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.

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!”

IAM Transport Lodge Endorses HR 676

Local Lodge 1635 of the International Association of Machinists and Aerospace Workers (IAMAW) has endorsed HR 676, national single payer health care legislation, sponsored by Congressman John Conyers (D MI). The bill is named the �Expanded and Improved Medicare for All Act.�

Jessica Morris, Recording Secretary, reports that the local lodge took this action �because a single payer option is the best way to ensure access for health care for all.� The local is a Transport Lodge representing 450 members who work for a number of airlines in Albuquerque, New Mexico.

Morris says that the union is looking forward to hearing from James Besante, a medical student and member of Physicians for a National Health Program (PNHP), who will speak on single payer at the upcoming meeting on March 13, 2014.

PNHP, an organization of over 19,000 physicians, can provide speakers on single payer health care to union meetings across the country. Just make a request to nursenpo@aol.com (502) 636-1551, and we will work with your union to set it up.

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.”

Continue reading…

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.”

Continue reading…

A Crusader on What Ails Artists

From the New York Times –

Beer bottles clinked and indie-rock classics played overhead at a gallery opening here on a Friday night recently, as one artist after another chatted with Julie Sokolow, a filmmaker and health care advocate who has documented the Pittsburgh scene in detail.

There was Eanna Holton, who makes horror masks and props and recalled spending the last five years paying off a $10,000 surgery bill for her toddler. China Horrell, her co-worker, had a pulmonary embolism that cost more than $100,000 to treat. And Daniel McCloskey, a comic-book artist, told of being uninsured when he smashed his teeth in a bicycle accident last year, at a cost of more than $22,000.

These are among the dozens of stories Ms. Sokolow, 26, has collected over the past two years, showing how the lives of Pittsburgh artists are intertwined with their struggles over the costs of medical coverage. Her online video series, �Healthy Artists,� has chronicled the experiences of more than 40 painters, poets and musicians � talented, ambitious and often with a painful story of medical debt � and drawn the attention of national media figures like Michael Moore.

�Everyone in America has a health care story,� said Ms. Sokolow, whose project has culminated in a new 30-minute documentary, �Healthy Artists: The Movie.�

Ms. Sokolow�s films � made on a shoestring budget and uploaded to YouTube � are also a microcosm of the national health care debate as it relates to the young creative class, a group that is disproportionately underinsured. And while her survey of Pittsburgh�s scene is unusual, it is also an example of grass-roots approaches around the country, like the O+ Festival in Kingston, N.Y., and San Francisco, where performers are paid in free health care.

According to one survey last year, 43 percent of artists lacked health insurance, more than double the national average for the uninsured.

�Julie�s work unearthed what was obvious but hidden at the same time,� said Dan Byers, a curator at the Carnegie Museum of Art in Pittsburgh who helped judge a �Healthy Artists� poster competition that is featured in the documentary. �It brought the more abstract national debate into a very specific, concrete, local context.�

Ms. Sokolow, who grew up in New Jersey and studied psychology and fiction writing at the University of Pittsburgh, said the origins of her project came through her volunteer work at a nonprofit organization, HealthCare 4 All PA. Assigned to film interviews with people who had dire health care problems, she was troubled by a lack of involvement among 20-somethings.

In response, the �Healthy Artists� series was conceived as a kind of �indie �Cribs� for social justice,� profiling young creatives in brief vignettes and getting them talking in a personal way about medical issues. The pieces were collected online and publicized through social media.

The goal, Ms. Sokolow said, was not to dwell on tragedies but to approach the problem with some optimism and use the films to advocate for broad reform through the idea that basic health care is a human right.

�I wanted to take a more positive approach, to not just focus on health care horror stories, but the people who would be empowered by a universal health care system,� Ms. Sokolow said. �Look at the work they are able to do without it. Imagine what they�d be able to do if they had a social safety net.�

Yet part of the power of the vignettes is how they detail the frustrations of freelancers in an economy in which health insurance has historically been tied to employment. In one profile, Jennifer Gooch demonstrated some of her work as a �musician, artist, crafter, maker, doer,� before tearfully recounting how she had declared bankruptcy after getting an $18,000 medical bill that included a colonoscopy.

�The procedure I got would have cost $800 in a socialized-medicine country, and I lost 10 years of credit,� Ms. Gooch, whose work has been covered by National Public Radio and the BBC, said in a recent interview. As a result of the bankruptcy, she had to give up her tailoring business. The $180-a-month plan she recently signed up for through the Affordable Care Act is a big help, she said, but still expensive.

The number of people ages 18 to 34 who have signed up for health coverage through federal and state exchanges grew substantially last month. But Ms. Gooch�s view was echoed by many artists who came out for a gallery crawl in the artsy Garfield section of Pittsburgh, some of whom said they had signed up for plans, while others said they still could not afford one.

Ms. Sokolow said that with the completion of the 30-minute documentary, the �Healthy Artists� project in Pittsburgh was now largely finished, and that she hoped it would be a model for activism in other cities. She is also finishing her first feature film, �Aspie Seeks Love,� another documentary about the dating life of a Pittsburgh man who learned in his 40s that he had Asperger�s syndrome, and in her parallel career as a musician, she is recording her second album.

�Julie�s ability to reach out through social media and connect artists and culture to a critical social policy issue is significant,� said Jim Ferlo, a Pennsylvania state senator who has introduced a single-payer health care bill. �I wish we could multiply her around the country.�

A subtext in the �Healthy Artists� films, and in Ms. Sokolow�s wider advocacy, is a challenge to the notion that artists must suffer outside the basic economic protections of society. A single-payer health care system, offering coverage to all, could solve that problem, at least as far as it applies to health. But an important step, Ms. Sokolow said, is persuading artists simply to stand up for themselves and address a problem that is felt by all but rarely talked about.

�I would like for artists to be advocates for themselves and their own health and not buy into stereotypes,� Ms. Sokolow said. �The people I profiled are working hard and trying to be healthy, and working against a society that�s not allowing that for them.�

Single Payer Rises Again

As the ACA takes effect, an alternative gains ground at the state level.

When Sergio Espana first began talking to people, just over a year ago, about the need for fundamental changes in the U.S. healthcare system, confusion often ensued. Some people didn�t understand why, if the Affordable Care Act (ACA) had passed, people still wanted to reform the system; others thought organizers were trying to sign them up for �Obamacare.�

Healthcare is a Human Right Maryland, the group to which Espana belongs, is in pursuit of something else: a truly universal healthcare system that would cover everyone and eliminate insurance companies once and for all. Espana and many others in the growing movement see opportunity in the renewed discussion around healthcare reform as the ACA�s insurance exchanges go into effect.

They believe that the ACA�s continued reliance on (and subsidies of) private insurance simply aren�t good enough. People are still falling through the cracks, employers are trying to dodge the requirement that they provide insurance for their workers, and many states refused federal subsidies to expand their Medicaid programs. What these activists want is a program that would replace existing insurance programs, cover everyone regardless of their employment status, and be funded by the government, with tax dollars. Such a plan had strong support when the national healthcare overhaul was being crafted in 2009�including initial backing by President Obama�but the president and Congress decided it wasn�t politically possible and passed the ACA as a compromise.

Now, the rocky launch of the healthcare exchanges that form the cornerstone of the Affordable Care Act has helped revive interest in single-payer, says Ida Hellander, director of policy and programs for the advocacy group Physicians for a National Health Program. New York State Assemblymember Richard Gottfried, the author of a 20-year-old single-payer bill that is receiving renewed support, points out that single-payer would avoid many of the issues of the ACA�s launch. �When you don�t have means testing and you don�t have to make guesses about who�s going to cover your doctor or your ailment, it�s very simple.�

While Republicans on the national stage have been grandstanding about �repealing and replacing� the ACA, grassroots activists are on the ground in many states organizing their neighbors around the idea of real universal healthcare. A national program remains the end goal, but Nijmie Dzurinko of Put People First! Pennsylvania believes that state efforts could have a domino effect. �Our job is to change what�s politically possible,� says Drew Christopher Joy of the Southern Maine Workers� Center, which is leading the effort in that state.

According to Hellander, about 25 states already have solid organizing toward single-payer, often accompanied by pending legislation. Some of these efforts predate the ACA: The California Nurses Association led the charge for single-payer in the mid-2000s, twice getting a bill through the California legislature only to have it vetoed by Gov. Arnold Schwarzenegger. Hellander says that the ACA has slowed down some efforts at state reform, as officials turned to setting up exchanges, but the law spurred others in Minnesota, Washington, Hawaii and Oregon. In New York, Gottfried notes that his bill has support from physicians groups, the nurses union and a majority of the lower house of the legislature. And in Massachusetts, considered the laboratory for the ACA, single-payer is now on the table thanks to gubernatorial candidate Don Berwick, the former administrator of the Centers for Medicare and Medicaid Services under Obama.

The biggest legislative victory to date has come in Vermont. Act 48, signed into law by Gov. Peter Shumlin in May of 2011, would begin to create a �universal and unified� healthcare system for the state. The bill, pioneered by the Vermont Workers� Center (VWC), is at the cutting edge of national healthcare policy. Its passage resulted from years of on-the-ground organizing around the principle that healthcare is a human right�that it must be universal, equitable, participatory, transparent and accountable.

However, Act 48 marks just the beginning of a lengthy process toward healthcare for all residents of the state, regardless of employment or citizenship. The next steps are to figure out how �Green Mountain Care� will fit into federal requirements set by the ACA and to pass a mechanism by which the program will be financed.

The VWC favors a more progressive income tax on individuals and employers, along with a wealth tax. Mary Gerisch, president of the VWC, says, �Even though new taxes or progressive taxation sounds very scary, in reality it�s going to be cheaper for everybody, just like it is in every other country, for them to pay it in taxation rather than to pay out of pocket at the doctor.�

This growing movement has attracted growing opposition, says Gerisch, who notes that a number of TV ads and websites have popped up to oppose Green Mountain Care. And Vermonters for Health Care Freedom, a new 501(c)4 organization founded by longtime Republican political operative Darcie Johnston, has paid for several ads and robocalling campaigns against the plan.

Small business owners, in particular, are susceptible to the fear that new taxes will put them out of business, Gerisch says. She mentions one example of a small business owner who was worried about a 10 percent tax (even though no tax has been decided upon), only to find out that he was already paying 13 percent of his profits to buy insurance for his employees, which would be unnecessary under a state plan.

Healthcare is a Human Right believes the organizing model pioneered in Vermont represents the best chance for passing universal healthcare, and the group is forging ahead with that model in its Maine, Maryland, and Pennsylvania chapters. Among the key elements are base-building and education. To combat corporate scare tactics, activists focus on arming citizens with good information.

In Maryland, according to Espana, more than 90 percent of the 1,200-plus people the organization has surveyed over the last year believe that healthcare is a right, and more than 86 percent support a publicly funded system. �Maryland has been coming off more and more as a progressive state. We�ve been able to get some version of a DREAM Act through, we got marriage equality last year�those are great victories but, economically, they�re not that transformational,� he says.

Joy sees an opportunity to build a strong community-labor alliance around universal care in Maine, where the state AFL-CIO has gotten on board with the Healthcare is a Human Right campaign, and the Maine State Nurses Association held a free health clinic to provide services and connect people to the campaign.

Dzurinko and Put People First! Pennsylvania have been organizing statewide�not only in Philadelphia and Pittsburgh, but in rural counties where the conventional wisdom has been that progressives can�t win. Dzurinko says that people in those counties frequently suggest, unprompted, that the U.S. should have a national healthcare system �like in Canada.�

�We often limit ourselves tremendously by not talking to people that we fear or that we have been told won�t agree,� Dzurinko says. �We can�t talk about universality unless we really are talking about everyone, and that means organizing in all communities.� Joy agrees: �If you�re not taking the time to really organize from the ground up, we�ll end up with the ACA again.�

For Espana, organizing around single-payer presents an opportunity to begin a broader discussion about economic justice and human rights. �All of these politics of austerity are just lies,� he says. �Through a fight for healthcare reform you can demonstrate that not only is it morally righteous for us to have a universal healthcare system, but it�s actually cheaper.�

Med Students Lobby for New Yorkers’ Health

Doctors must advocate for their patients’ health � with supervisors who approve procedures, for instance, or insurance companies that pay for services.

On Tuesday, dozens of doctors-to-be tried different advocacy skills � lobbying state lawmakers to advance proposals they believe will improve New Yorkers’ health.

“If we are not going to fight for our patients, who will?” Albany Medical College student Xin Guan asked a few dozen young adults in white coats who had stopped in the basement of the Legislative Office Building for coffee, bagels and a press briefing between their morning and afternoon visits to lawmakers.

It was the first Medical Student Advocacy Day, organized by Guan, originally from California, and two other second-year students from Albany Med, Ajay Major of Indiana and Phyllis Ying of Seattle.

Some 60 to 70 students from around the state joined them. A glance at the coats suggested most were from Albany Med, but some had traveled from several downstate schools, including Albert Einstein College of Medicine, SUNY Downstate Medical Center and Mt. Sinai Medical Center.

Guan, Major and Ying had prepped them with some activist training before the event. Lobbying representatives was a new activity for about half the students, they said.

While the group shared a concern for health issues, they spoke with legislators about proposals that interested them as individuals. Small groups organized around a few popular issues, including bills to provide universal health coverage for all New Yorkers, allow marijuana for medical use, and prohibit doctors from participating in the torture and improper treatment of prisoners.

Anti-hunger advocate Mark Dunlea gave the students a pep talk before they headed back out to meet their afternoon slate of legislators. Dunlea’s group, Hunger Action Network of New York State, works with a coalition of organizations that provide aid to low-income people who struggle with the costs of health care.

He told the students that their future profession would carry some weight with legislators. And he reminded them that legislators are public servants.

“Remember, these guys work for you,” he said.

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 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.

Vermont House Committee Considers Road to Single Payer

From the Brattleboro Reformer –

The health care committee of the Vermont House is lining up some of the tasks that will have to be finished before the state rolls out the first-in-the-nation single payer health care system, now scheduled for 2017.

Meeting Friday at the Statehouse, the committee heard from legislative staffers who outlined details that will have to be worked out, such as how to ensure the state gets the maximum amount of federal dollars and who would be covered.

There are details such as what would happen if a person living in Vermont works in another state where their employer offers health insurance or if someone from another state worked in Vermont and their employer didn’t offer insurance.

On Tuesday, Gov. Peter Shumlin recommitted the state to the single payer goal.

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.