Future of Public Option Depends on What Happens to Support for Single Payer

HCAN Rally at Chicago Aetna Headquarters | Feb. 16, 2009


In order to continue to tug health care in a more humane and less corporate direction, Americans should continue to stand up and speak out in favor of single-payer health care. The very future of the so-called public option and/or Rep. Alan Grayson’s "Medicare You Can Buy Into Act" depends on people who are willing to take a position for real healthcare for all, a system that does not work within the context of a for-profit system.


Jane Hamsher of Firedoglake and David Sirota, author of The Uprising: An Unauthorized Tour of the Populist Revolt Scaring Wall Street and Washington, are still working to keep the movement for a public option alive by delivering petitions to Sen. Michael Bennet of Colorado.


 Hamsher and Sirota are looking to force Sen. Bennet to offer an amendment including the public option when the Senate is in the process of adding "fixes" to the bill. And, since Sen. Bennet has a primary challenger who is also publicly stating he is for the public option, Hamsher and Sirota are making it possible for voters to apply pressure on the primary so Bennet might take action.


John Nichols, writer for The Nation, is already calling for a "reform of the reform." Suggesting there were "practical and political reasons" for supporting the recent health bill signed by Obama on Tuesday and that passage was part of a process, Nichols now hopes people will come together to build a "Medicare for All" framework around a core principle–that "everybody should have some basic security when it comes to their health"–which Obama declared the health reform enshrined in America.


The problem with continued willingness to support the public option is that it has the potential to be driven by people who misunderstand what just happened here. Facts and figures never suggested the public option was better than single-payer or that would reasonably improve the health care system. The public option was a market-based proposal that promoted the idea that if government competed in the health care market than costs for healthcare would go down.


Such a belief was and still is questionable.So, a few questions need to be asked before pressing on with campaigns for healthcare.


First, what happened? What passed? What did the bill reform?


Second, what did the movement for Medicare for All do already to try and get 51 senators and a majority of the House to support real healthcare reform even as the Obama Administration was compromising on healthcare with unyielding Republicans and forcing weak progressives to fall in line with the intention of ending the reform process soon?


Third, if Americans were unable to gain momentum or enough support for a public option (or a state single payer amendment), what makes one think the public option is going anywhere now that the health reform process is coming to an end?


"A Victory for Capitalism"


Despite the reports from the GOP and Tea Party groups, a socialist 9/11 that allows an Antichrist Obama to advance support for his extreme Muslim Stalinist beliefs even further did not occur. Really, what happened is insurance companies won at the expense of American taxpayers.


In the same article where Nichols calls for the recent health legislation to be reform, Nichols cites the Physicians for a National Health Care Program’s (PNHP) assessment of the bill.


PNHP notes that 23 million will remain uninsured nine years out meaning an estimated 23,000 unnecessary deaths could occur, millions of middle income people will be pressured to buy commercial health insurance costing up to 9.5 percent of their income which covers an average of 70 percent of their medical expenses, and $447 billion in taxpayer money will be given to insurance companies to subsidize and enhance their power to influence future health reform legislation.


Additionally, as with Massachusetts, PNHP further notes health care costs will continue to skyrocket, celebrated insurance regulations like ending denials on basis of pre-existing conditions will suffer from major loopholes since insurance companies helped craft the legislation, and women’s reproductive rights will be further eroded.


Michael Moore, director of Sicko and outspoken advocate for a Medicare for All system in America, said on Democracy Now! after the bill passed. He highlighted the fact that Americans will now be required to purchase insurance from insurance companies:


"the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it. Imagine Congress passing a law that required every person to buy–I mean, name any product–or watch my next movie. There’s a law that says now that you have to buy a DVD of every Michael Moore film. Woohoo! It’s like, hey, not a bad idea! I mean, I don’t know why–that’s what I’m saying. I don’t know why they’re so upset this week, because this bill is going to line their pockets to an even greater extent""


Moore added: 


"…in the long run, at least 15 million Americans are still not going to have health insurance. And as you said, those who have it are going to be forced to buy a defective product. And trust me on this one thing: the insurance companies, they’re not going to go quietly into the night on this, even though they lost. They’re going to find ways to trick up the system to get around it, to raise premiums. 


It’s not going to be as easy as it sounds. "Oh, you’ve got a pre-existing condition. No problem." Well, not exactly "no problem." You know, the so-called controls that this bill puts on them are Mickey Mouse. For instance, if they deny you health insurance–let’s say Aetna won’t give you health insurance because you have a pre-existing condition, and you say to them, "Hey, wait a minute. That’s against the law." And they’re going to go, "Whoa, yeah. Sue me." Because you know what the fine is, the fine for them for denying somebody because they have a pre-existing condition? One hundred dollars a day. So if you’re Aetna, and you’ve got a patient who maybe needs, you know, a $100,000 operation, what would you do? Would you pay out the $100,000 operation because the law says you have to? Or do you break the law but just get a $100-a-day fine? Because, let’s see, after a year that would be $36,500 versus a $100,000 operation. Gee, I wonder which one Aetna’s going to go for. And of course, they could just hope against hope that within a year the person without the operation might be dead, so they won’t have to be worrying about shelling out any more money to a doctor or to a hospital." [emphasis added]


Stack up Michael Moore’s claims against the information given by the Kaiser Family Foundation. It will probably be tough to disprove what Moore says, and if you do prove him wrong, that’s to the American people’s advantage. Also, take a look at this fact sheet Firedoglake put together before the vote on Sunday.


A Year Spent Asking for Too Much, Being Too Idealistic


A single-payer movement valiantly tried to organize the grassroots to support Medicare for All. Like any progressive issue, the principles of the movement ultimately divided support for health reform into two camps–one for Medicare for All and one for a weak public option they thought they might be able to get.


Health Care for America Now (HCAN),,, Howard Dean, etc. hedged their bets. And, let’s be honest–they lost because the health reform bill does not have a robust or weak public option.


The single-payer movement tried to offer up a dose of reality. For, example, Nicholas Skala, former research associate for PNHP, was asked to speak to the Congressional Progressive Caucus on the idea of a Medicare for All system (single-payer). He explained the difference between the public option and Medicare for All.


"Millions of dollars have been spent by political advocacy groups to commission polls and statistics "proving" that their health reform is "politically feasible." Yet political winds do not make good health policy. Careful examination of science and experience do. And it is in the science and experience that we see that single-payer offers the only way to truly comprehensive, universal and sustainable health care, and that "public option" schemes offer only more of the same: tens of millions of uninsured, rapidly deteriorating coverage, an epidemic of medical bankruptcy, and skyrocketing costs that will eventually cripple the system. 

First, because the "public option" is built around the retention of private insurance companies, it is unable – in contrast to single-payer – to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick. A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

In contrast, the "public option" will require huge new sources of revenue, currently estimated at around $1 trillion over the next decade. Rather than cutting this bloat, the public option adds yet another layer of useless and complicated bureaucracy in the form of an "exchange," which serves no useful function other than to police and broker private insurance companies. 

Second, because the "public option" fails to contain the cost control mechanism inherent in single-payer, such as global budgeting, bulk purchasing and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Supporters of incremental reform once again promise us universal coverage without structural reform, but we’ve heard this promise dozens of times before.

Virtually all of the reforms being floated by President Obama and other centrist Democrats have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked – for one year, until rising costs sank it."


Talk with progressives in Congress fell on deaf ears, unfortunately. The public option successfully distracted those for reform. In fact, the same problems that affect and impact elections decimated the movement for real reform. That is, individuals chose the most "electable" health policy, the one that politicians were most likely to support and exploit to their advantage during their re-election campaign, and abandoned single-payer.


Again, those who chose to not follow the facts and figures and push for single-payer lost. They did not get a public option.


Advocates for single-payer applied pressure on the process. The Baucus 8 were arrested on May 5th for challenging Sen. Max Baucus’ exclusion of single-payer from the debate on health care reform.


In October, the Mobilization for Healthcare for All (a coalition of groups for single-payer) began staging acts of civil disobedience in offices of insurance companies and offices of senators and representatives getting in the way of health reform. Doctors and nurses participated in these actions.


The Mad as Hell Doctorsled a tour across the nation to create attention for a Medicare for All system in this country. And, Dr. Margaret Flowers of PNHP became a lightning rod for the movement for real healthcare reform especially after appearing in an edition ofBill Moyers Journal in February of this year.


The single-payer movement never let up–never succumbed to the stigmatism that Democrats were trying to attach to it as they suggested they might, like Kucinich, be trying to "Nader" health reform. (The impetus being that Nader helped elect Bush and the movement might help Republicans defeat healthcare and possibly Obama in 2012 if they don’t abandon their principled stance on healthcare.)


The longer the process wore on, the more people abandoned their vocal support for a Medicare for All system. The Congressional Progressive Caucus and the Congressional Black Caucus abandoned the single-payer movement when they had the best chance to get Medicare for All through. Senators except for Sen. Bernie Sanders and maybe a few others did virtually nothing to get single-payer a hearing in the Senate.


In November 2009, when a version of health reform first passed in the House, Jane Hamsher rightfully challenged Rep. Dennis Kucinich on the fact that no bloc of Democrats organized to block a vote on legislation that didn’t include anything single-payer. In contrast, Republicans and Blue Dog Democrats organized to block the legislation from passing if it didn’t have (or lack) certain measures or policies.


Democrats with Low Expectations Ask, "Won’t the Public Option Delay Reform Even More?"


So, to the third question — what makes anyone think the "public option" is going anywhere, what do we do next, and why should we even be calling for a "public option" now that the process has come to an end?


Interests who have won big in the fight for healthcare tugged the bill in the direction they wanted healthcare to go as much as they possibly could. That’s why the "end-of-life provision" that launched Sarah Palin’s tour against "death panels" was dropped.


Republican cries of a socialist takeover of health care were given credence. Democrats didn’t want to impact or negatively affect the insurance companies whose greedy practices spurred health reform in the first place.That’s why theMedicare buy-in provisiondidn’t win support and why the public option was not in the landmark bill.


Provisions were dropped that would have benefited the LGBT community and Republicans forced Obama and Democrats to make it explicitly apparent that women would not be able to have control over their uterus after health care passed; insurance companies and the government could still prevent women from getting abortions.


Why all these victories for Republicans and conservative Democrats? Well, part of it is the framework. Obama never took discussion of healthcare out of the for-profit context this country currently operates under. So, everything was about the market and how the market could correct healthcare and talk never centered around making health care a public good.


Additionally, the Republicans and Blue Dog Democrats (conservative Democrats) never indicated they would compromise. Progressives did. Supporters for single-payer did. And when they didn’t have the votes, they didn’t have the guts to continue their support for single-payer so the public could see how Republicans and Blue Dogs were protecting the well being of insurance and pharmaceutical companies at the expense of consumers or citizens in this country.


Again, during October 2009, doctors and nurses from all over the nation were recruited by the Mobilization for Healthcare for All to engage in acts of civil disobedience in insurance companies. At the end of October, Matt Hendrickson, a doctor, risked arrest at a Cigna Office near Los Angeles.


Hendrickson said in an interview prior to the arrest, "The reason why the public option was introduced, according to congress people that have spoken to the single-payer movement, was because of the single-payer movement…There was such an upswell [by progressives] for single-payer that [leaders] opted for some compromise that would not have been given if there wasn’t so much support for single-payer."


The single-payer movement is why Rep. Lynn Woolsey (D-Calif), co-chairwoman of the Congressional Progressive Caucus indicated she would "introduce a robust public option bill [in the House] on the very day the president signs the reconciliation bill into law."


Supporting the public option now will at best lead political leaders into a battle that will result in a compromise where we get a few more tiny reforms that could have been passed into law at anytime. Therefore, all public option supporters should consider upgrading their support for the public option to support for Medicare for All (and at the very least the Medicare buy-in being promoted by Rep. Alan Grayson).




Reform will get closer to being the kind of reform this country needs when progressives are willing to take uncomfortable positions that put the politicians they think they have to vote for or else in positions where they have to support the uncomfortable position progressives are taking in order to win.


The health care policies America needs will be enacted when people are more concerned with the policies on the table and less concerned about the future of political leaders who might lose if they support the change they believe in.


Change that is not just cosmetic–that is not just a political but a social victory for Americans–will happen when people take unreasonable positions and get into uncomfortable conversations because, like past issues involving slavery, inequality, and poverty, they believe America has a moral imperative to provide security through healthcare to all of its citizens like other industrial democracies do.


The single-payer movement can provide a home for people willing to take these positions. The movement which fought hard over the past year can help take on bought and paid for politicians, media misinformation and disinformation on healthcare, and cynicism among progressives and Democrats who do not believe America could one day have a not-for-profit healthcare system.


And, to those who wish for a public option, join the ongoing fight for single payer. You just might get the pragmatists to compromise and pass a public option.

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