurance plans, it's impossible to negotiate consistently lower costs with health care providers and drug companies. A single payer system has the market clout to reign in costs. Most important, private insurance is a colossal waste of money. Administrative costs for Medicare are 2-3%. Approximately 30% of private insurance premiums go to overhead, profits, and executive salaries...Overall the administrative costs of private insurance exceed $400 billion a year. That's enough to cover all of the uninsured without raising taxes." (For a more detailed critique of HCAN's plan see: http://www.pnhp.org/blog/2008/07/09/a-policy-response-to-health-care-for-america-now/)
Most progressive supporters of incremental reform based on a private/public hybrid will admit that in an ideal world, they would prefer a single payer system. They will argue, however, that the insurance and drug lobby is so powerful that single payer would never pass -- a compromise which maintains the private insurance system but regulates it and provides a competing public alternative is more "pragmatic." I think this argument is misplaced. The private insurance industry will no sooner accept intrusive government regulation which limits its profits, and a public alternative which is truly competitive, than it would a single payer system. Incrementalists will also argue that most Americans won't accept single payer because they want to keep their present employer-based insurance, even though most Americans are seeing their share of premiums rise, their deductibles increase, their choice of doctors reduced, and their insurance claims often denied. But polls show that a majority of American voters will support a single payer system, a majority that is only likely to increase with a mass citizens' movement for single payer and further public education on the alternatives. A recent CBS News poll asked "Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?" 55% chose "One Program for All" and only 29% chose "The Current System."
HCAN is right that the only thing that can overcome the power of the insurance and drug lobby is a massive citizens' movement for universal healthcare. Where they're mistaken, in my opinion, is in trying to divert that movement to a compromise that will never work, rather than focusing that movement on forcing a Democratic Congress and a President Obama to pass and sign HR 676 and bring a truly universal healthcare system to America.
For earlier installments of this "Why Not Single Payer" series on the Huffington Post, please use the following links:
Part 1: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-a_b_67836.html
Part 2: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_70848.html
Part 3: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_75070.html
Part 4: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_84862.html
Part 5: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_94239.html