Health Care Now
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.
For the first time this year Healthcare-NOW! has set up a wiki for our annual Strategy Conference, held from August 22-24, 2014 in Oakland, CA with the Labor Campaign for Single-Payer Health Care and One Payer States.
Presenters, moderators, and attendees have uploaded their own notes, slideshows, photos, video, and sometimes even the full text of speeches for every single workshop and plenary.
You can keep coming back to the conference wiki as a great resource for the dozens of topics covered during the conference: state single-payer legislation, social media strategy, the health care is a human right model being pioneered in Vermont, getting to single-payer through the ballot, and much more.
Additionally, full video is available of the key plenary of the weekend: an in-depth strategy discussion of where the single-payer movement has been and where we need to get to, including John Nichols of The Nation, Vermont State Representative Kesha Ram, and Ethel Long-Scott of the Women’s Economic Agenda Project.
Steve Early worked for 27 years as an organizer and international representative for the Communication Workers of America. He is the author of a new book from Monthly Review Press titled Save Our Unions: Dispatches from a Movement in Distress. He is working on a book about political change and public policy innovation in Richmond, California.
Question 1: Both your new book Save Our Unions: Dispatches From a Movement in Distress - and your previous one, The Civil Wars in U.S. Labor - draw on your experience as a union negotiator and longtime single payer activist. In 2008, liberal foundations, major unions, and the AFL-CIO created and financed Health Care for American Now! (HCAN). This lobbying coalition had a name similar to ours but it soon distanced itself from the goal of single payer. In retrospect, what impact did HCAN have on labor’s quest for a better health care system?
I think HCAN “settled short” and was too compliant with Obama Administration goals. It also went in the wrong direction by embracing the notion that our system could be substantially improved by mandating and subsidizing the purchase of private insurance, maintaining employer plans where they still exist, and offering a “public option” as a not-for-profit alternative for the millions of new customers now shopping for coverage in our state-based insurance exchanges.
Even after the “public option” was eliminated from that package, HCAN over-sold Obamacare to its labor constituents. In retrospect, we would have been better off if the smaller bloc of pro-single payer unions and the more influential (but always overly pragmatic) organizational players in labor’s mainstream had united around the more modest goal of defending and expanding existing forms of publically-funded healthcare.
Labor’s top priority should have been reversing the partial privatization of Medicare–through the costly and inefficient Medicare Advantage program–which Obama criticized as a presidential candidate in 2008. Lowering the eligibility age for Medicare would have been a good incremental next step in the direction of single payer. Unions and their allies could also have tried to insure more of the low-income uninsured through Medicaid expansion—without the option of privatizing it, which the Obama Administration is now permitting in Arkansas, despite the bad track record of Medicare HMOs.
Labor should also have pushed for more federal support for state level experiments with single-payer—which the ACA has now complicated and delayed. Pre-emptive improvements and better funding of the VA system five years ago—instead of the current emergency intervention—might have strengthened that model of public healthcare delivery, which operates as a kind of British-style national health service for those eligible.
Unionized workers now face more, rather than fewer, health plan problems and cost shifting pressures. In frantic letters to Congressional leaders last year, the national presidents of the Teamsters, Laborers, Hotel Employees, and United Food and Commercial Workers unions warned that the ACA’s “unintended consequences” were multiplying to the point where millions of workers, retirees, and their families face “nightmare scenarios.”
Union members were told, correctly, that the ACA would expand Medicaid access for millions of lower-income Americans and make some important insurance market reforms. But organized labor also expected that this type of health care reform would aid union bargaining by leveling the playing field among all employers, much like the minimum wage and other protective labor legislation does.
Union officials believed, mistakenly, that the ACA would restrain medical cost inflation and corporate pressure for health care give-backs. Instead, those trends have continued to be a major cause of strikes and/or contract rejections at AT&T, Verizon, United Parcel Service, Boeing, and other big employers. In industries with multi-employer Taft-Hartley health care trusts, those are being undermined and put a competitive disadvantage by the ACA.
Some of the worst is yet to come. In both the private and public sector, employers are already citing the ACA’s 2018 tax on mis-named “Cadillac coverage” to justify further givebacks from workers who, in reality, only have a healthcare Chevy in their garage. And this is no “unintended consequence” of the law—it’s what it was designed to do.
According to MIT professor Jonathan Gruber, a top White House consultant, this impending 40 percent excise tax on higher cost plans “is intended to shift compensation away from excessively generous health insurance to wages.” Only someone completely disconnected from U.S. labor relations reality would claim that more premium sharing, higher deductibles and bigger co-pays will translate into better pay for workers, who will, instead, continue to suffer from little or no real wage growth because of such cost chifting.
Question 3: Does this crisis represent a new opportunity for single-payer activists to work with organized labor?
It’s a definitely a great opportunity to revive and strengthen the campaign for Medicare for All, but one fraught with some political dangers. That’s because the boomerang effect on labor and the ACA’s widely publicized implementation screw-ups may also end up discrediting health care reform in general.
Several hundred labor activists met in Chicago in early 2013 under the auspices of the Labor Campaign for Single-Payer Health Care. More than fifty unions and ten city or state labor councils were represented at this gathering. Everyone saw new openings to woo national and local unions previously more wedded to job-based health coverage and their own multi-employer welfare funds.
Later last year, the Labor Campaign collected hundreds of signatures on an “Open Letter to the AFL-CIO from Concerned Trade Unionists” that was distributed at the federation’s convention in Los Angeles. The letter criticized the ACA as the product of lobbying by a private insurance industry “whose business model relies on a failing employment-based system and whose profits depend on shifting costs onto the backs of workers while reducing choice and quality of care.”
However, even after some AFL-CIO convention delegates spent much time venting about President Obama’s failure to “fix” the ACA, only a few national unions have actually gone out, educated their members about this problem, and mobilized them accordingly. That job, as always, will have to be done at the grassroots, from the bottom up—every time a public or private sector union contract is up for renegotiation and management is seeking health care give-backs.
Question 4: For those who would like to learn more about fighting for health care as a human right within the labor movement or in solidarity with the labor movement, what further reading and resources would you recommend?
The Labor Campaign for Single Payer has produced invaluable material for union members on how to deal with the ACA, while fighting for something better at the state or national level, such as this briefing on the ACA for unions and union activists.
Other union critiques of the ACA include a recent UNITE-HERE research report, called The Irony of Obamacare: Making Inequality Worse.
To keep track of what’s happening in Vermont, to make health care a human right there, see the Vermont Workers Center.
You can register online now for the August 22-24 super-conference that will bring together Healthcare-NOW!, the Labor Campaign for Single-Payer Health Care, and One Payer States in Oakland, CA!
For the same $60 registration fee we normally charge for our 2-day conference, you can now attend the entire One Payer States conference, workshops being organized jointly by Healthcare-NOW! and the Labor Campaign, as well as a reception and keynote speakers for all three groups. We expect over 300 activists to attend, giving attendees a chance to learn from the best organizing going on around the country, build bridges between labor and community groups, and energize the movements for both state and national single-payer reform.
Please register today, so that you will have time to make travel and housing arrangements!
If cost is a barrier, a limited number of scholarships will be available – just follow the instructions on the registration page for requesting a discount or solidarity housing.
We’re incredibly excited to be joining the Labor Campaign and One Payer States, and we will update you with keynotes, workshops, and panels when the full agenda becomes available!
July 30, 2014 will mark the 49th anniversary of Medicare, our only publicly financed, universal health plan, which lifted a generation of seniors out of poverty. Each year Healthcare-NOW! coordinates Medicare’s birthday as a national day of action for single payer healthcare.
Please email Ben to let us know if you would like to plan or are planning an action this year, so we can email you educational materials, help publicize your event to activists in the area, and put you in touch with others who are planning actions elsewhere in the country.
In years past Healthcare-NOW! has coordinated up to 50 actions on or around July 30th. We want this whole week to be filled with events across the country that will help the movement increase its visibility and outreach. This will be a great organizing opportunity for local and national organizations, and a way for even small actions to become part of a larger movement for the week!