Tuesday, March 15, 2011

Single Payer/Medicare for All

An interview with Margaret Flowers

Dr. Margaret Flowers is a congressional fellow of Physicians for a National Health Program (PNHP). I recently interviewed her for OpEdNews.

BRUNWASSWER: Republican lawmakers, fresh from their November victory, are pledging to move immediately in the new Congress to dismantle the health care law that President Obama gave so much attention to. What's your take on that?
FLOWERS: As you know, Physicians for a National Health Program does not support the new health law. Overall, we find that it does more harm than good by further privatizing our health care and failing to address the fundamental problems of rising costs and lack of access to care for tens of millions of people. That said, we find the Republican plans to dismantle the health law reprehensible, given that they are willing to remove what coverage was gained under the law and offer no effective alternative to our health-care crisis.
The Republican calls to repeal the law are mere political posturing and will not succeed. In fact, the health industries, which contributed more heavily to Republican campaigns in the last election cycle than to Democrats, do not want the full law repealed. Republicans will more likely succeed in defunding portions of the bill and relaxing regulation of the health insurance industry. This will only escalate our health care crisis.
The health law passed in 2010 has already begun to unravel as the Department of Health and Human Services has had to issue multiple waivers excusing businesses and insurance companies from complying with provisions in the law that they refused to meet. A large part of the increase in coverage under the law was based on an expansion of Medicaid. However, states are facing severe budget deficits which will prevent them from implementing the expansion. Republican efforts will likely accelerate the unraveling.
This is why PNHP and the many other organizations that advocate for Single Payer/Medicare for All continue to push forward in educating and building the grassroots voice for single payer. We recognize that our health-care problems have not yet been appropriately addressed or solved.
There are millions of us who share your concern about the current health-care crisis. How do you channel that public distress to meaningful and positive change?
Civil unrest in this nation is growing. Although information about this unrest is largely censored by the mainstream media, we see that non-union workers' and anti-poverty movements are growing, as are more organized actions, such as the prison protests in Georgia, nurses' strikes, and veteran-led antiwar civil resistance. This type of unrest is to be expected if we look at what happens historically in nations that experience such severe wealth inequalities as we have in the United States.
Some of the civil unrest is turning to violence. In the absence of constructive and nonviolent avenues for social change and as unemployment, lack of access to health care, homelessness, and poverty grow, the level of violence may increase. This is why we must educate, organize, and engage in actions that change the balance of power away from corporate interests to the needs of people.
There are three important principles that can guide effective action. First, our movements, whatever the issue, must be independent of political parties. The Republican and Democratic parties are both controlled by concentrated corporate power. There are some differences between those parties, but overall they serve corporate power and not the people. We must be willing to hold all legislators accountable to act on behalf of people even if that means that they lose a few elections until the shift occurs. And independence means we will have to make our own media because mainstream media is also controlled by corporate interests.
Second, we must be clear about what we ask for and pose solutions for all our problems. For health-care it is a national single payer health system. For unemployment and the environment, it is investment in green jobs and ending oil and coal dependence. For the economy, it is developing sustainable local economies and ending Wall Street bailouts. And so on. We must educate the public through local events and independent media about these solutions.
And third, we must be uncompromising in our demands. We are too often willing to accept partial or non-solutions to our problems because we are told that what we want is politically infeasible. When we look at health care, we are told that single payer is not politically feasible. We have heard this for decades. However, the legislation that passes which is supposed to be politically feasible fails from a practical standpoint. It simply doesn't work. The number of uninsured continues to grow and soaring health-care costs are destroying our families and businesses. At some point, we have to realize that we determine what is politically feasible because we hold the power of the vote. We must learn to use that power.
It is important to realize that work for peace and for social and economic justice is all related. The various movements need to join together to create a healthy, prosperous, and just country. For me, this means that we must organize large acts of non-violent resistance that focus on weakening corporate power and letting legislators know that business as usual cannot continue. This is why I joined the veterans in their action against war at the White House in December.
What can you tell us about specific efforts for single payer?
There is a lot happening at the state level when it comes to single payer. Currently, 20 states have single payer health bills in some phase of the legislative process. California passed a state single payer bill in 2006 and 2008. I just returned from a large health professional student-led march, rally, and lobby day at the state capitol in Sacramento. The California single payer coalition is continuing to move forward to pass single payer. California faces such a serious budget crisis that I was told the legislature will be basing their cuts on what will result in the least number of lives lost.
We are particularly enthusiastic about Vermont. They are poised to pass a single payer health bill this legislative session. The state hired Dr. William Hsaio from Harvard to design their health system. He has designed health systems for five countries, the most recent being the single payer system in Taiwan. The new governor of Vermont, Peter Shumlin, ran on a strong single payer platform. And Vermont has Senator Sanders, who has been a long-time proponent of single payer. Even with all of the stars seeming to be aligned, it is going to be a difficult process to get single payer passed in Vermont.
Legislation will also be introduced at the national level again in both the House and Senate this year. It is important to work at both the state and national levels because we cannot predict where we will be successful first. The ultimate goal is a national single payer health program so that all people will have access to care.
Tell us about the national deficit, the commission, and efforts to cut social insurances like Medicare and Medicaid.
The president appointed a commission to look at our national deficit last April, the National Commission for Fiscal Responsibility and Reform, composed of 18 people, 14 of whom were fiscal hawks. The commission received support and staff from the Pete Peterson Foundation, which has advocated for cuts to our social insurance programs for decades. It was interesting that the president created this commission despite opposition from within the Democratic Party. During the summer and fall, there was considerable effort by the Peterson Foundation and in the media to convince people that Social Security and Medicare/Medicaid were to blame for the deficit and that they would need to be changed by either raising the age of eligibility or otherwise placing more of the cost onto the individual.
Members of the single payer community testified before the commission and built a public education campaign called Hands Off Our Medicare to counter the misinformation coming from the deficit commission and the media. The commission was required to vote on recommendations to reduce the deficit by December 1. They missed the deadline and were not able to gain enough votes to pass a package of recommendations. However, many believe that their proposed actions will turn up in legislation being put together in the coming year.
It is commonly accepted that the rising cost of health care is a fundamental cause of our national deficit, besides the wars and financial catastrophe. Several members of the commission rightly said that we must deal with the cost of health care in order to effectively resolve the deficit. Unfortunately, while the commission has made the correct diagnosis, they are ordering the wrong treatment. The commission proposed some initial cuts to Medicare including the funds that help to pay for training doctors, and proposed more drastic measures if the initial steps are not effective.
Of course, the initial steps will not be effective because they miss the cause of Medicare's difficulties. Medicare and Medicaid are not the causes of our national deficit, they are the victims of a broken health system. As our overall health-care costs rise, so do the costs of Medicare and Medicaid. The most effective way to control costs would be to expand and improve Medicare and put everybody in the country on Medicare instead of using hundreds of different health insurances as we do now.
The administrative savings alone of a single payer national health program would be around $400 billion. There are other ways that Single Payer/Medicare for All controls health care costs, such as giving hospitals and other medical institutions a global budget and negotiating for the prices of pharmaceuticals, medical devices, and services.
We will need to watch carefully to make sure that Congress does not chip away at Medicare and Medicaid over the next few years. These social insurance programs have been effective in improving the health of the population they serve and in lifting people out of poverty. It is imperative that we preserve and protect them as we continue to push for improved Medicare for All.

Joan Brunwasser is a co-founder of Citizens for Election Reform which since 2005 has existed for the sole purpose of raising public awareness of the critical need for election reform.

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