December 17, 2009

By Donna Smith


Sickening. Saddening. Maddening. And the stuff of future determination in the political struggle for healthcare for all in the United States.

On the floor of the U.S. Senate today, Sen. Bernie Sanders of Vermont rose to offer his single-payer, Medicare for All amendment No. 2837 and to begin debate. Then, one of the two Republican doctors in Senate, Sen. Tom Coburn, R-Oklahoma, demanded a full reading of the 700-page amendment.

From the Senate gallery, I watched as Sen. Max Baucus told Sanders the only way to halt the Republican delay tactic would be to withdraw the amendment. Sanders stated emphatically to Baucus, “I will offer this amendment.” But both men left the chamber as the amendment reading went on.

The Republicans seemed to be pleased with the procedural maneuver. Periodically one of the Democratic leadership would walk over to Coburn and chat. He’d smile and lean on his stack of documents – everything being very well staged for the C-SPAN cameras.

I thought how cold and callous it all looked from the gallery – healthcare is not a laughing matter for millions of us. This crisis has killed thousands of our fellow citizens and bankrupted millions more. I fail to find any of that remotely funny or something over which any Senator ought to feel pride as he or she blocks progress towards a better healthcare system.

The words of the amendment were clear and clean. And though not many were there to actually listen, I couldn’t help but hear the details of the amendment and wish people could grasp the simple beauty of knowing each of us, all of us would have the care we need when we needed it at a lower cost. Instead, we’re going to have more of the mess we have now – more insurance company influence over our lives and our bodies, and in many cases at a higher cost.

Single-payer, amendment number 2837 sounded pretty good to me. I was more than willing to wait out the Republican mischief and the Democrats’ worry about not passing something – anything – before Christmas. I was more than willing to listen to every word.

After two hours of reading page after page of the amendment, Sanders stepped back up to his desk and withdrew the amendment. The reading stopped. And the fight for single-payer, Medicare for all died for this Congressional cycle.

Senator Sanders stood proudly and defiantly at the microphone and delivered the floor speech on behalf of single-payer. By then it was all over except for getting his intelligent remarks and his passion on the record. Those who care about where we need to go with this nation’s healthcare system should listen to Senator Sanders’ floor speech from today, December 16, 2009.

The fight will go on. As surely as the deaths attributable to a lack of access to healthcare in the United States will continue to mount and as surely as the number of bankruptcies directly related to medical crisis will also continue to rise, so too will the cry for real healthcare justice. This Congress and this President are not going to get to the place we needed them to go. They are not extending healthcare as a basic human right to all of us.

It makes me wish I had purchased a little health insurance stock along the way. Because as soon as Joe Lieberman made sure that he cleared out any chance of any public insurance expansion at all from this bill, the for-profit health insurance companies saw their stocks begin to rise again.

So, how do we get through this cycle? Will there be a conference committee effort to restore a state based single-payer amendment to health reform legislation? Or will we just watch as Congress passes some messy piece of something that isn’t likely to do very much at all to mitigate the healthcare crisis in this nation just to claim they did something?

And what of the single-payer advocates and movement? Well, in the words of the brave nurses who never took “no” for an answer on other healthcare issues from the “Governator” or anyone else, “We’ll be back.” Healthcare is a human right now and it will be when we win this struggle. It’s just going to take more time and, unfortunately, more suffering to get where we need to go.

Meanwhile, many of us wait anxiously for reports out of Pennsylvania where they were having a state Senate hearing today on their state single-payer bill. We have miles to go before we sleep.


By Donna Smith


As my grandmother used to say, “I was born on a weekend but not last weekend.” The latest insult to Americans hungry for a bit of healthcare justice for all comes from the news that the Senate health bill now allows insurance companies to place annual limits on payments for some catastrophic illnesses, like cancer.

Surprise, surprise, surprise. Another day. Another lie uncovered in the process. Another piece of this reform bill that favors the for-profit health insurance industry.

Associated Press’ Ricardo Alonso-Zaldivar writes, “Health care loophole would allow coverage limits”: “A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

“The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

“As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not ‘unreasonable.’ The bill does not define what level of limits would be allowable, delegating that task to administration officials.”

Read that passage again folks. The bill was “tweaked.” No official or legal amendment required when the insurance industry needs a tweak they damn well get a tweak. And this is quite a tweak.

Just hours ago, I continued to read reports that claimed our healthcare reformers in Congress were doing away with pre-existing condition clauses and also ending lifetime caps on coverage. Some patients and families were thrilled with this change alone, and most especially those people struggling with serious illnesses.

This summer, a friend of mine in Colorado was asked to introduce President Obama at a forum in Grand Junction. Nathan Wilkes was selected to do so because he could speak clearly and passionately about his family’s troubles keeping enough insurance coverage for his son, Thomas, who has a serious blood disorder. My friend has been and is a supporter of Medicare for all, single-payer type reform, but this opportunity to introduce the President and weigh in about eliminating lifetime benefit caps was a powerful pull. Nathan gave an intelligent and emotional intro for the President, and he was later invited to Washington to watch Obama’s address to Congress on healthcare reform.

Well, the joke’s on you Nathan and on a lot of others who trusted the details of reform being sold by members of Congress and President Obama. Only this is not at all funny. Families like the Wilkes family will go broke trying to keep kids like Thomas alive. And kids like Thomas will die without the care they need.

Nathan responded to the latest news out of the Senate with the clarity of a father who has fought hard to support reform that would make our system better not more problematic, “Now it looks like such plans will have a floor before they start covering (beyond the deductible/out-of-pocket) and a ceiling at which they stop (no “unreasonable annual limits”). That is the sweet spot for profiteering health insurers. They avoid paying the common and the catastrophic, while soaking up premiums from all of us.”

The death panels allowed by this legislation are those set up and protected by the insurance industry – and tweaked into law by Congress and the President.

You simply cannot do this sort of tweaking and not have people notice. Did you think the Wilkes family wouldn’t notice when the annual cap is reached for Thomas and they have to start paying out of pocket or stop treatment?

This process has been fraught with disclosures of the misleading marketing of various details in the reform legislation from all involved. Who can the American public trust on this? Anybody?

As we sit on the verge of 2010, we citizens have some more political work of our own to do. We need to do some tweaking in the streets and at the polls. Because we surely are not going to get healthcare as a basic human right from this Congress and this administration. Neither the Republicans nor the Democrats seem to get it.

When we do the math for ourselves and when we watch you all play a deadly game of push-me, pull-me with our healthcare reform legislation, we know for certain you are only maneuvering for political advantage while we are out here fighting for our lives, our health and for our financial security. You didn’t hear us loudly enough at the polls in 2008, apparently.

Let me get this straight. You will force us to buy private insurance products that will not guarantee approval of treatment or payment for treatment. You will tax our insurance benefits if our employers offer those deemed as “Cadillac coverage” regardless of whether or not we make less than $250,000 a year. You cannot guarantee that employers will keep our current insurance plans and provider networks or that insurance companies will keep benefits and providers the same – therefore we cannot keep what we’ve got if we like it. You’ve crumbled on the notion of any real public option for coverage at all much less a “robust” option — whatever that squishy word ever meant. And now insurance companies will decide when we’ve had enough treatment for serious illness each year.

Wow. Sweet tweaking indeed for the profit-takers — and without so much as a debate or airing on the floor of the Senate. It seems only the things that would benefit real people require an appropriate following of legal process in Congress and full debate — amendments like Senator Bernie Sanders’ single-payer amendment aimed at strengthening real reform haven’t even gotten a hearing. We’re still fighting for that.

Please don’t insult us any more by selling this legislation as healthcare reform or even health insurance reform. This seems more and more like health industry protection and less like anything at all to do with providing what President Obama declared as a basic human right during the campaign. Even he said the only way to get to full coverage is a single-payer plan. And that’s a tweak too far from profit protection, it seems.

Hang on, fellow citizens. This healthcare mess is about to get messier and make you wonder if anyone told us the truth at all. Then we’ll have some serious tweaking of our own to do in 2010 and 2012. We will not forget this.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

By Joseph Huff-Hannon for The Huffington Post

New York, NY. December 10, 2009 — On Thursday morning, a group of friends and colleagues, mostly middle-aged, sat and chatted over coffee at a midtown deli near Grand Central Station. Then Laurie Wen, an organizer with the Mobilization for Healthcare for All, showed up with a box of granola bars and a bag full of T-shirts, and everybody cheerfully rolled up their sleeves to write the number of an attorney on their forearms.

Two hours later most of them were in jail, and the “fourth wave” of a nationwide campaign to use civil disobedience to push for a single-payer plan had delivered its demands to the doorstep of Senator Chuck Schumer’s midtown Manhattan office.

It’s a particularly poignant day for Rich Marini, one of the advance team of people sitting here today — and not in a good way.

“Ironically, today is the day that my company stopped providing health care to its employees,” says Marini of Staten Island, a programmer at an IT firm called Tango Inc. “Henceforth all employees will have to pay in out of pocket about $8,000 a year. We were all told we have the “opportunity to re-enroll.” On the second floor of the deli, Laurie reminds everybody that in at least 20 other cities across the country, people are sitting in at the offices of health insurance companies and politicians. Senator Chuck Schumer has raised the ire of these activists in New York because of his role in recent negotiations in the Senate to lower the age of eligibility of Medicate from 65 to 55. The catch: this is viewed by many as a way to abandon the public option, or any anemic version thereof that remains in legislation currently being considered by the Senate.

This bit of horse-trading is seen by activists here as a paltry trade-off, and one that reflects the senator’s friendliness to the insurance industry over the desires of his constituents. According to, Schumer is the biggest recipient in Congress of donations from the HMO/Health Services category, raking in $99,650 in campaign contributions this year. At press time a message left with Senator Schumer’s New York press office was not returned.

“The frustration of his constituents is very real,” says Dr. Laura Boylan, a neurologist who and member of Physicians for a National Health Program while marching in a boisterous picket line in front of Schumer’s office before giving a brief address to the crowd. “He’s claimed to be for single-payer in the past, but he hasn’t moved on anything. I don’t want to see any more people who have bleeding in heir brain because they can’t afford to take care of their diabetes. We’re not going away.”

One thing that’s impossible to ignore about this emerging movement is the willingness of health care professionals here in New York, and across the country, to risk arrest and the resulting legal headaches, borne out of their experiences in the trenches of America’s dysfunctional health care system.

“In my work, I see a lot of poor women who won’t be covered by the Democrats’ new plan,” says Dan Murphy, a 35-year old medical student with close-cropped blond hair wearing dark blue scrubs. Dan, who specializes in OBGYN, is one of the first to link arms with fellow activists in front of Schumer’s office, obstructing foot traffic in and out of the building. And he’s one of the last to be handcuffed and pulled to his foot before being deposited in a paddy wagon nearby. At the end of the action nine had been arrested on the relatively light charges of disorderly conduct.

“I think we’re going to see many more of these, because the fight is far from over,” says Laurie Wen, busy exchanging contact details with the legal observer on the scene. “Nothing important was ever won in this country by us accepting crumbs.”

Click here to view pictures from the sit-in.

The Prescriptions Blog at The New York Times also published an entry on the sit-in.

by Matt Schlobohm, Public Policy & Poltical Mobilization Director, Maine AFL-CIO, and Charlie Urquhart, Organizer, Maine Labor Group on Health

On Friday October 23, 2009 the delegates at the Maine AFL-CIO’s 27th Biennial Convention unanimously passed a resolution calling on the AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance.

The resolution was enthusiastically supported by the delegates and is rooted in the belief that to win a Medicare for all single payer system the labor movement needs to pursue a different strategy – one that is rooted in building a broadbased social movement, taking a long term approach to this fight, organizing around basic principles and pursuing relentless rank & file education and mobilization.

Maine AFL-CIO Vice President & IBEW 567 Training Director Don Berry laid out the Federation’s position, “Most union leaders are clear that we need a single payer system to solve the healthcare crisis. Yet as a labor movement our strategy has not been clearly, solidly and unambiguously behind single payer. We think it is time for us to commit to and stick with a long term strategy to win Medicare for All. That’s the only thing that’s going to get us out of the healthcare crisis we face at the
bargaining table and in society at large and its high time we put our full force behind it.”

Building on the momentum of the National AFL-CIO’s historic and unanimous passage of Resolution 34 that called for the creation of a Medicare for All, single payer social insurance program, the Maine AFL-CIO saw this resolution as an important step to making that resolution real and pursuing some important next steps.

In this spirit the Maine AFL-CIO unanimously passed the following resolution:


Single Payer Healthcare Resolution
Whereas the National AFL-CIO unanimously passed Resolution 34 strongly endorsing a Medicare for All single payer health care system;

Whereas 39 State AFL-CIO Federations, 134 Central Labor Councils, and 572 different labor organizations have endorsed HR 676;

Whereas as a State Federation we strongly believe that a Medicare for all national health insurance system with single payer financing is the solution that is required to solve the healthcare crisis union members face at the bargaining table and that we face collectively as a society;

Whereas regardless of how the current healthcare reform effort concludes in Congress it will not come close to solving the current healthcare crisis;

Whereas historically, significant structural changes in this country have occurred when progressive forces have built powerful social movements that organize around a long term strategy that involves relentless rank & file education, organizing around basic fundamental principles, having rank & file leaders lead the movement and committing to a long term approach to the issue;

Whereas we strongly believe that to win a single payer national health insurance system the labor movement needs to pursue that kind of strategy and work to build a broad based working class social movement and;

Whereas we believe that had we collectively pursued such a strategy after the last healthcare policy failure in Congress in the mid 1990s – by staking out a strong single payer position, educating our membership as deeply as possible, pushing for political support of single payer legislation and sticking with that approach for the last fifteen years – we would be in a much stronger position today to win meaningful healthcare reform;

Therefore, we call on the National AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance. We think this process should:

1. Start with a Single Payer labor movement summit

2. Involve, among others, Central Labor Councils, State Federations and rank & file single payer union activists in the planning process

3. Do an assessment of how we’ve historically built powerful social movements in this country and put our best thinking forward about what would need to be done today to build a social movement powerful enough to win single payer

4. Include a commitment of resources from the AFL-CIO of no less than the resources that have been devoted to the current health care reform effort

5. Include a commitment from the AFL-CIO to support state’s efforts to pass single payer legislation

Submitted by: the Western Maine Labor Council to the Maine AFL-CIO’s 27th Biennial Convention

Approved unanimously by Maine AFL-CIO Convention delegates: Friday October
23, 2009

Distributed by:
All Unions Committee For Single Payer Health Care–HR 676

By Jeff Muskus for The Huffington Post

While Democratic leaders abandoned the public option on Thursday, one senator reignited his push for an amendment that would allow states to test-pilot single-payer health insurance systems.

No matter what federal health care reform finally looks like, the Senate should give interested state governments the right to prove single-payer critics wrong, Sen. Bernie Sanders (I-Vt.) said during a floor speech Thursday.

“I think we have got to give states the option, the flexibility to go forward with a single-payer system if that is what they want to do,” Sanders said. “Once they’ve done it and done it well, other states around the country will say, ‘We want the same thing. It’s the cost-effective way to provide comprehensive health care to all of our people.'”

Sanders said his state single-payer amendment “could pass and could have the Republicans’ support.” Given the death of even a weak public option from which states could opt out, he shouldn’t bet on it. Sanders acknowledged he won’t get much support for the federal single-payer amendment he penned with Democratic Sens. Sherrod Brown (Ohio) and Roland Burris (Ill.), but he wants the chance to fight for it just the same.

“One of my concerns as we hurdle down to the finish line here, I don’t know who will be able to offer amendments,” Sanders said. “I offered the amendment, I want the right to have that debate. I don’t need 20 hours, I don’t need five days. I would love to discuss with my Republican friends that issue, Democrats, that’s an amendment that has a right to be offered and should be offered.”

States would still run the government insurance system even in Sanders’ federal single-payer model, but the feds would cover the costs with additional payroll and income taxes. Though he said the current bill marks progress, Sanders said the needed debate and changes are far from over, and one change tops his list.

“I do not think we are at the two-yard line. I think a lot of work has to be done to improve this bill,” he said. “I think at the end of the day, the only way you’re going to provide comprehensive universal health care to all is with a Medicare single-payer system, which ends hundreds of billions of bureaucracy and waste engendered by the private insurance companies.”

Over 125 Healthcare-NOW! members at our 2009 strategy conference voted to oppose the current Congressional version of health insurance reform legislation. While we recognize that many of our allies and supporters may disagree about specific aspects of the pending legislation, we believe that, taken as a whole, it is not worthy of our support. In fact, most of the so-called reforms contained in the bills have already been tried and proven to be a failure at the state level in Massachusetts.

Instead, we should act based on evidence of what works. Medicare, with its lower administrative costs and higher rates of satisfaction, remains the “gold standard” for real healthcare reform.

We anticipated the healthcare debate this year would focus on the true stakeholders: patients and those who care for them. But improved Medicare for All (single-payer) was pushed off the table, by Congress and the private health industry, preventing the American people from learning how access to quality, universal care can be financed without increasing cost to the public.

Pushing single-payer off the table has resulted in deeply flawed legislation by the House and Senate which amounts to a massive bailout of the profit-making health industries that will increase their ability to lobby and influence legislators in the future. At the same time, patients will receive little in the way of protection or improved ability to afford needed healthcare. The legislation is designed to fail and in the meantime, will waste billions of dollars and delay the process of creating effective health reform.

Therefore, Healthcare-NOW! opposes the current health legislation for the following reasons:

1. During the time that it will take for the health insurance legislation to begin (2013 in the House version and 2014 in the Senate version), tens, if not hundreds, of thousands of Americans will die.

2. Millions of people will remain uninsured: 17 million in the House version and 24 million in the Senate version.

3. Medical bankruptcies will continue as families will face out-of-pocket costs up to $10,000 in addition to the cost of premiums and the cost of uncovered services.

4. People who are uninsured will suffer the further indignity of being forced to pay a fine which may be as high as 2.5% of their income (House version).

5. The number of people who are under-insured will increase. There is no guarantee that premiums will be affordable even for those who qualify for federal subsidies. It offers a “public option” so small and weak (and estimated to be more expensive than private insurance) that it is set up to serve as an example of failure.

6. People will continue to be consigned to only receiving the quality of care that they can afford. Instead of a standardized benefit plan that covers all necessary care, people will have to choose from a tiered set of plans. The least expensive plans will cover only 60% of necessary care and patients will be required to pay the balance.

7. The legislation will not control healthcare costs and will increase the waste in healthcare spending. The regulation of insurance companies, which is predicted to fail by industry whistleblowers, will be expensive to enforce. The “exchange” will add another level of bureaucracy which in Massachusetts has added a 4%surcharge to each insurance premium.

8. Private health insurance will be given 30 million more customers, and its stranglehold on the healthcare industry will be even greater. The legislation transfers hundreds of billions of public dollars to private insurance companies. Between $447 and $605 billion in public dollars (depending on the Senate or House version) will be given to the private insurers in the form of subsidies.

9. The bill writes into law protection for the drug manufacturers from having to deal with the collective purchasing power of the American people. Pharmaceutical corporations have already raised prices on brand name prescriptions by 9% this year. Bio-tech firms receive a windfall 12 year patent on new pharmaceuticals.

10. The legislation continues to allow discrimination based on age and immigration status. Older enrollees can be charged up to twice as much as younger enrollees. And enrollees will be required to prove citizenship in order to receive subsidies. Non-citizens will be required to bear the full cost of purchasing insurance.

11. In order to reach a bare majority to pass the bill, the House accepted limits on the reproductive healthcare rights of women beyond current stringent federal restrictions.

We will continue to do everything in our power to support the efforts of Senator Bernie Sanders to submit a substitute single-payer amendment during the Senate debates. This historic opportunity to debate and vote on single-payer from the floor of the Senate will help set the framework for the future. And we will support all efforts to amend existing legislation in ways that would make it easier to achieve state-level single-payer reforms.

Just as we call on Congress to start for scratch, now is the time for all of those who believe that healthcare is a fundamental human right to think about what we need to do to “start from scratch” and build our movement into the future. Many of those who sincerely believed that supporting incremental reforms and the public option was a pathway towards healthcare for all have seen their aspirations betrayed by a failed bargaining strategy embraced by Congressional leaders and the Obama administration. Once this legislative moment is over, we need to join with them in a renewed fight for healthcare for all.

The mission of Healthcare-NOW! is to educate and advocate for a national publicly-funded health system: improved Medicare for all. We will continue to build the Medicare for all movement until we reach the day when all who live in the United States receive the same health security that is a right in other industrialized nations. We welcome all people who support healthcare reform to join with us in this movement. Together, we will succeed.

No matter where you live, call Senator Schumer and Gillibrand to urge them to vote yes for the Sanders two single payer amendments (one to adopt single payer nationally, the second to allow states to do it). The states right amendment has a lot of support from Republican Senators, so more likely to pass. You can also fax or drop off a copy of a letter in support of single payer to their offices.
Tell them you want them to vote for Senators Sanders, Burris and Brown’s amendment number 2837.
Gillibrand, Kirsten E. – (D – NY)
(202) 224-4451
Web Form: fax 202 228-3027
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Schumer, Charles E. – (D – NY)
(202) 224-6542
Web Form:, fax  202 228-0282

Thursday, December 10, 2009


Health professionals, patients demand expansion of Medicare

Chanting “55 is not enough, Medicare for all,” 9 protesters were arrested at a sit-in at Sen. Schumer’s office in mid-town Manhattan this morning.

Referring to Schumer’s push to lower Medicare age eligibility to 55, advocates for Medicare-for-All state that opening it up to only one portion of the population is not enough and will not begin to tackle the real culprit of skyrocketing costs of the whole healthcare system: private health insurance.

“We need to spread out the risk pool and take out the profit motive of private health insurance. That’s the only way to cover everyone and control costs,” says Laurie Wen, an organizer at Healthcare-NOW!, which organized the action.

Those arrested include patients who have experienced abuse from private health insurance companies as well as a doctor, a nurse, and a medical student.

Sen. Schumer has been the center of attention since news broke Tuesday evening that Democrats had reached “broad agreement” on certain parts of the Senate healthcare reform bill. He led negotiations among a group of ten liberal and moderate Democrats, where a key proposal emerged to lower the age eligibility of Medicare from 65 to 55.

Bev Rice, a retired nurse who was arrested, says “Throughout my career I’ve seen so many people suffer and die prematurely because insurance companies denied the care they needed. I have Medicare and it works. Making Medicare available to people from age 55 on is a step in the right direction, but it’s not enough. It should be open to everyone.”

“I want a publicly funded healthcare system because my life should not be in the hands of insurance CEOs who profit from denying me care,” says Kate Barnhart, whose doctor ordered a brain scan for a tumor in early September, but the procedure’s approval has been repeatedly delayed by her insurance company. Barnhart was one of 17 people arrested at a September sit-in protesting against an insurance company’s frequent and sometimes deadly practice of denying care. “I had been paying $900 a month for my premium,” she says. “Last week, my insurance company terminated my policy. Does my senator think this is OK?”

Medicare was established in 1965 and has since become one of the most popular government programs. It’s financed through taxes, and seniors have the freedom to choose their doctors. Advocates say a Medicare-for-All system is the most cost-effective way to deliver health care.

“It’s very simple: you take out the private middleman, and what do you get?” asks another arrestee, Dr. Laura Boylan, referring to the private health insurance industry. “$400 billion worth of profits, CEO salaries, stock options, and administrative waste.”

A neurologist who is a member of Physicians for a National Health Program, Dr. Boylan sums it up, “Expansion of Medicare to everyone would save money and lives; we’d all be better off.”

The New York sit-in was organized by Mobilization for Health Care for All, a national civil disobedience campaign advocating for a Medicare-for-All system. The campaign has organized over 35 sit-ins across the country in the last two months. On December 10th, International Human Rights Day, 20 actions are taking place at senators’ offices in 16 states and Washington, D.C. For a complete list of participating cities, go here.

Citizen juries demonstrate massive support for single-payer

By Kip Sullivan, JD for PNHP

“They contradicted both beltway and public opinion polls. The whole damn world seems to think the Clinton plan is the way to go. Yet they like the single-payer system, which isn’t even getting considered in Washington.”

That was how the president of the Jefferson Center characterized the outcome of a five-day “citizen jury” experiment in which 24 “jurors” listened to and questioned 30 experts on health care reform. (Patrick Howe, “‘Citizens jury’ supports Wellstone’s health care proposal over Clinton plan,” Minneapolis Star Tribune, October 15, 1993, 10A.) Of those 30 experts, only one, Senator Paul Wellstone (D-MN), spoke in favor of single-payer. (Gail Shearer of Consumers Union, which had endorsed single-payer by 1993, was one of the 30 experts to speak to the jury, but it is not clear from the Jefferson Center record that she spoke in favor of single-payer.)

The jury heard expert testimony for and against all three of the major types of health care reform legislation that have been promoted in the US over the last four decades. Senator Wellstone presented the case for his single-payer bill, numerous speakers made the case for Bill Clinton’s managed competition bill (a bill based on competition between insurance companies that use managed-care cost-control techniques), and numerous speakers made the case for what later came to be called “consumer-driven” health insurance policies (competition between insurance companies that sell policies with deductibles on the order of $2,000 for individuals and $5,000 for families).

The jury voted by massive majorities to reject the market-based proposals – managed competition and high-deductible policies – and, by a landslide majority (17 out of 24, or 71 percent), to endorse Wellstone’s single-payer bill. At the time the Jefferson Center report noted only that a majority of jurors voted for single-payer. The actual vote count was reported years later by Barry Casper in his book, Lost in Washington: Finding the Way Back to Democracy in America.

The unbearable lightness of polls

Observers were surprised at the jury’s rejection of the Clinton plan because polls taken at the time the Jefferson Center jury was meeting (the second week of October 1993) were reporting that a majority of the public supported Clinton’s Health Security Act, his “managed competition within a budget” bill that was supposed to create a system of universal health insurance. For example, a Gallup/CNN/USA Today poll (see Exhibit 1 page 10) released on September 24, 1993 showed 59 percent endorsed Clinton’s bill. But just three weeks later, on October 14, 1993, the jury rejected Clinton’s bill by a vote of 19 to 5. Five jurors out of 24 comes to 21 percent, far below the 60-percent level one would have expected based on polls.

The enormous gap between the citizens jury’s vote on Clinton’s bill and contemporary poll results illustrates a well known problem with polls: Although they can produce consistent and accurate results when the question is about something the respondents are familiar with, such as whether they have health insurance, they can produce wildly divergent and inaccurate results when the question is about a complex issue that respondents have had little time to study or even to think about.

Contrast, for example, a 2007 AP-Yahoo poll, which found 65 percent of Americans support a Medicare-for-all system, with a 2009 CBS poll which found only 50 percent think “government” would do a “better job” of providing health insurance than the insurance industry. The AP-Yahoo poll posed this question (the order of the two solutions was reversed from one respondent to the next):

Which comes closest to your view?

The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance;

The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.

Sixty-five percent of respondents chose the second solution – the Medicare-for-all solution – while only 34 percent chose the current system.

Now consider the June 12-16, 2009 CBS poll which asked: “Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?” Fifty percent said “the government” would do a better job versus 34 percent who said “the government” would do a worse job.

Now, just to raise your skepticism about polls another notch, consider this wrinkle. When CBS asked the same question two months later – during August 27-31, 2009 – they found 13 to 14 percent of respondents had changed their minds in favor of the insurance industry. That is, by late August (by which time dozens of tumultuous “town hall” meetings about the Democrats’ health care “reform” legislation had taken place), the percent who thought “the government” would do a better job had fallen to 36 (from 50 percent) while the percent who thought “the government” would do a worse job had risen to 47 (from 34 percent).

How do we make sense of these seemingly contradictory results? Do we trust the late-August CBS poll and say only one-third of Americans support single-payer? Or do we go with the AP-Yahoo poll and say two-thirds support single-payer? Or do we split the difference and say the June CBS poll got it about right – that half of Americans support single-payer?

Fortunately, we are not reduced to rolling dice or drawing straws. We can examine research that uses methods more reliable than those used by the typical poll, notably two citizen jury experiments. And we can examine polls that have produced contradictory results to see if we can find a reason why. I will use the remainder of this paper to report on the two citizen juries. I’ll examine polling data more closely in Part III of this series.

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Introduction to a Six-part series

By Kip Sullivan, JD for PNHP

“Americans are scared to death of single payer.”

These words were not uttered by some foaming-at-the mouth wingnut. They were written by Bernie Horn, a Senior Fellow at the Campaign for America’s Future, a member of Health Care for America Now, on June 8, 2009. Horn explained that he was moved to write this tripe because single-payer supporters were asking why Democrats had taken single-payer off the table to make room for the “public option”:

The question most frequently asked by progressive activists at last week’s America’s Future Now conference was this: We hear Obama and congressional Democrats talking about a public health insurance option, but why aren’t they talking about a single-payer system like HR 676 sponsored by Rep. John Conyers? Why is single-payer “off the table”?

Horn went on to assert that single-payer had been taken off the table because Americans want it off the table. He claimed polling data supported him, but he cited no particular poll. The truth is that the Campaign for America’s Future (CAF) and other groups in Health Care for America Now (HCAN) had decided years earlier they would push Democratic candidates and officeholders to substitute the “option” for single-payer, and they would tell both Democrats and progressive activists that Americans “like the insurance they have” and that Americans oppose single-payer.

The argument that single-payer is “politically infeasible” is not new. That argument is as old as the modern single-payer movement (which emerged in the late 1980s). It is an argument made exclusively by Democrats who don’t want to support single-payer legislation – a group Merton Bernstein and Ted Marmor have called “yes buts.”

The traditional version of the “yes but” excuse has been that the insurance industry is too powerful to beat or, more simply, that “there just aren’t 60 votes in the Senate for single-payer.” But the leaders of the “option” movement felt they needed a more persuasive version of the traditional “yes but” excuse. The version they invented was much more insidious. They decided to say that American “values,” not American insurance companies, are the major impediment to single-payer.

How did the “option” movement’s leaders know that Americans oppose single-payer? According to Jacob Hacker, the intellectual leader of the “option” movement, they knew it because existing polling data said so. According to people like Bernie Horn and Roger Hickey at CAF, they knew it because focus group “research” and a poll conducted by pollster Celinda Lake on behalf of the “option” movement said so.

About this series

This six-part series explores the research on American attitudes about a single-payer (or Medicare-for-all) system to evaluate the truth of the new version of the “yes but” argument. We will see that the research demonstrates that approximately two-thirds of Americans support a Medicare-for-all system despite constant attacks on Medicare and the systems of other countries by conservatives. The evidence supporting this statement is rock solid. The evidence against it – the focus group and polling “research” commissioned by the “option” movement’s founders – is defective, misinterpreted, or both.

In Part II of this series, I will describe two experiments with “citizen juries” which found that 60 to 80 percent of Americans support a Medicare-for-all or single-payer system. The citizen jury research is the most rigorous research available on the question of what Americans think about single-payer and other proposals to solve the health care crisis. It is the most rigorous because it exposes randomly selected Americans to a lengthy debate between proponents of single-payer and other proposals.

Of the two “juries” I report on, the one sponsored by the Jefferson Center in Washington DC in 1993 remains the most rigorous test of public support for single-payer legislation ever conducted. After taking testimony from 30 experts over the course of five days, a “jury” of 24 Americans, selected to be representative of the entire population, soundly rejected all proposals that relied on competition between insurance companies (including President Bill Clinton’s “managed competition” bill) and endorsed Sen. Paul Wellstone’s single-payer bill. These votes were by landslide majorities. Washington Post columnist William Raspberry accurately noted, “Perhaps most interesting about last week’s verdict is its defiance of inside-the-Beltway wisdom that says a single-payer … plan can’t be passed” (“Citizens jury won over by merits of Wellstone’s single-payer plan,” Washington Post October 21, 1993, 23A).

In Part III, I’ll review polling data and explore the question, Why do some polls confirm the citizen jury research while other polls do not? We will discover an interesting pattern: The more poll respondents know about single-payer, the more they like it. We will see that polls that claim to find low support for single-payer provide little information about what a single-payer is (they fail to refer to Medicare or to another example of a single-payer system), they provide misleading information, or both. For example, when Americans are asked if they would support “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers,” two-thirds say they would, but when they are asked, “Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?” fewer than half say “government” would do a “better job.” Although neither question provided anywhere near as much information as the citizen jury experiments did, it is obvious the former question was more informative than the latter.

In Parts IV and V, I’ll discuss the evidence that “option” advocates cite for their claim that single-payer is opposed by most Americans. Part IV will examine polling data that Jacob Hacker uses to justify his refusal to support single-payer and his decision to promote the notion of “public-private-plan choice.” Part V will examine the survey and focus group “research” done by Celinda Lake for the Herndon Alliance and subsequently cited by leaders of HCAN, the two groups most responsible for bringing the “public option” into the current health care reform debate.

We will see that Hacker’s research relies on polls that pose such vague questions that the results resemble a Rorschach blot more than a guide to health care reform strategy. Would you make a decision about whether to abandon single-payer based on a poll that asked respondents to choose between these two statements: (1) “[I]t is the responsibility of the government in Washington to see to it that people have help in paying for doctors and hospital bills… ;” and (2) “these matters are not the responsibility of the federal government and … people should take care of these things themselves”? I wouldn’t, but Hacker did. If it turned out that about 50 percent of the respondents said it was the federal government’s responsibility, 20 percent said it was the individual’s responsibility, and the other 30 percent split their vote between government and individual responsibility, would you read those results to mean Americans “are stubbornly attached to employment-based health insurance”? I certainly wouldn’t, but Hacker did. Would you use this poll as evidence that “American values [are] barriers to universal health insurance”? I wouldn’t, but Hacker did.

The “research” that Celinda Lake did for the Herndon Alliance used strange methods. For example, she selected her focus groups based on their answers to questions about “values” that had nothing to do with health care reform. The values included “brand apathy,” “upscale consumerism,” “meaningful moments,” “mysterious forces,” and “sexual permissiveness.” “Meaningful moments,” for example, was described as, “The sense of impermanence that accompanies momentary connections with others does not diminish the value of the moment.” Do you think it’s important to ask Americans about their “sense of impermanence” before deciding whether you will support single-payer legislation? I don’t, but Celinda Lake and the Herndon Alliance did.

The “option” movement’s “research” turns out to be no match for the more rigorous research which demonstrates two-thirds of Americans support Medicare-for-all.

In Part VI I discuss the wisdom of allowing polls and focus group research to dictate policy and strategy, something the “option” movement’s founders talked themselves into doing. Hacker has been especially vocal about this. He repeatedly urges his followers to think “politics, politics, politics,” a squishy mantra that, in practice, translates into an exaltation of opportunism. The failure of Hacker and HCAN to object to the shrinkage of the “public option” by congressional Democrats, from a program covering half the population to one that might insure 1 or 2 percent of the population, documents that statement.

The fact that two-thirds of the American public supports single-payer does not mean the enactment of a single-payer system will be easy. It won’t be. But it does mean the new “yes but” justification for opposing single-payer, or indefinitely postponing active support for single-payer, is false and should be rejected.

Stay tuned.