Healthcare, Not Health Insurance

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).

Healthcare, Not Health Insurance

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).

Obamacare’s Empty Victory

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.

True Single-Payer Healthcare System Being Considered in New York Assembly

From Truthout –

New York State Assemblyman Richard Gottfried, who represents the Chelsea and Hell’s Kitchen sections of Manhattan (D-75th District), has introduced a bill to implement a true single-payer healthcare system in New York State. Although the legislation made it out of the healthcare committee of the Assembly last year, it then was basically stonewalled from going much further.

Gottfried, chair of the health committee, told BuzzFlash at Truthout, the bill was re-introduced at the beginning of this session on January 8th of 2014.

What makes Gottfried’s bill distinct is that it would — if implemented in its ideal configuration — be a true single-payer healthcare system for all New Yorkers (except Veterans, who receive care through a government-administered system of providers employed by the Veterans Administration.)

This differs from what is called the Vermont “single-payer” system, which is a laudable one coming down the pike. But the Vermont healthcare insurance program would more accurately be called a comprehensive coverage system than a true single-payer.

Gottfried’s bill (2078A) would create the New York Health Trust Fund and all New Yorkers — in theory — (except veterans) would eventually receive care through the fund. They would carry a “New York Health” card for all their medical needs. Although still far from being enacted, what would make Gottfried’s bill a near seamless single-payer, if passed and implemented in its ideal form, is that the federal government would (and that is something, alas, unlikely to see for the time being given current DC private insurance control of politicians) pay Medicare and other federal programs directly into the state health insurance program. (Medicaid is already paid to states to administer the program within each state — but Gottfried’s bill would make Medicaid party of the pool of money funding “New York Health.”) There are still some gaps and exceptions that would be closed at a later time were the bill ever to be passed and the feds were to provide waivers, but it puts the first stage of a state single-payer on the map of consideration even if it is a political long shot.

Continue reading…

Single-Payer Is Not Dead

The prospects for single-payer health care — adored by many liberals, despised by private health insurers and looking better all the time to others — did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.

Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.

First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.

Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act — as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.

My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.

“Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.

Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.

The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”

In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.

Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.

Under the Vermont plan, employers and individuals would no longer have to buy private health coverage.

They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.

William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.

How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.

It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.

Bear in mind that the most acclaimed health care systems — in Germany, in France and our Medicare — combine single-payer for basics with private coverage for the extras.

Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.

Go forth, Green Mountain State. Show us what you can do.

Single-Payer Is Not Dead

The prospects for single-payer health care — adored by many liberals, despised by private health insurers and looking better all the time to others — did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.

Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.

First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.

Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act — as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.

My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.

“Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.

Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.

The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”

In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.

Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.

Under the Vermont plan, employers and individuals would no longer have to buy private health coverage.

They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.

William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.

How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.

It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.

Bear in mind that the most acclaimed health care systems — in Germany, in France and our Medicare — combine single-payer for basics with private coverage for the extras.

Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.

Go forth, Green Mountain State. Show us what you can do.

Single-Payer Is Not Dead

The prospects for single-payer health care — adored by many liberals, despised by private health insurers and looking better all the time to others — did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.

Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.

First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.

Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act — as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.

My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.

“Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.

Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.

The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”

In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.

Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.

Under the Vermont plan, employers and individuals would no longer have to buy private health coverage.

They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.

William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.

How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.

It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.

Bear in mind that the most acclaimed health care systems — in Germany, in France and our Medicare — combine single-payer for basics with private coverage for the extras.

Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.

Go forth, Green Mountain State. Show us what you can do.

Is Obamacare a Step Toward Single-Payer?

NO, NO and no: That’s been the Republican Party position on health care reform since the Obama administration’s first months in office. No matter how many pro-industry concessions were made in drafting what came to be called the Affordable Care Act (ACA), Republicans never wavered in their all-out opposition.

But increasingly since its disastrous rollout last fall, the ACA has had critics from the left, too–people who oppose a “reform” that falls far short of universal coverage while threatening harsh financial penalties on those who can afford them least unless they purchase the defective products of the private insurance industry.

Groups that criticized the ACA all along, such as Physicians for a National Health Program and National Nurses United, continue to stand for a “single-payer” program–where the government cuts out the insurers and guarantees health care for all under a system similar to the current Medicare program for the elderly, but much better funded and available to the whole population.

Then there are those among liberals and the left who disagree with both sides. They continue to defend the ACA–on the grounds that it is a step toward universal health care.

An editorial in the Nation magazine last month, for example, acknowledged that the ACA came about because Barack Obama and Democratic leaders in Congress “believed [single-payer] was politically unachievable, so they cobbled together a hybrid of public regulation and private insurance that has come back to haunt them.”

Nevertheless, wrote the Nation’s editors, the left should defend this “hybrid”: “Progressives must step in not only as ardent advocates for better implementation of the ACA–a relatively easy task–but also for structural repairs to the law that will make it a better bridge to the truly universal, truly humane and truly functional health care system that America needs…Indeed, winning [the fight for the ACA's effective implementation] will make future reforms all the more possible.”

The Nation is wrong. The ACA isn’t a bridge to universal health care. It is a cul-de-sac, structured above all else to maintain the central role of the health care industry in general, and private insurance companies in particular.

Achieving universal health coverage and access to care will require dismantling the core of the ACA and replacing it with something else entirely. Making a defense of the ACA in the way the Nation does–as a step in the direction of a single-payer system–cedes ground to the right and is counterproductive to the goal of winning health care as a human right.

Continue reading…

Single-Payer Activism Gets Boost from Obamacare

Dr. Richard Propp and Alice Brody thought Obamacare might sink their movement.

Instead, based on the interest they say they are getting, the federal Affordable Care Act has buoyed their cause of universal health coverage, or “improved Medicare for all,” they said.

At the heart of the new federal law are government-run online markets that provide one-stop shopping to public and private insurance plans for previously uninsured people. The intent was to improve access to health care.

But confusion over the insurance websites and disappointment with the coverage offered has fueled interest in something the activists say is simpler and better � a national health system supported with tax dollars. On Tuesday, they’re screening a documentary about the issue at the First Unitarian Society in Albany.

Recently joining the ranks of single-payer promoters are young adults and labor unions, they said. Both have been dismayed by the trend toward higher-deductible health plans, whether through the new government-run health exchanges or from private employers.

“We’re really surprised at how much new interest there is in this issue,” said Brody, 69, who is active in Single Payer New York, which has supported a proposed state law that would create universal health coverage for New Yorkers.

Propp, 79, launched the Capital District Alliance for Universal Healthcare in 2005. The group is an affiliate of Healthcare-Now!, a national grass-roots advocate that supports similar federal legislation.

The trouble with the Affordable Care Act, single-payer proponents said, is that lawmakers gave too much weight to the concerns of the industries that profit from an overpriced medical system. The result, they say, was a convoluted law that perhaps no one understands completely.

“The reason Obamacare is so complex is it’s so gerrymandered,” said Dr. David Ray of Albany Medical Center, who is active in CDAUH and heads the local chapter of Physicians for a National Health Program, a Chicago-based advocacy group. “The power of the moneyed interests � specifically the insurance industry and the pharmaceutical industry � was not taken out of the equation.”

By contrast, Medicare is easy to apply for and use, they said.

“You can understand Medicare,” Brody said. “The main problem with Medicare is it only serves the elderly, who are very sick. That’s why costs are high on Medicare.”

Another group whose support of universal health coverage may be surprising is doctors. Close to 60 percent of doctors support a single-payer health system, according to PNHP. Doctors support universal health coverage because it would make their business operations simpler, Ray said. Instead of meeting the requirements of dozens of insurance contracts, they would have to handle just one � with the government.

“Most physicians are dealing with so many masters, in terms of the insurance companies,” Ray said. “Single-payer is the only road to continuation of physician autonomy. And if there’s anything that physicians care about, it’s their autonomy.”

Ray, who has practiced medicine for 35 years at the former Community Health Plan and at the Whitney M. Young Jr. Health Center in Albany, said he has long held a philosophy that doctors should be paid for keeping people healthy, not for treating them only when they’re sick. His work at Whitney Young, an Albany-based clinic serving low-income patients, showed him the need for better health coverage for all people, he said.

Propp founded CDAUH when he retired, shortly after reading a Harvard study that showed uninsured people with diabetes had a 50 percent higher death rate than insured patients.

Brody’s impetus to join the movement came with the understanding in recent years that her childhood had been shaped by her family’s struggle to secure adequate health care. Her mother had multiple sclerosis, and her father worked three jobs to pay the household and medical bills. She and her sisters, Brody said, raised themselves.

“Health care should be a human right,” Brody said. “You have a right to be able to, if you’re sick, go see a doctor. It should be with you from birth to death.”