Toward Democracy

Single Payer is Coming....

Single Payer is coming....

by Mary Zepernick

As songwriter Leonard Cohen sings in his ironic rumbling voice, “Democracy is coming, to the U.S.A.!.” 

Indeed, people from California to Maine and in between, weary of  waiting for gifts bestowed from on high, are increasingly claiming their right to make decisions about what does and does not go on in their communities - from stopping harms to creating new institutions. And what these activists, many of them speaking up and stepping out for the first time, are most dramatically encountering is the power of government and corporate complicity - giving rich political meaning to the term codependency.

A case in point is health care. As Nobel economist Paul Krugman wrote in the New York Times, January 29, 2009:  “The whole world is in recession.  But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe - in which millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care.”

Also in January, Jessica Yarbrough distributed the results of the  California Nurses Association and National Nurses Organizing Committee research. “Establishing a national single-payer style healthcare reform system would provide a major stimulus for the U.S. economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the U.S. economy, according to the findings of a groundbreaking study released today.”

Earlier this spring it took a firestorm of protest for the administration to include at the last minute three single payer advocates (including Congressman John Conyers, lead sponsor of HR 676, a single payer bill) in a large forum on health care reform. As Krugman asked in his January 29 column: “Why has the Obama administration been silent at least so far, about one of President Obama's key promises during last year's campaign - the promise of guaranteed access to health care for all Americans?”

On May 5, advocates of a national single-payer system confronted the Senate Finance Committee roundtable on health reform. Ralph Nader reported that the insurance industry was at the table, along with the Business Roundtable, the U.S. Chamber of Commerce, Blue Cross Blue Shield, the Heritage Foundation, and the AARP. “But not one person who stood for what the majority of Americans, doctors, nurses, and health care economists want  -  single payer - was at the table.”

In fact “eight doctors, lawyers and other activists stood up to Senator Max Baucus and the private health insurance industry. And the corporate liberals in Congress.”  Nader wrote that the Baucus Eight “directly and respectfully confronted a room full of corporate lobbyists.  and corporate controlled Senators.”  And were arrested for their efforts!

Most emblematic, however, of the primary obstacle to national health care, as well as most remedies in most areas of our common life, is the following passage from a New York Times article of  May 10 titled “Industry Pledges to Control Health Care Costs Voluntarily.”

...[A] dministration officials said, they do not have a way to enforce the commitment, other than by publicizing the performance of health care providers to hold them accountable.

By offering to hold down costs voluntarily, providers said, they hope to stave off new government price constraints that might be imposed by Congress or a National Health Board of the kind favored by many Democrats.

In remarks prepared for delivery to health care providers on Monday, Mr. Obama says: “These groups are voluntarily coming together to make an unprecedented commitment. Over the next 10 years, from 2010 to 2019, they are pledging to cut the growth rate of national health care spending by 1.5 percentage points each year - an amount that's equal to over $2 trillion.”

Despite corporate maneuvering, however,, to paraphrase Leonard Cohen, single payer is coming to the U.S.A. But like other areas of social, ecological and economic policy, corporate control of the electoral and legislative processes will oppose anything that threatens their power and profits.

Asserting our promised democratic rights - whatever the issue at hand and whether in the local, state or national arena - requires organizing and demands in numbers like those that forced the inclusion of at least a few single payer advocates in the administration's forum. It's equally important to act boldly, like the Baucus Eight whose arrest for simply wanting a seat at the table exposed more widely the fact that the fix is in.

Yet another approach is to create alternative policies and institutions. For example, it's clear to most people that national health care won't be achieved until there are models “on the ground.”  Currently, the most advanced such plan is in a place that may seem unlikely: Cape Cod.

The Cape Care Community Trust Bill, filed in the current Massachusetts legislative session, is the result of a grassroots effort to create a single payer, community owned health care plan for all Barnstable County residents. Its seeds were planted over five years ago at a citizen-organized forum on health care. The outcry for a single payer system led two panelists, a family physician and the county human services director to assemble health care, political, business, and social agency leaders who met for a year to achieve consensus on a set of values and principles that would underlie such a plan.

Enter the activists! Cape Codders for Peace & Justice and Cape Cod WILPF learned about this effort and created a campaign to use the 2006 town meetings to get word out and build support. A non binding resolution was drafted in support of creating a single payer health care plan; town teams were created; and signatures gathered to put the question on the warrants of 14 of Barnstable County's 15 towns. Following a vigorous campaign that included media, presentations to community groups and public officials, and countless phone calls, the resolution passed in ten towns and the Barnstable Town Council -  and the Cape Coalition was launched, now including a 16-member Steering Committee, with Candace Perry, a WILPF member, the coordinator and four other branch members on the committee. We established a Model Plan Development group, and have an Advisory group of community leaders and a mailing list of some 300 Cape Codders. And in classic campaign fashion, the Cape Care Coalition has a brochure, buttons and t-shirt, and soon will have caps to keep the sun out of beachgoers' eyes.

The next phase was plan development, a rigorous project of actually creating the details of Cape Care. This was accompanied by continuing speaking and media work, numerous community forums, and the collection of endorsements from individuals and organizations for the mission statement:  To create a regional, community-owned health care system to provide all Barnstable County residents comprehensive and affordable health care, delivered through the current and expanded network of providers.

In 2008, as the Model Plan was being fashioned into legislation, Cape Care joined the statewide single payer coalition Mass-Care, of which we're a member, to organize on short notice a policy question on the November ballot: Shall the representative from this district be instructed (1) to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts, and (2) to oppose any laws penalizing the uninsured for failing to obtain health insurance. In the ten districts that had the question on their ballot, three of them on Cape Cod, it passed by an astounding average of 71%.