You've come to an old part of SW Online. We're still moving this and other older stories into our new format. In the meanwhile, click here to go to the current home page.
What kind of health care reform?

September 14, 2007 | Page 3

THE U.S. Census Bureau's announcement last month--that the number of people in the U.S. without health insurance climbed again last year to 47 million, or about one in every six Americans--underlined the grave condition of the U.S. health care system. But the intense interest in Michael Moore's documentary Sicko has inspired hope that a movement can be built to win real change.

STEFFIE WOOLHANDLER is a veteran health care activist, cofounder of Physicians for a National Health Program and a professor at the Harvard Medical School. She talked to Socialist Worker's NANCY WELCH about the crisis of the system, and what we should be fighting for.

- - - - - - - - - - - - - - - -

WHAT YOU call the "slow-motion collapse" of employer-sponsored health coverage, coupled with exposés of the dismal state of U.S. health care like Michael Moore's Sicko, has forced many politicians to start talking about universal health care. But there's a difference between their proposals for "universal" health care and the "single-payer" national health program you support, right?

A NATIONAL single-payer health system would provide all effective treatments for free so everyone would be covered without co-payments or deductibles. There would be full coverage for services. That's the type of system they have in many other developed countries.

The words "universal coverage" are used so much in the United States, on the other hand, that they've almost lost their meaning. Mitt Romney's "universal" proposal in Massachusetts, for instance, is a relatively minor tinkering with the insurance system.

What else to read

Woolhandler's Physicians for a National Health Program has a Web site that makes the case for a government-administered single-payer program and has information on single-payer legislation sponsored by Rep. John Conyers.

Healthcare-Now posts a regularly updated calendar showing events around the issue of health care. The California Nurses Association Web site is filled with health care horror stories from both patients and providers, plus ideas of how to get involved in organizing for a change.

For a compact history of U.S. health care policy and the struggles for a national health program, from the progressive era to today, read One Nation, Uninsured: Why the U.S. Has No National Health Insurance, by Jill Quadagno.

Donald Barlett and James Steele's Critical Condition: How Health Care in America Became Big Business--and Bad Medicine is a fact-packed expose of the for-profit health care industry. Marcia Angell, a former editor of the New England Journal of Medicine, takes on Big Pharma in The Truth About the Drug Companies: How They Deceive Us and What to Do About It.


So some politicians have been saying that they want universal coverage, and then offering health insurance policies that are coverage in name only. The policies are so skimpy that even though you have insurance, you still can't afford medical care.

That, of course, is an increasing problem here in the state of Massachusetts with the new Massachusetts health law. It's going to force people to buy those skimpy policies.

WHAT DO you say to the argument that, while inadequate, these plans mandating coverage are at least a step in the right direction?

I DON'T agree with the idea that forcing people to buy skimpy policies is a step in the right direction.

There are some aspects of the Massachusetts law that are okay. There is some expansion in coverage for lower-income people. That coverage is highly subsidized, and that part of the law--Medicaid expansion, if you will--is working to some extent.

What I disagree with is the mandate requiring middle-income people to go out and buy these skimpy policies. The big problem is that people just cannot afford the policies. They end up spending so much money on worthless policies that they have even less money in their pockets to get health care when they need it.

So for someone my age, I'm forced to purchase a policy that costs $4,100 a year, and then once I've got that policy, I've still got a $2,000 deductible. You've already depleted your bank account, and when you need care, you've got to locate more money.

So someone might actually be worse off in that setting than if they were completely uninsured. I don't think that's a step in the right direction.

Some other aspects of the Massachusetts bill were also paid for by siphoning money away from public-sector institutions and the safety-net providers who provide care for uninsured people. So by siphoning funds away from these public institutions, you may leave poor people worse off than they were at the get-go.

DO YOU agree with those health-care advocates who believe it would be impossible to pass national legislation, like Rep. John Conyers' HR 676, for a single-payer national health program, and therefore it makes the most sense to try to pass a single-payer law at the state level?

WELL, I do think a state bill is possible, but it needs to be a single-payer bill that offers real national health insurance. And you need to pay for that some other way than by what we're doing in Massachusetts and other places, which is to starve the public sector.

So I do think a single-payer bill is possible at the state level, but of the reforms that have been enacted at this point, none are single-payer.

THE LAST time people were really talking about a national health program was in the early 1990s, around the election of Bill Clinton. What should we learn from the last time around?

THE MAIN thing is to maintain some clarity about what's a useful reform and what's just hot air. We should remember that not everyone who says the words "universal coverage" is actually going to do something that will offer meaningful coverage to everyone.

It gets very confusing, because in an election season, everybody likes to use words that attract votes. But in order to be a step forward, it has to be a plan that provides real coverage.

That way when people get sick, they're not going to have a worthless piece of paper that they paid a lot of money for, but doesn't make it possible for them to go to a doctor unless they pay more out of their own pocket. That's not worth doing.

And neither is minor tinkering around the edges, like Romney is talking about. Robbing the public sector and sending that money into the private insurance industry to sign up poor people into private insurance is going to leave many, many poor communities worse off than they already are.

It's by and large the Republican strategy to do this--defund the public sector and send that money to private contractors. I think that needs to be exposed for what it is: not just an attack on poor people, though it's certainly that, but also an attack on the public institutions that have provided a safety net for America's poor.

HOW ABOUT what the Democratic presidential candidates have been saying about health care on the campaign trail?

THE DEMOCRATS tend to propose some coverage expansion, often based on a Medicaid-like model, where tax money is used to provide public insurance for some people.

None of them, however, is really talking about a single-payer plan where we would get rid of the private health insurance industry and cover everyone in a single plan like Social Security. The exception is Dennis Kucinich, who is a big single-payer supporter.

John Edwards' plan, although it's not single-payer and I don't think it will get us universal health care, has the positive, from my point of view, of being funded by rolling back the Bush tax cut. That, in and of itself, would make the society much more fair and redistribute income.

But all of the Democrats, with the exception of Kucinich, are still talking about including the private health insurance industry smack-dab in the middle of the health care system, with all of its high overhead costs and waste.

And for that reason, it will be much too expensive to be able to afford real universal coverage. We're likely to continue to see people with all sorts of interests promoting plans with all sorts of gaps like co-payments, deductibles and uncovered services.

WHAT DO you encourage people to do instead of just watching as the election season unfolds?

I THINK people need to actively support the concept of single-payer. Obviously, a specific example of this is HR 676. They need to go out into as many forums as possible, and, speaking as loudly as possible, they need to say we need single-payer.

If there's a candidate debate or candidate appearances, people need to be bird-dogging these candidates and saying, "What about single-payer?" When people write letters to the editor, they need to be arguing the case for single-payer.

People who work within organizations like labor unions, medical staff at hospitals, religious organizations and community organizations need to be setting up meetings where they discuss the issue of single-payer health care, and where they garner endorsements for HR 676.

It's often a good conversation that goes on if you try to persuade an organization to endorse HR 676, by explaining what single-payer is. We've got several hundred labor unions that have endorsed HR 676, and it's great having their names on as endorsers, but even more useful are the kinds of discussions that activists have had at labor councils and labor union meetings on these issues.

Physicians for a National Health Program does a tremendous amount of work within the medical profession. Many hundreds of times each year, we present conferences the evidence showing that medical professionals should be supporting single-payer health care.

But if I had to put it in one line, I'd say: Get out there, in public, discussing single-payer, and getting other people to discuss it and endorse it.

DO YOU see someone in the Senate introducing a comparable bill to HR 676--and if not, should that stop people from organizing around the call for national legislation?

SENATE SPONSORSHIP isn't imminent, but there are several people who have in the past supported ideas like single-payer, and who are saying, "Show us the movement, and then you can get me to bring it out. I'm not willing to go out there in front at this point, but show me the movement."

So there are people within the Senate. Two of the newly elected senators did endorse HR 676 when they were the House representatives--Bernie Sanders and Sherrod Brown. Ted Kennedy, in fact, introduced single-payer bills throughout the 1970s, and when issues of universal health care did end up on a ballot in Massachusetts, he endorsed them.

He also endorses all sorts of lesser reforms, but he's been very clear that if we can bring a show of movement and momentum toward real national health insurance, he'd be willing to work on it.

So we don't have anyone now who'll do it, but there are folks who have been willing to support it in the past. It depends on the strength of our movement.

Home page | Back to the top