A high-powered lobbying group is gearing up to push for what it calls health care reform--but the group has already made huge concessions to big business at the outset and endorses Barack Obama's inadequate health care plan.
The organization, Health Care for America Now (HCAN), was formed in July of this year. The group stole its name from Healthcare-Now, a national grassroots organization that supports a "single-payer" health care system modeled on Medicare, in which the government would act as the single insurer. HCAN, by contrast, backs Obama's supposedly more "realistic" approach, which preserves the central role of the private insurance companies, who have left more than 47 million people uninsured.
There have been important, if modest, steps taken to organize around single-payer by activists across the country in the past several years. HCAN threatens to derail this movement, and channel it into support for Obama.
HCAN is made up of major liberal and labor organizations. The steering committee includes four big unions--AFSCME, Service Employees International Union, United Food and Commercial Workers and the National Education Association--plus Moveon.org, the community organizing group ACORN, the National Council of La Raza and Planned Parenthood.
Each of these organizations donated $500,000 to HCAN. Atlantic Philanthropies, funded by billionaire-turned-philanthropist Chuck Feeney, kicked in $10 million to bring the total war chest to $40 million.
That cash allowed the group to kick off a multimillion-dollar national ad campaign. It hired organizers, created a flashy Web site, produced videos attacking the health insurance industry, contacted members of Congress to sign on to a statement titled "Which Side Are You On?" and created a buzz that poorly funded grassroots groups in favor of single-payer couldn't match.
HCAN's national campaign manager is Richard Kirsch, a former supporter of single-payer himself. He abandoned that position in 1993 to lobby for Bill and Hillary Clinton's dead-on-arrival Health Security Act. Clinton's failed proposal would have created "regional health alliances" that preserved the private health-care industry--but Kirsch supported it anyway.
Recently, single-payer advocates got some momentum with HR 676, a bill sponsored by Rep. John Conyers (D-Mich.) that would create a Medicare-style national health care program. But HCAN's Kirsch opposes the effort. As he wrote in response to questions from single-payer activists:
The goal of Health Care for America Now is to build a national movement to win the implementation of health care reform that meets the principles in our Statement of Common Purpose. We believe that a properly designed single-payer bill is one way of doing that, but not the only way.
Many of the organizations that belong to HCAN support a single-payer reform and have endorsed HR 676. But in joining HCAN, they recognize that the major focus needs to be on winning quality, affordable health care for all rather than advocating for only one approach.
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IN PLACE of single-payer, HCAN claims to offer a "bold new solution" to the health care crisis--a hybrid system of three options: keep your private insurance plan, pick a new private insurance plan, or join a government-financed public plan. HCAN further calls for tougher regulation of health insurance companies to "quash greed once and for all."
In fact, there's nothing bold or new about HCAN's plan. David Himmelstein, cofounder of Physicians for a National Health Plan (PNHP), calls the HCAN proposal "a superficially attractive health reform that has a long record of failure--akin to prescribing a placebo for a serious illness when effective treatment is available."
As Rose Ann DeMoro, executive director of the California Nurses Association, wrote in an open letter to HCAN titled, "Why is Health Care for America Now Giving up on Real Reform?" "There's only one way to stop the insurance industry abuses--it's to actually stop them."
Several states have tried to implement HCAN's strategy of extending coverage while leaving private insurers in place. All such efforts have failed--in Oregon in 1989, in Tennessee, Minnesota and Vermont in 1992, and Massachusetts in 2006.
Under the Massachusetts plan, for example, the uninsured are legally mandated to purchase costly and substandard insurance policies, or lose their income tax deductions. Two years after the program began, 7 percent of the state's population remained uninsured, and 86,000 people gave up their $219 personal tax exemption. The plan was also much more expensive than anticipated, with the budget for this year increased by an additional $150 million, to $869 million.
By contrast, a national, single-payer solution would be more cost-effective and wouldn't penalize low-income people who can't afford individual insurance mandates. As DeMoro wrote, "In search of a supposedly politically viable plan, [HCAN has] surrendered in advance on the only overhaul that will actually cure the disease, a single-payer, expanded and improved Medicare-for-all reform."
To understand HCAN's logic, it's important to note that it is not a grassroots campaign, but a lobbying group, with headquarters on K Street in Washington. HCAN works with Democratic leaders in Congress as well as Obama's campaign. Its proposals closely parallel Obama's, so it's no surprise that he signed on to HCAN's statement of common purpose.
What was a surprise to single-payer activists is that John Conyers, the sponsor of the single-payer bill HR 676, signed on with HCAN. As Conyers said in a press release:
I am proud to join HCAN's broad progressive campaign to raise awareness about the need for true universal health care reform. The HCAN coalition and I are united by our belief that the current non-system of health care run by profit-hungry insurance companies is unsustainable and inhumane...
I remain firmly committed to the passage of my single-payer universal health care bill, HR 676, and believe that private insurance will never provide the kind of guaranteed affordable health care America needs. However, I agree with HCAN that a true policy debate in the Congress can only begin when there is broad consensus that the sham reform trumpeted by the industry is off the table.
Why would Conyers join forces with an organization that explicitly preserves a role for the "profit-hungry insurance companies"? Why wouldn't he try to win the organizations on the steering committee on HCAN to work for his single-payer legislation? It's because he accepts the logic of political "realism" as defined by big business and the Washington powerbrokers.
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THIS KIND of "realism" has derailed campaigns for single-payer previously. In 1971, Sen. Ted Kennedy pushed single-payer legislation co-sponsored by Rep. Martha Griffiths. But opposition from the Nixon and Carter administrations and the National Association of Manufacturers was fierce, and in 1974, Kennedy abandoned his own bill.
Kennedy said then that he still believed in the principles of national health insurance, but he was reluctant to reintroduce the bill because he didn't think he could get more co-sponsors. He then introduced a bill co-sponsored by then-House Ways and Means Committee Chair Wilbur Mills. That legislation, which was never passed, aimed to provide universal health coverage, but kept the private insurance industry in the game and continued to link health insurance to employment.
Thus, by putting off a fight for single-payer until circumstances were more "favorable," the principle itself was compromised away.
Since then, prominent Democratic politicians have rarely endorsed a genuine single-payer plan. Barack Obama, however, did so as he began his campaign for the U.S. Senate. Speaking at a union conference in 2003, Obama declared that he was a proponent of single-payer and announced, "Everybody in, nobody out"--the PNHP slogan.
Yet as Obama became a major political player, he dropped his support for single-payer. Now he argues that if we were starting from scratch, he would be in favor of a single-payer system--but since we aren't, he's not.
Nevertheless, many activists have enormous hope that Obama, if he wins the White House, will do the right thing and enact single-payer. Some argue that because Obama was in favor of this in 2003, he understands it's the only way to insure everyone and control costs as well.
But that's not how things work in Washington. The Democratic Party is a capitalist party, funded by big business, and the health insurance industry is among the top contributors to Obama's campaign. It's folly to believe Obama would willingly back legislation that puts the insurance companies out of business.
Obama and the Democratic Congress will only push for a single-payer solution if they are forced to do so by a large, grassroots movement.
In the meantime, advocates of single-payer will have to sharpen the debate with HCAN. In the name of pragmatism and political expediency, HCAN is attempting to corral the single-payer movement into backing Obama's hybrid plan. If they succeed, another opportunity will have been lost to win single-payer and to make health care a human right in the United States.
Helen Redmond is a member of the Chicago Single-Payer Action Network (CSPAN.) and the International Socialist Organization (ISO.) She writes for the Socialist Worker. She can be reached at email@example.com