Why is Single Payer -Almost-"Off the Table?

Why is Single-Payer Health Insurance (Almost) “Off the Table?”

2009, in American politics, was a year spent arguing about health insurance reform. Right after he took office, Barrack Obama signaled to Congress that one of his top
 priorities would be to receive a health insurance bill that he could sign into law, hopefully by the fall.

Many committed and sincere activists, who had worked to bring about reform of health insurance for years, were perplexed by Obama’s refusal to consider a government 
run single-payer health insurance system (SP) for America. Our next door neighbor to the north, Canada, established such a system in the 1970’s, where government pays for virtually all health care, but doctors and hospitals remain
mostly private. Canadians love their system of health insurance. It covers everybody with a generous government plan, and costs about half of what the American system does.

So why can’t we do the same thing in the U.S.? The easy answer is opposition from the private insurance industry. They have money to burn on Washington lobbyists, and they really hate SP. A just, government-run health insurance system that covered everybody would mean the end of private health insurance in America. Of course they hate SP. How could they not?

When you see the millions of dollars that people like Senators Nelson or Lieberman collect in campaign contributions from private health insurance companies, it’s
 tempting to say, “That’s it! That’s why they oppose SP.” Tempting, but incomplete.

If any possibility for progressive change in America is to become a reality, it must receive the backing of the labor movement. This backing is absolutely necessary, but not necessarily sufficient. It takes support from outside labor 
as well, to move things in a good direction, but the labor movement is definitely the big guy here.

By “labor movement”, I mean the people who really control the money that comes in every month from the members in the form of dues. People like AFL-CIO president 
Richard Trumka and SEIU president Andy Stern. Those two are a big part of the reason why the public option (PO) got as far as it did as part of health insurance reform this year. Both of them really backed it. On the other hand, I’ve never heard either of them support SP.

I know, many local labor councils have voiced support for SP. But, like Deep Throat reminded us, we should follow the money. If you figure an average of $30/month from 13 million members, unions in the U.S. have a cash flow that 
places them in about the middle of the Fortune 500. Labor controls a lot of money, and almost none of those big bucks are controlled by SP supporters. The real leaders of labor sit atop international unions; that’s where the dues go every 
month, and those guys are not for SP.

Why is this? Union members are everyday people, like you and me, and single-payer would be great for us. What’s the deal?

Put simply, union leaders guard their own personal interests, just like the rest of us. They don’t just look after the interests of their members. And the main interest that every union leader has to take care of every day is to keep the dues
 coming in. Get more dues, if possible, but never let collection go down. A decrease in dues could threaten the institutional survival of any union.

Since around 1990, American unions have been very worried about losing members (dues), and the organized portion of the workforce has been getting smaller and 
smaller. One way to counteract this is to try to organize new members, which isn’t going very well. The other way is to try and keep the members they have. A very important element of keeping present members on the rolls is to have
 union contracts that provide more money and better benefits than workers have who are not members of unions.

That, I think, is the big problem that Trumka and Stern have with SP. It would mean that everybody, members and non-members alike, would have the same health care
 benefits. So, if health care is the only consideration, why would anybody want to remain a member of her/his union (and keep paying dues?) No point in it, if the same health insurance was available to those who quit the union. Of course, health care is not the only consideration, but it’s a big one, a really big one.

It looks to me like big labor leaders consider SP a threat to their institutional survival. I believe that is why it’s “off the table”, as far as Obama is concerned. Without the support of big labor, there is just no way Obama could get SP past Baucus, Lieberman, Nelson, and the private insurance companies.

But the idea of a robust PO just might have gained the support of labor leaders. Trumka and Stern came out for one, probably because they figure they could secure a better deal for their members than the general public, since private
 insurance would not be eliminated. Maybe union members would get private hospital rooms and spa vacations. Who knows?

By “robust” I mean a PO that would provide health insurance to anybody at any time with no penalty for age or pre-existing condition, (“guaranteed issue.”) Private insurance would also be forced to follow these rules. A robust PO would piggyback on Medicare rates, but not join Medicare, and demand that any provider that takes Medicare should also 
accept the PO. And we could get started with a less than robust PO, and improve it over time.[1]


I believe that Obama needed the left (SP backers) on his side in order to get the PO past its’ opponents, which are mainly insurance companies. As we all know, that was not the case. Thousands of SP backers kept insisting on
 SP, when the PO really needed their support. It reached the point here in Seattle where Senator Patty Murray was shouted down at a health care rally by chants of single-payer! single-payer! She was trying to voice support
 for getting a health reform bill from Congress and was an identified supporter of a PO. Good grief!

Another interesting reason that SP is off the table is lack of support from the public.

I recently came across a fascinating poll, Voter 
Attitudes on a Public Health Plan, by an outfit called Lake Research Partners. I had already seen a number of polls that seemed to indicate public support for SP. After I read the Lake poll, I realized those other polls asked the wrong questions.

The Lake poll asked people to compare 3 different situations for health insurance in America, and say which they would prefer. 1. All private insurance-15% preferred.
2. All public insurance (SP)-9% preferred. 3. A combination of public and private, where people can choose (PO)-73% preferred! 4. Don’t know-2%.

After studying the Lake poll, I realized that the polls that seemed to show majority support for SP had not included in their questions the idea of “public only.” I’m sure private insurance companies are well aware of the lack of support 
among the public for a program where people get no choice, where they would have to give up what they have and take what the government offers. I can just imagine the “Harry and Louise” ad blitz we would see if SP ever became a serious issue in Congress!

This story, lack of public support for SP, might be different if there was institutional muscle (big labor) behind SP. Maybe folks could be won over. But, as I have already said, support from the big guys in the labor movement is just 
not there.

I did say “almost” off the table, didn’t I? California just might be an exception to my analysis. A bill for a State SP system has passed the legislature in California twice, only to be vetoed by the Terminator, er, Governor. Currently, SB 810 (SP) has passed the CA State Senate again, 22-14, and been sent to the house for consideration this summer. 22-14 doesn’t look like enough to override a veto by Schwarzenegger, so we’ll have to wait and see. But still, SP has come very far in California. What’s the deal there, how did they get this close?

For one thing, we’re talking California here. There is a rich, progressive, left wing tradition in the big state. Upton Sinclair organized End Poverty in California, and almost became governor. Berkeley students braved fire hoses and humiliated the House Un-American Activities Committee there. California was the spiritual center of the anti-Vietnam War Movement. Ceaser Chavez organized farm workers
 and led legendary strikes there. They have an economy there bigger than most nations. The huge economy gives them a certain independence in these matters. Bedsides, California prides itself on being a little different from the rest of
 the country.

Two points on labor in California: Andy Stern and SEIU have been just about kicked out of the state by a vibrant and courageous SEIU local that now sees itself as a separate union with the name of National Health Care Workers Union (NUHW). NUHW leaders, under president Sal Roselli, don’t appear to be having much to say about health insurance in California. I think that’s wise; they should stick to organizing. But, I bet Roselli, a true progressive, is not anti-SP like his old boss, Andy Stern.

My other point about labor there is that it’s possible that big names in the film industry fill labor’s institutional muscle roll. Many stars have appeared at California OneCare (California’s SP advocacy group) rallies. OneCare looks like
 it has a few bucks to spend on campaigns and educational efforts; I bet a good part of their money comes from Hollywood (bless their hearts!)

Some, like the San Francisco Chronicle, think that many of the Democrats in the legislature who are voting for SP now, are only doing it because they know it will be vetoed. It’s a no-cost way to poke at Schwarzenegger. It will be fascinating to see what happens next year, if a Democrat is elected governor this fall (2010.)

All of this leaves us with the question, “what should we be doing?” The answer depends on whether or not Obama and the Dems can get a health care bill passed in the next six weeks or so. I agree with New York Times columnist Paul
 Krugman; the proposal unveiled by the White House on 2/21/10, deserves all the support we can muster. It covers almost everybody in America with affordable, decent health insurance, and its' passage would greatly strengthen the Democrats over the coming years. After it passes, maybe something could actually be done about unemployment. If it doesn’t pass, the Republicans will get a huge boost, and
 might be able to re-take Congress this fall.

It would be great if the Senate petition to include PO under reconciliation were to take off and lead to including a PO in the legislation this year, but I have my doubts. The time for building support for the PO was last spring, when Obama
 could have joined us. I’ve already commented on what the left forces in the health care reform movement were up to back in May. Thousands of people took to the streets on May 30th, 5000 here in Seattle alone. In the Seattle parade, I’m pretty sure that I carried the only public option sign, and then
 Senator Murray got shouted down during her speech. I’m afraid that we’ve missed our chance for the PO for a while.

Assuming the bill passes, and Obama signs it, there’s not going to be much interest in health insurance reform for a while. Progressives should closely watch how reform is implemented. Maybe it will work for a while, maybe not.

If the Republicans manage to stop the bill, it will be obvious that we need to build a bigger, stronger mass movement, so we can overcome the “Party of No”
(Republicans.) If we do decide to build that movement, I would suggest that we consider our main slogan carefully. We should rally around simple and powerful words that make it easy for everyday people to join us. SP won’t work; that’s what I wrote this whole paper about. PO isn’t a very catchy tune, either. PO, 
like SP is too complicated to organize a grass roots movement around.

I suggest that the success we had with the slogan “Health Care is a Right”, here in Seattle in 2005, should be considered. 13,000 people signed our petition, then the city council put it on the ballot, as an advisory measure for voters 
to agree or disagree. 102,000 (70%) of our fine voters said Yes! I think what happened here could be repeated across the country. When it was tried in Chicago and Tacoma, it worked just as well. If we had millions of Americans voting and marching for “Health Care is a Right”, I bet Obama and the Dems could push the Republicans out of the way, and really get something done.

Brian King

Seattle

bpjking@comcast.net

Views expressed on this page are those of the authors and not necessarily those of Campaign for America's Future or Institute for America's Future