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Health Care for All: Why We Need a New Prescription

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Posted on Oct 1, 2013

By Scott Tucker

(Page 5)

DM: Physicians for a National Health Program is a nonpartisan, single issue advocacy organization, advocating for a single payer national health program. We have not inquired about political affiliations of our members, but through casual conversations, I know that many members are not pleased with the Democratic Party and its neo-liberal leadership that specifically excluded single payer from consideration during the initial stages of the reform process. Some of our more avid members happen to be Republicans, some nonpartisan, and, of course, several are Green Party members, since single payer is part of their platform.

Even though single payer legislation has been introduced in Congress, it is not realistic to expect any action when one party—the Republicans—currently has an agenda of obstructing government. With gerrymandered districts, it is unlikely that that will change in the near future.

Politicians do not lead, they follow (including following lobbyists’ money). We would have to have a critical mass of grass-roots support before the politicians would pay attention. Although polls indicate that a majority of the public would prefer a national health program, that support does not translate into activism. Single payer ballot measures in California and Oregon had considerable support until close to election time. It took only a few sound bites from insurance industry ads to destroy that support, and both measures lost by staggering margins. The stated support for single payer is very fragile.

Creating movements requires education, coalitions, and intensive grass-roots organizing. PNHP’s mission is to educate the public on single payer, and that is the role that we fill in coalition efforts in grass-roots organizing. Our expertise is in policy, but not in politics, so we are dependent on other coalition members to move the process. We have held numerous strategy sessions and do recognize the need for greater activism, but our organization is not the vehicle for that. For that reason we supported the founding of Healthcare-NOW! (not to be confused with the Obamacare supporters—Health Care for American Now), a single pager advocacy organization dedicated to activism. They are quite active, but their efforts have not yet approached the threshold that we need.


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The Washington Post article by Matt Miller that you cited mentioned the very strong support by Canada’s business community for their single payer system (their Medicare). I personally know several Republican businessmen here who are privately supportive of the single payer concept, but are not ready to lead the advocacy parade, though who are likely to join in once there is a groundswell of support.

I think that it would be a mistake to allow U.S. socialists and other leftists to capture the single payer concept and jealously guard it as their own. It is a far better business model of health care than our current, fragmented, dysfunctional system that has only been expanded by Obamacare without correcting the intolerable flaws in the financing infrastructure. Although it is trite to say this, we really should lay politics aside and join together in an effort to start receiving much greater value for our nation’s health care investment. You have to question the intellect of anyone who would continue to support our current system if they were adequately informed on the health policy issues.

Could we have a Saskatchewan moment? When they began their single payer program they did not have to go to Ottawa to try to extract funds from a multitude of federal programs, but rather their federal government had already authorized funds to be transferred to provincial health programs for their own use. In the United States, although we have various waiver programs, we do not have a mechanism of releasing most federal program funds to the states (Medicare, Medicaid, CHIP, VA, FEHBP, IHS, etc., plus ERISA waivers). For a state to establish a single payer system, enabling legislation would be required which would be as politically difficult as would be enacting a national single payer program. Can you imagine our current highly polarized, cutthroat Congress coming to agreement on such legislation?

ST: The new health insurance exchanges (sometimes called health insurance marketplaces) will be different in each of the 50 states. Not everyone will be shopping around for coverage, especially if they are satisfied with their existing Medicare coverage. Many others, however, will need to be guided through the terrain of new regulations. What advice would you give to people looking for such immediate guidance? And what kind of state coalitions now exist to promote a truly comprehensive health care system for all?

DM: For those who want to know their options under Obamacare, is an interactive site that can answer most of your questions and lead you to your options. There will also be publicity campaigns in most states that may provide you with other resources, especially if you do not have access to an online computer—though most libraries have them.

As you interact with Obamacare, keep in mind that if we had a single payer system, you would not need to make any choices, but rather just register with the system once only, and you would have much better health care coverage for the rest of your life.

There are many organizations and coalitions throughout the nation that continue to advocate for single payer. PNHP has an interactive map that can provide you with some of the resources in your state.

Keep a watch out for single payer activities and join in them when you can, and take friends and associates with you. Networking will help to grow the movement.

ST: Last question, Don, and I thank you for your time and work. There will be political differences in the spectrum of any democratic movement, including the movement for comprehensive health care, and some of those differences are plain enough in this conversation. But there is significant moral ground in common, and a temporary tent on that ground is still better than any sectarian bunker. We must orient ourselves in the terrain of human pain, aging, illness and death, not just in the terrain of party programs and election campaigns. Don, how would you define your ethical and professional creed in your daily work for health care reform?

DM: For my home office that I use for my health reform advocacy work, I had put away all of my credentials and hung on the wall only one item: the Oath of Hippocrates. The credentials are only about me. Health care is about the patient. We need a health care system that respects the primacy of the patient.

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