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Why is Health Care for America Now Giving Up on Single Payer?

By Rose Ann DeMoro
Executive Director
California Nurses Association

The big splash of news and internet coverage for the new Health Care for America Now coalition of labor, progressive and liberal groups is a reminder of the critical importance of health care reform. And a reminder that partial solutions, such as those proposed by the coalition, will only perpetuate, not end the health care crisis.

The groups behind the new coalition are working in concert with the Obama campaign and Democratic leaders in Congress to build "consensus" around a plan that would presumably be introduced in the first days of the next administration, and pushed through to a quick vote before opponents can mount a "Harry and Louse"-style counter attack.

But, in search of a supposedly politically viable plan, the advocates of this approach have surrendered in advance on the only overhaul that will actually cure the disease, a single-payer, expanded and improved Medicare for all reform.

Their good intentions will leave the same failed system in place, and will not even blunt the political opposition from those on the right and corporate interests who will continue to challenge anything that looks like even modest reform.

They create a false hope of systemic change that won't be, squandering the opportunity to achieve the fundamental reform so desperately needed with so many lives in the balance.

They've also missed one of the most important lessons of the failure of the Clinton plan of 1993-94 which collapsed in part due to the absence of a broad, grassroots, activist movement needed to counter the insurance industry. Only single payer engenders such a movement, the very reason the single payer bill now in Congress, HR 676, has more co-sponsors than any other reform bill with tens of thousands around the country already working to enact it.

Health Care for America Now has identified the main culprit and obstacle to genuine reform. As their inaugural ad proclaims, ”Will health insurance companies ever put your health ahead of their profits? We can't trust insurance companies to fix the healthcare mess."

There's just one problem -- the coalition's proposal does nothing to end the actual practice of insurance companies putting their profits ahead of your health. Nor does it fix the two central components of the health care morass -- insurance company denials of care and the financial squeeze facing American families due to ever skyrocketing healthcare costs which is exacerbated by the escalating credit crisis.

Consider the four healthcare questions posed by families in the first 30-second ad: "Will they pay for his inhaler? Is my surgery covered? Can I choose my child's doctor? Will they cover the chemo?"

All are the direct result of care denials and price gouging by the insurers -- and none would be solved by the HCFAN "statement of common purpose."

How does the HCFAN coalition propose to crack down on the insurance pirates? With a "watchdog role" on the plans "to assure that risk is fairly spread" and that "insurers do not turn people away, raise rates or drop coverage based on a person's health history or wrongly delay or deny care."

You can watch someone rob your bank, but unless you stop them, the vaults are still going to be stripped bare. If you're looking for the hammer or any enforcement mechanism in the HCFAN proposal, don't bother, it's not there.

The insurers don't care if we know they are thieves, they will continue to deny and delay care because it's in their DNA. It's how they are set up to operate, it's how they make money for their shareholders, it's how they generate plush pay packages for their executives, and it's how they compete with the other insurance giants.

Nor does the HCFAN proposal contain any effective cost controls on the insurers. Their commitment to basing pricing on "ability to pay" is a recipe for merely getting the healthcare you can afford, not what you need. It also fails to assure real choice of providers beyond the limited network established by all private insurance plans.

The bone the coalition sponsors throw to single payer advocates is the false promise of a public plan side by side with private insurance. The public plan, they contend, will be so much more attractive that the private plans will just wither away. Don't count on it.

The insurance companies will always be able to lower their prices with cut rate plans with lower standards that they can aggressively market through massive advertising, tele-marketing, even door to door salesmen (as some do now) with a marketing campaign that the public plans will not have the funding to be able to match.

The private plans can then continue to cherry pick the younger and healthier patients while the sicker and older patients are dumped in the public plan, wrecking the whole idea of a risk pool and driving up the costs for the public plan to operate. The competition won't starve the private plans and cause them to wither away, they'll starve the public plan.

There's only one way to stop the insurance industry abuses -- it's to actually stop them. The rest of the world has figured this one out -- see the study in Britain earlier this year that found that the U.S. ranks last in preventable deaths among 19 industrialized nations even though we spend twice as much on healthcare as anyone else. Isn't it time we figured it out here as well?

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee.

Posted on July 10, 2008

Comments

It's sad that our country is run by plutocrats, and that they have such influence with our Representatives and Senators. Congress continues to fund a war that should not have happened while giving tax breaks to the wealthy and ignoring those who need help.

Dan Kanoza

Posted by: dan kanoza at July 10, 2008 01:37 PM

No proposed reform of our health care system that includes the private insurance companies will solve our health care crisis because it is exactly the health care industry, and especially the insurers, that screwed up our system in the first place with their greed.

What healer, in hoping to cure a wound, leaves the infection in? Only fools. The private insurance companies are the infection in our health care system. They cannot be left in.

We must open our eyes and realize that we cannot have profit in our health care system. The money in that system is sacred and should be used for actual care of actual patients.

HCAN has betrayed us and sold us out.

Posted by: Sue Cannon, RN at July 10, 2008 11:53 PM

So the federal government will do a better job managing the massive administrative burden that is healthcare... they will streamline the process better than a for-profit company competing with other for-profit companies can do... right... Sorry folks, but the way insurance companies drive profits is through driving efficiencies, not through unfair claim denials. The whole basis of this argument is flawed and a poorly veiled attempt to capitalize on the public's fear by demonizing an industry.

Posted by: Mark Hebert at July 11, 2008 07:48 AM

This message is coming from the former Clinton organizing team at the DLC. This group is promoting over and over again that we cannot get to universal unless we give managed care plans the opportunity again to "do it better".

Their plan rests on having populations that equal about 30 percent in a local region (doing this by co-mingling public plans and state employees into one pool) to force competition amongst the managed care plans. Go this site and read about it by the primary organizer, David Osbourne. The link is http://www.psg.us/resources/pdfcontent/Health%20Care%20Reform%20White%20Paper%200608.pdf

These are powerful groups and the managed care plans have aggressively been working with them to broaden the message that we can never have universal, single payer here in America because Americans like the idea of someone else managing their care AND the tax implications of this proposal are so daunting, it will cripple our economy.

Instead we have uncontrolled costs of health care crippling individual families, killing our opportunity to compete with every other industrialized country in the world on high end products because of our hidden healthcare fees and forcing businesses to find creative ways to keep employees and at the same time keep profits - by eliminating coverage for families or tying these plans to HSAs.

We have to counter their message with the truth. We are already taxed at a rate for health care in this country that cripples our economy, we have people literally dying waiting for life-saving treatments while insurance companies decide the treatment plans and families, who with one visit to a doctor, can become improverished because of a medical diagnosis.

This is America, let's do it right and get it done.

Posted by: Rep. Shelley Madore at July 11, 2008 09:26 AM

I agree with Ms. DeMoro. Having been on several calls with HCAN, I can attest to her accuracy about the group's goals. If we stay true to principles of inclusion for all people, affordability, and access, keeping the insurance company profits as a major part of the mix assures failure.

Having the state mandate purchase of a commodity in a largely unregulated private market (and backing it up with sanctions) has no precedent other than liability insurance. Health care is not an 'accident'. It is not something you do to someone else from which they have to be protected. Insurance is the wrong medium, and reliance on the 'free market' makes no sense if the need is huge but the ability to pay is impossible. When the supply CANNOT meet the demand because cost is out of sight, the market becomes an archaic mechanism for that supply.

Far better for us to perceive health care coverage as we do utilities - at least when we had the sense to regulate those - with medicine provided by doctors and hospitals, and the monetary aspects of coverage handled by the government linked not to a price but to your income.

One thing the government does really well is that. Look at Medicare, Social Security, and any tax in/pay out system. The government is GREAT at that! It's efficient, little overhead, and items are tied directly to you, the individual. Medicine should be practiced by those who do that best. That is what Medicare does and does well.

Keeping the fantasy that the 'market' works, that it can be controlled, that it is more efficient- all that is entirely offset by our experiences with Medicare Part D and the Massachusetts mandate plan that has left at least half the uninsured absolutely unable to afford it, even with the skimpy subsidies offered, and with no cost controls at all.

It's time to think anew. Trying the same thing over and over and expecting different outcomes? Well, you know the word for THAT.

Posted by: Elizabth Sholes at July 17, 2008 03:47 PM

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