So where does the state single payer movement go from here?

A national health insurance reform bill is on the brink of passing and all is well on Capitol Hill.

But that doesn’t mean too much for the rest of the country.  Much of the country still wants more than a public-option-free, far-from-single-payer, band-aid-like bill to fix our broken health care system.  One writer states, from the interesting vantage point of Australia, where they do have universal health care:

But Australia has something that America lacks: a universal public system that provides basic medical services for all.

Here, thanks to Medicare, you can be cared for in a public hospital without going broke regardless of your health insurance status…But the political compromise [Barack Obama’s] been forced to adopt fails to address the morbidity at the heart of the system.

It’s taking the disease and trying to turn it into the cure.

The solution, the real health care reform that we’ve been asking for since Teddy Roosevelt’s time, lies with the state single payer movement.  And, at least here in Pennsylvania, we’re moving full speed ahead.  All that this bill means for us is that we’d better move fast if we want real health care reform any time soon.

For now, this health care bill seems to be the best we’ll get out of our dysfunctional national government.  It does expand Medicaid coverage, it does set up new health clinics, it does expand insurance coverage in some helpful ways.  But it doesn’t address at all some fundamental problems in our system.  

In that sense, it is like a band-aid.  Instead of just patching up the system, though, we need to completely rework it.  The idea of making profit off of someone’s sickness – off of keeping someone else sick instead of treating them! – is fundamentally flawed.  And the bureaucracy of the insurance companies, among other factors, inflates health care costs to a ridiculous point.

So, as most of you reading this probably agree, the solution is single payer.  And we’re not going to get that at the national level.  Just like they did in Canada, we’ve got to take it to the states.

In Pennsylvania, we’ve got a supportive governor, a supportive Democratic Party, and strong bipartisan support in the legislature.

And, according to the people who are at the top of this campaign, the passage of the health bill in DC isn’t stopping us.

So, politically, HR 3590 is a feat; policy-wise, HR 3590 is rife with problems, challenges, and opportunities.

Washington’s election year “spin” aside, HR 3590 does not deal fundamentally, systemically, or expeditiously (2014 implementation date) with questions of “affordable, comprehensive, quality, healthcare for all” even close to the degree that PA’s HR 1660/SB 400 tackles those questions.  

Moreover, while the national healthcare bill funnels nearly a trillion dollars to buy or subsidize insurance for the uninsured in the profit-first market, and compels (through threat of fines) the purchase of more insurance in the same Blues-monopoly market, HR 3590 does nearly nothing to address the problem of underinsurance – either for the newly insured or for those who are currently insured.  Insurance premiums, deductibles, co-pays, and incidence of medical bankruptcy will continue to escalate under HR 3590.

We citizens of Pennsylvania cannot afford to wait until 2014.  Nor will we ignore the obvious shortcomings of HR 3590 or the new policy opening presented by this political breakthrough.    

Taking action on this has become more urgent than before.  If states are to establish insurance exchanges by 2014, that means that they will already by making major changes to their health care system then, and support for single payer could seriously wane.  Combine this with the fact that supportive Governor Ed Rendell is not up for reelection (although pretty much all of the Democratic candidates support the legislation) in 2010, and you start to get an idea of what is needed.

So what can you do?

Well, the one organization really pushing for this is HealthCare4AllPA.  If you’re not in Pennsylvania, please donate to them and tell any friends or family or colleagues in PA about the important work they’re doing.  Also, check out similar national organizations and organizations in other states, including (but certainly not limited to) Montana, California, Kentucky, and Wisconsin.  (If you’re in PA, this page will also help you find other groups in PA and local groups.)

If you’re lucky enough to be in Pennslyvania, there are several steps you can take.  See if your representative and senator supports the bill.  Email them.  Call them.  Lobby them.  Circulate petitions around your neighborhood and then deliver them to your legislators, like I’m in the process of doing.  Write a letter to the editor.  There are so many options!  Some are easy and only take five minutes, but if you want you can also give hours upon hours of your time to this worthy cause.

No matter where you live, no matter how you live, this is worth your time.  The states are where fundamental health care reform will come from, and here in PA we’re lucky enough to be closer than most.  Without your help, though, this will never become a reality


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    • rossl on March 23, 2010 at 2:35 am

    the Australia story

    • dkmich on March 23, 2010 at 11:19 am

    They are trying to put an opt out on the ballot in November in order to ensure that the Government doesn’t come between us and our doctor.  Can they do that?   If so, why can’t we opt out of Afghanistan.   This country is so nuts.  

  1. For a sense of what Medicare for All would be like, we need look no further than Canada.   With respect to healthcare, the difference from one side of the border to the other with the U. S. is figuratively as stark as the physical border between Haiti and the Dominican Republic is in a literal sense.

    The wikipedia article discussing the Canadian healthcare system is a virtual treasure trove of information, and is a fascinating read.  Here is one excerpt (bolding was added by this writer to provide emphasis)…

    Canada has a publicly funded medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada’s system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate.  Most government funding (94%) comes from the provincial level.[16]. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province’s medical associations, usually on an annual basis. Pharmaceutical costs are set at a global median by government price controls.

    To some extent, despite some abortive attempts to launch universal healthcare in Alberta and British Columbia, beginning in 1935 and 1936, finally, in 1946, the province of Saskatchewan enacted the fledgling system that eventually became the system enjoyed by Canadians today…

    It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open union hospitals under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas’ Co-operative Commonwealth Federation government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.

    You may be tempted to ask yourself, “How do Canadians view Tommy Douglas today”?

    In November 2004, Canadians voted Tommy Douglas, Canada’s “father of Medicare,” the Greatest Canadian of all time following a nationwide contest sponsored by the CBC.[13][14]

    Following Sasatchewan’s lead in 1946, Alberta enacted a similar program in 1950.  By 1957, the federal government in Canada agreed to provide 50% of the funding for any province that enacted a similar healthcare system.  By 1961, all ten provinces agreed to establish similar programs.  Remebering that the United States passed Medicare in 1965, Canada passed the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan, establishing a Medicare system at the same time.  

    With regard to the wikipedia article, the sections with the headings of Criticisms (which discussed wait times), Cross Border Health Care, and Comparison with Other Countries are particularly fascinating.

    I have read that such a program has actually been enacted in San Francisco, which is a beginning.  Once a state enacts such a program, and its residents become sold on it, the pressure will surely build in adjacent states, especially where there are large numbers of people crossing state lines between jobs and home.  It is particularly interesting that Montana is listed as a state where a similar single payer system may be considered, especially given that it shares a common border with Saskatchewan, birthplace of the current single payer system in Canada.  

    Here, south of the border, efforts continue to lay the foundation for a single payer healthcare system, spearheaded by Rep. Alan Grayson (D), as described in a recent  article by this writer.  You can sign the petition here.  

    Like Canada, single payer in this country may have to begin with the states.  May Pennsylvania, home to the Declaration of Independence, the “Cradle of Liberty”, be the first to usher the United States from the 19th to the 21st century.

    Courage is rightly esteemed the first of human qualities because it is the quality which guarantees all others.  – Winston Churchill

    You can always count on Americans to do the right thing – after they’ve tried everything else. – Winston Churchill

  2. … that it does not resolve any of the main drivers of the runaway health care cost inflation implies that sometime over the next ten to twenty years, the employer-provided health care system will be a thing of the past and almost everyone will be in the health care exchanges.

    So where does the fight for not-for-profit publicly administered health insurance go (as one required element of an actual health care reform)? To the exchanges.

    Individually, (1) putting a Medicare Buy-In into the exchanges (2) pooling the exchanges from state into regional then a national exchange and (3) replacing the punitive Individual Mandate with an employer pay or play mandate with the payment going toward the health care exchange premium are each “fixes” to problems that will actually be experienced.

    Collectively, they are a substantial step toward a universally accessible, not-for-profit, tax-funded, publicly administered system.

    How hard that fight is may depend in part on how long the radical reactionaries can lock the Republican party in total repeal mode … the longer they are committed to total repeal, the more time there is to build a coalition to pull the health care exchanges out of the ditch on the side of the road.

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