Rx and the Single Payer
By Bill Moyers and Michael Winship
Moyers/ourfuture/blog: May 22, 2009
In 2003, a young Illinois state senator named Barack Obama told a local
AFL-CIO meeting, "I am a proponent of a single-payer universal health care
program."
Single payer. Universal. That's health coverage, like Medicare, but for
everyone who wants it. Single payer eliminates insurance companies as pricey
middlemen. The government pays care providers directly. It's a system that
polls consistently have shown the American people favoring by as much as
two-to-one.
There was only one thing standing in the way, Obama said six years ago: "All
of you know we might not get there immediately because first we have to take
back the White House, we have to take back the Senate and we have to take
back the House."
Fast forward six years. President Obama has everything he said was needed -
Democrats in control of the executive branch and both chambers of Congress.
So what's happened to single payer?
A woman at his town hall meeting in New Mexico last week asked him exactly
that. "If I were starting a system from scratch, then I think that the idea
of moving towards a single-payer system could very well make sense," the
President replied. "That's the kind of system that you have in most
industrialized countries around the world.
"The only problem is that we're not starting from scratch. We have
historically a tradition of employer-based health care. And although there
are a lot of people who are not satisfied with their health care, the truth
is, is that the vast majority of people currently get health care from their
employers and you've got this system that's already in place. We don't want
a huge disruption as we go into health care reform where suddenly we're
trying to completely reinvent one-sixth of the economy."
So the banks were too big to fail and now, apparently, health care is too
big to fix, at least the way a majority of people indicate they would like
it to be fixed, with a single payer option. President Obama favors a public
health plan competing with the medical cartel that he hopes will create a
real market that would bring down costs. But single payer has vanished from
his radar.
Nor is single payer getting much coverage in the mainstream media. Barely a
mention was given to the hundreds of doctors, nurses and other health care
professionals who came to Washington last week to protest the absence of
official debate over single payer.
Is it the proverbial tree falling in the forest, making a noise that
journalists can't or won't hear? Could the indifference of the press be
because both the President of the United States and Congress have been
avoiding single payer like, well, like the plague? As we see so often,
government officials set the agenda by what they do and don't talk about.
Instead, President Obama is looking for consensus, seeking peace among all
the parties involved. Except for single payer advocates. At that big White
House powwow in Washington last week, the President asked representatives of
the health care business to reason together with him. "What's brought us all
together today is a recognition that we can't continue down the same
dangerous road we've been traveling for so many years," he said, " that
costs are out of control; and that reform is not a luxury that can be
postponed, but a necessity that cannot wait."
They came, listened, made nice for the photo op. and while they failed to
participate in a hearty chorus of "Kumbaya," they did promise to cut health
care costs voluntarily over the next ten years. The press ate it up - and
Mr. Obama was a happy man.
Meanwhile, some of us looking on - those of us who've been around a long
time - were scratching our heads. Hadn't we heard this before?
Way, way back in the 1970's Americans were riled up over the rising costs of
health care. As a presidential candidate, Jimmy Carter started talking about
the government clamping down. When he got to the White House, drug makers,
insurance companies, hospitals and doctors - the very people who only a
decade earlier had done everything they could to strangle Medicare in the
cradle - seemed uncharacteristically humble and cooperative. "You don't have
to make us cut costs," they promised. "We'll do it voluntarily."
So Uncle Sam backed down, and you guessed it. Pretty soon medical costs were
soaring higher than ever.
By the early '90s, the public was once again hurting in the pocketbook.
Feeling our pain, Bill and Hillary Clinton tried again, coming up with a
plan only slightly more complicated than the schematics for an F-18 fighter
jet.
This time the health industry acted more like Tony Soprano than Mother
Teresa. It bludgeoned the Clinton reforms with one of the most expensive and
deceitful public relations and advertising campaigns ever conceived - paid
for, of course, from the industry's swollen profits.
As the drug and insurance companies, hospitals and doctors dumped the
mangled carcass of reform into the Potomac, securely encased in concrete,
once again they said don't worry; they would cut costs voluntarily.
If you believed that, we've got a toll-free bridge to the Mayo Clinic we'd
like to sell you.
So anyone with any memory left could be excused for raising their eyebrows
at the health care industry's latest promises. As if on cue, hardly had
their pledge of volunteerism rung out across the land than Jay Gellert,
chief executive of Health Net Inc. and chair of the lobbying group America's
Health Insurance Plans, assured his pals not to worry abut the voluntary
reductions. "We believe that we can do it without undermining the viability
of companies," he said, "and in effect enhancing the payment to physicians
and hospitals." In other words, their so-called voluntary "reforms" will in
no way interfere with maximizing profits.
Also last week, John Lechleiter, the chief executive of drug giant Eli
Lilly, blasted universal health care in a speech before the U.S. Chamber of
Commerce: "I do not believe that policymakers have yet arrived at a full and
complete diagnosis of what's wrong and what's right with U.S. health care,"
he declared. "And I am very concerned that some of the proposed policies-the
treatments, to continue my metaphor-will have unintended side-effects that
make our situation worse."
So why bother with the charm offensive on Pennsylvania Avenue? Could it be,
as some critics suggest, a Trojan horse, getting the health industry a place
at the table so they can leap up at the right moment and again knife to
death any real reform?
Wheelers and dealers from the health sector aren't waiting for that moment.
According to the non-partisan Center for Responsive Politics, they've spent
more than $134 million on lobbying in the first quarter of 2009 alone. And
some already are shelling out big bucks for a publicity blitz and ads
attacking any health care reform that threatens to reduce the profits from
sickness and disease.
The Washington Post's health care reform blog reported Tuesday that Blue
Cross Blue Shield of North Carolina has hired an outside PR firm to put
together a video campaign assaulting Obama's public plan. And this month
alone, the group Conservatives for Patients' Rights is spending more than a
million dollars for attack ads. They've hired a public relations firm called
CRC - Creative Response Concepts. You remember them - the same high-minded
folks who brought you the Swift Boat Veterans for Truth, the gang who
savaged John Kerry's service record in Vietnam.
The ads feature the chairman of Conservatives for Patients' Rights, Rick
Scott. Who's he? As a former deputy inspector general from the Department of
Health and Human Services told The New York Times, "He hopes people don't
Google his name."
Scott's not a doctor; he just acts like one on TV. He's an entrepreneur who
took two hospitals in Texas and built them into the largest health care
chain in the world, Columbia/HCA. In 1997, he was fired by the board of
directors after Columbia/HCA was caught in a scheme that ripped off the Feds
and state governments for hundreds of millions of dollars in bogus Medicare
and Medicaid payments, the largest such fraud in history. The company had to
cough up $1.7 billion dollars to get out of the mess.
Rick Scott got off, you should excuse the expression, scot-free. Better
than, in fact. According to published reports, he waltzed away with a $10
million severance deal and $300 million worth of stock. So much for
voluntarily lowering overhead.
With medical costs rising six percent per year, that's who's offering
himself as a spokesman for the health care industry. Speaking up for single
payer is Geri Jenkins, a president of the California Nurses Association and
National Nurses Organizing Committee - a registered nurse with literal
hands-on experience.
"We're there around the clock," she told our colleague Jessica Wang. "So we
feel a real sense of obligation to advocate for the best interests of our
patients and the public. Now, you can talk about policy but when you're
staring at a human face it's a whole different story."
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Michael Winship co-wrote this article. Bill Moyers is managing editor and
Michael Winship is senior writer of the weekly public affairs program Bill
Moyers Journal, which airs Friday night on PBS. Check local airtimes or
comment at The Moyers Blog at www.pbs.org/moyers.
Research provided by editorial producer Rebecca Wharton.
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