Surprise In Mass. Primary: 21 Percent For Single-Payer Candidate Berwick

Note to politicians: Backing �Medicare for all� is looking less and less like electoral poison. If, deep in your heart, you believe American health care would be better off with a Canadian-style, single-payer system, you might now consider coming out of the closet. (In Democratic primaries in blue states, at least.)

 

 

That�s my suggested takeaway from the striking Massachusetts Democratic primary showing of Dr. Donald Berwick, who rocketed from near-zero name recognition among general voters to 21 percent at the polls. Catch him saying forcefully in the video above: �Let�s take the step in health care that the rest of the country hasn�t had the guts to take: single payer. Medicare for all.�

Now, Vermont not only has a mainstream politician who backed a single-payer system � Gov. Peter Shumlin � it�s actually translating the idea into practice as we speak. But let�s put it this way: This seems to be the first time that a candidate in a mainstream political party in a state that is not a verdant utopian duchy has run on a single-payer platform. And though he did not defeat the longtime familiar faces, he did surprisingly well.

Of course, we knew that Massachusetts voters tend to like the idea of single payer. As recently as 2010, 14 fairly middle-of-the-road districts voted in favor of a non-binding ballot measure calling for �creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts.�

Analysts projected that the results meant a statewide majority in support of a single-payer system. The single-payer idea had polled well in non-binding ballot measures before, as well. But now we�ve seen that sentiment translated into support for a candidate.

Other politicians, including President Obama, have backed the general idea of a single-payer system, but they always add a �but,� said Dr. Steffi Woolhandler, who helped found Physicians for a National Health Program.

�And the �but� usually has to do with the political situation,� she said. �But it�s actually important to say what�s the right thing to do and to really work toward the right solution, and that�s what Don [Berwick] has been willing to do, to say, �We need single payer and skip the �but,� let�s just say we need single payer and that we need to start working toward it.��

Will Berwick�s strong showing change the playing field for other candidates? Dr. Woolhandler says yes: �Politicians understand votes. Unfortunately, they also understand money. But they do understand votes, and I think other politicians will see that voters are behind the idea of single payer.�

I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, �That sounds right to me. Let me tell you my story.�

�I remember a carpenter in Hingham,� he said. �I don�t think he would have said he was a progressive � he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess � embarrassingly, to me � I was expecting some pushback. But he immediately said, �I�ve got to tell you a story.� And he told me about his struggle to get health insurance.

�He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered � to his dismay � that the deductible did not apply to the year, it applied to each separate episode. So this guy, who�s working with his hands and trying to just get through and have his family�s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, �Enough of this!� He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.�

Overall, Dr. Berwick said, �The response has been extremely positive beyond anything I would have anticipated. When I took the position, I had no polling information. I did it because I was looking at the state budget and seeing the erosive impact of rising health care costs on everything else we need to do. The numbers were stunning to me. I got briefed by the Mass. Budget Policy Center and they said � as I remember the numbers and have been quoting them � Parks and Recreation were down 25 percent, local aid was down 40 percent, higher education was down 30 percent.

You really can�t find a line item on the state budget that hasn�t been down in real terms in the last decade. Except health care is up 59 percent. That was the number that stuck in my mind when they briefed me. And as I went around the state and began to see what we need to do for schools, for transportation, for affordable housing � the term I�ve used, and it�s a bold term but it�s confiscation. It�s with benign intent, but health care is essentially taking away opportunities from public investment.�

�And then you meet with businesses and you get the same story. Businesses talk about how the continuing increase in health care costs is cutting opportunities for them to grow and develop their businesses. And then when you talk to labor � I remember meeting with the painters� union, and I asked the person who was hosting me to show me their paychecks, and the union wage scales over the past few years � you can see it right there in black letters � the take-home pay per hour has not been going up. What is going up is contributions to health care. So the logic was strong.

�And the reactions have been consonant with those data. People are very frustrated. They don�t understand their health insurance. They can�t read their policy. They know it�s not transparent. And they are suffering from vastly increased costs.�

No anti-Canada, anti-England backlash against what could be seen as an attempt to �nationalize� or �socialize� health care?

Not really, Dr. Berwick said. �Initially, you have to explain it, like, �What exactly do you mean? Medicare is a federal program.� If you say it�s Medicare for all, that doesn�t quite do it. But as I explain it to people, you take all the funds, put them in a single pool, make that pool publicly accountable, constantly subject to scrutiny and redefinition, stop the paperwork, stop the complexity, that could save 10 percent of the total bill over the first couple of years.�

�People do have questions, like, �Is this a government takeover of health care?� And you explain, �No, no, no. It�s the same delivery system, your doctors and hospitals, this is not nationalization or the state taking over care, but it is a single payment system. So I would say, the reaction to this has been stunningly positive. Could this be catalytic? I certainly hope so. I�d hate to see Vermont lap Massachusetts on being the first to show what a rational payment system looks like.�

Neither of the Massachusetts primary winners � Democrat Martha Coakley and Republican Charlie Baker � backs a single-payer system, so it�s actually pretty well guaranteed that Vermont is going to lap Massachusetts in the single-payer realm.

But perhaps the question is whether Vermont and Massachusetts will follow the pattern of gay marriage: The Vermont Supreme Court broke the ice in late 1999 with its decision on �civil unions,� but it was � arguably � the 2003 decision by the highest court of Massachusetts that set gay marriage on the road to the big-time.

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.

Tim Carpenter’s Politics of Radical Inclusion: In the Streets and in the Polling Booths

Tim Carpenter never lost faith in the very real prospect of a very radical change for the better. And he never lost his organizer�s certainty that the tipping point that would make the change was just a few more phone calls, a few more rallies, a few more campaigns away.

So he kept on organizing.

To the last.

Carpenter, the lifelong social and economic justice campaigner who nurtured Progressive Democrats of America from its founding a decade ago into a national movement, died Monday at age 55 after a long battle with cancer.

Not many hours before I learned that he had passed, Tim was on the phone with me, running through the latest numbers from a national petition drive he and PDA had organized to urge Vermont Senator Bernie Sanders to seek the presidency. They were over 10,500. A few hours after the call, he emailed me, with more numbers. They were over 11,000. That was typical Tim. His enthusiasm for politics was immeasurable, and infectious.

But Tim�s was never a typical politics. He knew the drill: he had been at the side of presidential candidates, developed winning electoral strategies and helped to organize movements around every essential issue of the Carter, Reagan, Bush, Clinton, Bush (again) and Obama eras. But Tim was always about something more; he was never satisfied with an election victory, or a legislative success; he wanted to transform politics because he wanted to transform America into a land that realized what he believed was an irrevocable promise of liberty and justice for all.

To achieve that end, Tim knew it was necessary to transform a too-often centrist, too-frequently compromised Democratic party into a dramatically more militant and more meaningful organization than it has been for a very long time. Mixing memories of the New Deal with elements of the 1960s civil rights and anti-war movements, linking the vision of the Rainbow Coalition with the new energy of fast-food and retail workers demanding a $15 minimum wage, Tim sought to define and achieve what one of his heroes, author and Democratic Socialists of America chair Michael Harrington, described as �the left wing of the possible.�

Tim refused to compromise with politics as usual. Yet, he refused just as ardently to be pushed to the margins. He waded into the middle of every new fight, grabbed a stack of precinct lists, distributed them to the activists he�d brought along in that beat-up car with Bob Dylan blasting on the stereo, and headed for the doors shouting, �Teamwork!�

�The Progressive movement is driven by people, but it is only successful because of people like Tim Carpenter,� said Congressional Progressive Caucus co-chair Keith Ellison, D-Minnesota, a PDA board member who got it right when he said, �Tim showed the kind of determination and courage that was contagious. His passionate idealism was matched only by his inexhaustible commitment to making those dreams a reality.�

Combining his encyclopedic knowledge of movement history and electoral strategy with the knowing optimism of one who had actually bent the long arc of history toward justice, Tim embraced an �inside-outside strategy� that was designed to go around the party elites and link insurgent campaigns to grassroots movements.

�In the polling booth and in the streets� was his vision, and if that meant breaking with the party establishment and aligning with the demonstrators outside the party convention, or outside the White House of a Democratic president, so be it. The principles were the point, and while Tim could join a coalition with folks who might not share every one of his positions, he believed his mission was to pull that coalition to the left.

Tim was a Democrat�to the frustration of his Green, Socialist and social Libertarian friends�but he was never a member of the Democratic Party establishment. He was the thorn in its side, declaring, �I�m not satisfied with the party as it is. I want the party as it should be.�

Tim cut his teeth on campaigns that recognized the connection between transforming politics and transforming the country: as a kid working �behind the Orange Curtain� (in then hyper-conservative Orange County) for George McGovern in 1972 and for the remarkable radical intervention that was Tom Hayden�s 1976 US Senate bid. Tim was a trusted aide to the Rev. Jesse Jackson�s 1988 �Rainbow Coalition� run for the presidency, an inner-circle strategist for Jerry Brown�s 1992 presidential run (addressing that year’s Democratic National Convention and urging delegates to “Save Our Party” from ideological compromises and corporate influence), a key figure in Dennis Kucinich�s anti-war presidential campaign of 2004.

Tim worked on plenty of campaigns that lost�as well as winning campaigns such as those of Congresswoman Donna Edwards, D-Maryland, Massachusetts Governor Deval Patrick and, to his immense delight, Senator Elizabeth Warren, D-Massachusetts�but he didn�t count wins and losses. He was interested in movement building. Drawing together veterans of the 2004 Kucinich and Howard Dean campaigns, Progressive Democrats of America grew, with Tim as its national director, into a network of activists and elected officials on the left of the party.

At the core of the mission was Tim’s vision of a movement-guided politics.

It was the same vision that shaped Tim’s grassroots activism, as a Catholic Worker advocate for the homeless who slept on the streets of Santa Ana to challenge police harassment; as an organizer of the anti-nuclear Alliance for Survival who counted musician-activists Jackson Browne and Bonnie Raitt as friends and comrades; as an organizer and champion of groups that opposed not just wars but the overreach of a military-industrial complex�from United for Peace and Justice to Democrats for Peace Conversion. To begin to list Tim�s causes, his victories and his ongoing struggles would take days�or weeks if Tim was still telling the stories. But suffice it to say that, for more than four decades, he was there�behind the scenes, sleeping on the floor, risking arrest, flying in with the rock stars, counseling the presidential candidates, remembering the name of every son and daughter of every activist, making the money pitch, organizing, always organizing.

The Nation named Tim as its “Progressive Activist of the Year” some years back. And it was far from the only honor accorded him. When Congressman John Conyers, the Michigan Democrat who is the senior progressive in Congress and arguably in America politics, learned that Tim was sick, he told the US House, �Tim has been indefatigable in pressing forward progressive ideals to help strengthen our American democracy. He has been in the forefront of progressive causes, from promoting nuclear disarmament to fighting to abolish the death penalty to establishing health care as a human right, as well as securing voting rights and jobs for all.”

Around the same time, Tim�s daughter ran up to him with an envelope from the White House that had arrived in the mailbox of the family�s Florence, Massachusetts, home. When they opened it, there was a note from President Obama, wishing Tim well while celebrating his resilience.

That was how most of us took the news that Tim was ailing. Knowing he had beaten cancer before, we wanted to believe that Tim was unstoppable. When he warned �it�s pretty serious this time,� we paid attention to his actions, not his words. Because even as he made the rounds of doctors and hospitals, treatments and hospice preparations, he was still on the phone, still texting, still emailing, still organizing.

Tim was determined that Progressive Democrats of America, a group founded when Democrats were not doing enough to oppose the war in Iraq or to advance a �Medicare for All� reform of a broken health-care system�PDA’s slogan: �Healthcare Not Warfare��would keep embracing new issues: amending the US Constitution to end the buying of elections by billionaires and corporations, getting Washington to take seriously the threat of climate change, blocking “Fast Track” and the Trans-Pacific Partnership trade deal.

Tim believed every battle could be won, by building bigger coalitions, by getting more people engaged.

Tim had a remarkable gift for what actress and PDA advisory board chair Mimi Kennedy referred to as �radical inclusivity.� He was always welcoming young activists into the fold, flying off to meet with folks who might form a new PDA chapter, asking people to tell him what new issues they were working on�and then asking how he could help. He had a faith that the change was going to come: a faith born in having won and having lost but never having surrendered the organizer�s dream of a movement that would be unstoppable.

We were in California last year and Tim asked a crowd to:

Help us grow this movement. Help us to put 435 activists in every congressional office, and another 100 activists in every Senate office to say: not only is it time to end this war, not only is it time to bring about healthcare as a human right, but it�s time for our community to stop turning our back on those who so desperately need us. To stop talking just about the middle class� It�s time to talk about the 50 million Americans who are poor.

A politics that speaks not only for the middle class but for the poor�proudly, energetically, radically�jumps boundaries that many top Democrats still avoid. But that was what Tim Carpenter wanted.

“It’s our responsibility to build that movement, your responsibility, my responsibility,” Tim said, even as he warned, �I may not be with all of you when you are out there in those streets, in those struggles, but I will be with you in spirit.�

If we did not fully understand then, we do now.

Tim Carpenter was right. The building of the politics he wanted�more powerful than any party or politician�is now our responsibility. But Tim is with us in spirit, still telling us that the key is not money or television ads, not caution or compromise. It’s a passion for justice. It’s a belief that peace is possible. And, like Tim said, it’s “Teamwork!”

The Neoliberal Turn in American Health Care

The failings of the Affordable Care Act are rooted in a long shift away from the idea of a truly universal health care.

Last year�s three-ring Congressional shutdown circus � for many little more than a desperate rearguard action by an isolated rightwing fringe to undo the fait accompli of Barack Obama�s health care reform � reinforced with each passing day the gaudy dysfunction of the American political system. But we miss something crucial if we construe the perseverance of Barack Obama�s 2010 Affordable Care Act (ACA) as nothing more than the overdue victory of commonsense health care reform over an irrelevant and intransigent right, or, even more, as the glorious culmination of a progressive dream for American universal health care long deferred.

For many commentators, though, this is precisely what the ACA represents. With the law�s passage in March 2010 and its survival in the face of a constitutional review by the Supreme Court, they have concluded that the battle �over universal health coverage,� as one writer for the Washington Post put it, �is basically over.� Unfortunately, the evidence does not permit such a sanguine conclusion.

Most plainly, when we consider the provisions and limitations of the law, it becomes clear that though it may help many, the ACA fails fundamentally to create what so many had hoped for: a system of universal health care. Leaving millions still uninsured and many more �underinsured� � a well-described and researched phenomenon in which the possession of health insurance still leaves individuals and families with dangerous financial liability when illness strikes � the ACA falls well short of the standard of universal health care as it is understood elsewhere in the social democratic world.

But more broadly, when we consider the ACA through the lens of political economy, an even more concerning narrative emerges, one that says even less about the triumph of social democracy and more about the sharp shift of the political center and the disintegration of the New Deal left. For the law fundamentally leaves intact a system of health care predicated, as we shall see, on key neoliberal health care beliefs, for instance the �moral hazard� of free care, the primacy of health consumerism, and the essentiality of the private health insurance industry.

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With Hippocratic Oath, Doctors Pledge Allegiance to Patients, Not Profits

The Maine Medical Association recently updated a 2008 poll of their members that asked the question, �When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a �Medicare-for-all� approach?� In 2008, 52.3 percent favored the Medicare-for-all approach. In the updated poll, released last week, that number had risen to 64.3 percent.

It�s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently, doctors formed the core resistance to �government-run� health insurance in the U.S.

A number of factors account for this impressive change, but the huge administrative burden on practicing physicians created by our plethora of private insurance schemes is certainly near the top of the list.

The other day, I spoke with a Maine physician nearing retirement and looking forward to it. She was recently returning home after a long day in her practice, carrying her �homework,� a pile of administrative paperwork several inches high. Her husband asked her how she got so far behind in her paperwork. �I wasn�t behind at all,� she replied. She did this much paperwork, mostly insurance forms, at least twice a week.

American physicians spend at least three times as much time, money and effort on administrative work related to payment and insurance coverage as our Canadian brethren, with their single-payer system. Administrative hassle is a major factor driving more and more American doctors to sell our practices to large corporations that take care of the back-office work. The Affordable Care Act has only added to that burden. Sixty percent of doctors now work for corporations, and that number is growing.

Working for a corporate provider of health care services is a mixed bag. He who pays the piper calls the tune. As both for-profit and nonprofit health care corporations have become increasingly focused on the bottom line, doctors working for them have come under increasingly subtle and not-so-subtle pressures to generate revenue for their employers.

Some tests and procedures are more profitable than others. Increasingly, doctors� �productivity� is measured by the amount of profitable revenue we produce rather than by the results we get for our patients. But in health care, profitability is a very unreliable measure of value because doctors� fees and other health care prices are often set arbitrarily.

When we graduate from medical school, most of us take the Hippocratic Oath, swearing our primary allegiance to our patients. Young doctors tend to take their oath very seriously. Most doctors truly want to do what�s best for patients, not their insurance company or our employers� bottom line.

But in today�s corporatized and increasingly monetized health care environment, the demands for generation of profit often directly conflict with our clinical judgment. The belief that doctors and other healers act as stewards for our patients� welfare has long earned us a special place in society and the trust of our patients. That position and that trust, so critical to healing, is now threatened.

This conflict has made many doctors very angry. Practicing a profession that has traditionally been a calling has become a business. Doctors today are caught in a system corrupted by an excessive focus on money that is forcing us to behave in ways that conflict with our professional ethics. We are growing very tired of being told how to practice medicine by insurance company bureaucrats and corporate MBAs.

This is another major cause of the burnout experienced by increasing numbers of doctors. Many older doctors are now simply looking for a way out. Others are calling for systemwide reforms that will allow them to return to focusing on the welfare of their patients. Hence the results of the recent MMA poll.

In an excellent new book called �What Matters In Medicine�, longtime Maine family doctor David Loxterkamp points out that medical care, while often using scientific jargon, methods and tools, is at its core a profession about relationships, not profits. That�s something the bean-counters and policy wonks who have become increasingly influential in determining the nature of our corporatized health care system seem unable to understand.

It�s time to remove corporate profit from the financing of health care, and perverse financial incentives from the direct provision of services. It�s time for improved Medicare-for-all.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

Hillary Clinton Likes Obamacare, Opposes Single-Payer

From the Huffington Post –

Hillary Clinton has confirmed, to a paying audience of 20,000 sellers of electronic health records systems, that she supports Obamacare, and opposes single-payer health insurance.

Speaking to a closed-to-the-press meeting of the “HIMSS14″ (Healthcare Information and Management Systems Conference 2014) in Orlando Florida on February 26th, she condemned the Canadian and other nations’ single-payer healthcare systems by saying, “We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque.” The presumption is that what works in Canada cannot work here, that local control must trump everything in order to fix what’s wrong with American health care.

The data prove her statement to be false, if not irrelevant. America’s healthcare problems are deeper than that. The latest OECD data on healthcare costs show that the U.S. spends by far the world’s highest percentage of GDP on healthcare, 17.7 percent; and also show that the average U.S. life expectancy is 78.7 years; by contrast, Canada spends 11.2 percent, and their life expectancy is 81.0 years. The OECD average expenditure is 9.3 percent , and life expectancy is 80.0 years. So: the U.S. spends twice as high a percentage of GDP as every other OECD nation, and gets markedly inferior results. This makes the U.S. far less economically competitive than it otherwise would be; but, the healthcare industries finance conservative politicians such as Hillary Clinton, Barack Obama, and all Republicans; so, those politicians don’t like single-payer — it would take much of the excess profits out of exploiting the sick, and those excess profits help to fund their campaigns.

The American people’s financial losses produce exceptional financial gains for the investors in healthcare-related stocks, and also inflate the pay for executives in those firms. This helps to fund lots of what conservatives such as Antonin Scalia lovingly call “free speech” — campaign commercials.

A physician in Canada headlined in the Los Angeles Times on 3 August 2009, “A Canadian doctor diagnoses U.S. healthcare,” and he wrote: “Until 50 years ago, we had similar health systems, healthcare costs and vital statistics.” But this situation ended with Canada’s single-payer system, where, “all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays. On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.” Nobody goes bankrupt in Canada to pay for needed care. Their system is shared sacrifice, not all of the downsides dumped onto the poorest and the sickest, who can’t pay their bills and end up in emergency rooms until they die of needless ailments.

The Canadian doctor explained that, in that year: “Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.”

So, Hillary received many bursts of applause from her audience of people who profit from other Americans’ being vastly overcharged for inferior healthcare. In fact, the transcriber of her speech headlined “Hillary Clinton wows the HIMSS14 crowd.”

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Labor Builds Support for Medicare for All

While Obamacare Enrollment Continues to Lag, Labor Builds Support for Expanded and Improved Medicare for All

The 113th Congress will likely be remembered as the most unproductive in our history, and with an overall approval rating of 9 perent, it is safe to say that most Americans do not consider this bunch to be a noble group of public servants engaged in good works for the people of this country. It is rare that any member of Congress is honored on any level these days, but one truly worthy exception is Rep. John Conyers (D-MI), who early in December was honored with a breakfast celebration attended by some 40 union representatives at a restaurant on East 29th Street in New York City.

Those present included leaders from Actors Equity, The International Alliance of Theatrical Stage Employees (IATSE) and the New York City Central Labor Council (NYCCLC), whose President, Vincent Alvarez, declared his support for Mr. Conyers’ bill HR 676, The Expanded and Improved Medicare for All Act, and promised to deliver their 1.3 million members to back this cause. This is a very significant development, as the 300 unions under the umbrella of the NYCCLC are made up of truck drivers, teachers, nurses, operating engineers, construction workers, janitors, train operators, electricians, fire fighters, retail workers and many more hardworking Americans who, along with everyone else in our nation, would benefit greatly from this revolutionary healthcare plan. They are the face of American labor today, and Mr. Alvarez spoke of the need for labor and the general public to unite and work together for this imperative cause: providing affordable, quality healthcare to all Americans.

We might recall that it was labor that gave us the middle class during the post World War II years as they worked to indeed lift all boats in that time of unprecedented prosperity. Can they lead our nation once again in this time of unprecedented need? They have been taking quite a beating, and have been decimated in several states by the lackeys of the 1 percent. But their values are America’s values, and it is critical that they remain a vibrant force for change in this country.

Mr. Conyers was introduced by his longtime friend, TV talk show host Phil Donahue, and other speakers that morning included Robert Score, Recording-Corresponding Secretary of Local 1 of IATSE, and Stephen Shaff, speaking on behalf of Progressive Democrats of America. Mr. Conyers himself noted that it took him 15 years to move Congress to declare a national holiday for Dr. Martin Luther King, so he is prepared for a long haul to achieve Medicare For All. He has reintroduced HR 676 in every Congress since 2003, and has now garnered support from 54 other House members, along with an impressive 609 union organizations, including 146 Central Labor Councils/Area Federations and 44 State AFL/CIO’s. Obamacare’s failure to address the Taft Hartley Plans and the operating procedures under which they work could create even more union support for the Single Payer movement. The president must address this issue.

Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.

Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! — as well as some doctors — to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care — including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs — what’s not to like? And if you like your doctor, you actually could keep him or her — did you hear that, Mr. President? You can also pick any doctor you like — no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a “provider” or “vendor,” and we could become patients again, ending our dehumanizing role as a “consumer” or “customer.”

Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama’s second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.

Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) — who is also a doctor — have both introduced Single Payer bills. Bernie’s bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.

Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can’t the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott’s home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.

In the Greider article in this month’s The Nation, entitled “Reviving The Fight For Single Payer,” he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that “…the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies.” Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.”

Rep. McDermott – an advocate for Single Payer for decades – further wondered if hospitals will become “too big to fail” as they continue to merge and buy up private practices, and continue hiring younger doctors as salaried employees. Mr. Greider also made the following revelation: “An AMA survey in 2012 found the majority of doctors under 40 are salaried employees.” Rep. McDermott sees the troubling direction of this trend, noting that many new doctors “…will simply be serfs working for the system,” and Mr. Greider referred to another key point in the AMA research, noting that “…hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Mr. Greider added further insight from Rep. McDermott: “Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.” Even so, Rep. McDermott remains optimistic that stronger health care systems resembling Single Payer will spring up moving forward.

The New York Daily News offered a scathing editorial on December 24th entitled “Can This Patient Be Saved?” in which we were given a blow-by-blow analysis of the devastatingly mishandled rollout of the Obamacare exchanges and the problems millions of Americans have been having signing up for them. The situation was so bad that the deadline was extended until Christmas Eve for those to sign up who wanted their insurance to kick in on January 1, 2014. The CBO projects seven million will sign up in 2014, in addition to the about 1.1 million this year — well below the Administration’s projections. Meanwhile, millions will be losing their current plans due to the mandate. The question of more people losing their insurance than gaining it as a result of the president remaking the “healthcare economy” was also raised in this Op Ed piece.

Key provisions of the bill have already been waived in the past three years since its passage, and an additional postponement of the requirement for companies with fifty or more employees to offer health insurance or pay a tax penalty has now been postponed until 2015.

The individual mandate requiring most Americans to find coverage by April is also waiving penalties for those who had insurance and lost it this year. Most glaring in this critical article is the fact that there is “little reliable” information on who is getting what as far as coverage is concerned, and at what cost. The even larger question is, will those younger and healthier people opt in at all? If not, financially this boondoggle will sink. Obamacare is counting on them.

As the tinkering continues on the ACA, a major architect of this mess has just been rewarded by the president with an ambassadorship offer to China. Senator Baucus, do you not know the meaning of the word “retire?”

All good wishes for a (hopefully) healthy and happy New Year!

- with Jonathan Stone

The Obamacare We Deserve

Today marks the beginning of health care coverage under the Affordable Care Act�s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president�s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president�s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare�s rocky start � clueless planning, a lousy website, insurance companies raising rates, and the president�s telling people they could keep their coverage when, in fact, not all could � is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics �expose� the fact that President Obama endorsed a single-payer system before 2004, they�re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney�s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they�ll use some of that to try to privatize Medicare.

For many people, the �affordable� part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet � I would be remiss if I didn�t say this � Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter�s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won�t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let�s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year � money that would be going to hospitals and treatment.

In blue states, let�s lobby for a public option on the insurance exchange � a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients� health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont�s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That�s why corporate money will soon flood into Vermont to crush it. The legislators who�ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let�s get started. Obamacare can�t be fixed by its namesake. It�s up to us to make it happen.

Michael Moore is a documentary filmmaker whose 2007 film �Sicko� examined the American health care industry.