Real Health Care Solutions

Editor’s Note: “The 2008 election campaign is almost sure to be a health care election — even before we’ve done much organizing at all,” said America’s Future co-director Roger Hickey at a conference sponsored by New Jersey Citizen Action on November 13. “So imagine what will happen once we get going.”

In this keynote speech at the “Conference on Health Care for All: Real Solutions for New Jersey and the Nation” in New Brunswick, N.J., Hickey outlines what he sees as possible.
Progressives — armed with facts and a compelling philosophy about the nation’s obligations to its senior citizens — were able to organize and beat back an effort by the Bush administration and conservatives to privatize Social Security. In the health care debate, progressives have even more ammunition — not just a sound principle, but a specific framework for providing health care to every American.

By using that ammunition smartly, the next president will have a strong mandate for radical moves toward universal health care. Hickey explains how.

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Thank you, and good afternoon. I want to thank New Jersey Citizen Action - and the New Jersey Statewide Health Care Coalition - for organizing this important conference.

I am honored to be invited because our country is on the brink of another historic debate about health care for all. We seem to have this debate every 20 years, and organizations like yours will make sure that voices of America's working families are not only heard in that debate - you will insist that the people you represent have a big hand in designing the reforms that will get us affordable, quality health care for everyone in America.

I am proud of my long history with New Jersey Citizen Action - and Phyllis Salowe-Kaye and her colleagues. Years ago I spoke at a big USAction meeting - to sound the alarm about conservative plans to privatize Social Security and urged that we work together to stop them. Phyllis Salowe Kaye and New Jersey Citizen Action were already on the case, educating their members and telling the entire New Jersey congressional delegation that they had better sign our pledge to strengthen, not privatize Social Security. And during the 2000 elections, Phyllis and I were proud to stand together with a political newcomer running for the U.S. Senate - named Jon Corzine - as he signed our Social Security pledge. Turned out the kid was a natural. He knows how to talk about ideas and win a few elections.

In 2004, when President Bush declared privatization his number one domestic priority, Jon Corzine was his chief opponent in the senate and New Jersey Citizen Action made sure that Bush couldn't come into the state without negative headlines about his plan to destroy Social Security. Together, working through a coalition called Americans United for Change, we defeated privatization, made Bush a lame duck - and we have since gone on to challenge Bush around a more positive goal - expanding SCHIP - the Children's Health Insurance Program. As you know Bush has stubbornly used his veto on SCHIP - with another one coming before Thanksgiving - forcing his party, as an election approaches, to vote against insuring kids. [Bush seems suicidal - but then Bush doesn't have to run again, just the rest of them.]

Encouraging news

Today you have gathered with us to talk about what we need to do to achieve a system of health care for everyone in our country. I know that most of you share the same vision of social insurance that brought us Social Security in the 1930s and passed Medicare in the 1960s. I know that most of you are at this conference because you want to enlist in a movement to guarantee health care for all. Perhaps your only worry has to do with whether we can pull it off. And that's a real concern. Anyone who has been awake in recent years has seen the power of the special interests to foil or pervert social progress again and again - as they did in 1993 and 1994.

So let me start with some encouraging news: despite the fact that so far we activists have done very little - beyond our campaign to expand SCHIP - the issue of health care has already become the number one domestic issue of the upcoming political campaigns.

Now how did that happen?

Well, the great thing about elections is that they force the politicians to talk with real Americans. Or else their pollsters have to talk to us, and we real Americans have told them that - while struggling to make ends meet and hold families together - we have had to deal with a health care system that is unraveling - in which employers are either dropping coverage or raising the costs of deductibles and co-pays. More and more people are changing jobs and discovering that their new employers' health plan is either more expensive or non-existent.

Or they take up the self-employed or free-lance life in this brave new economy - and they discover they either cannot afford to buy a decent health plan - or that old illness from the past is declared a pre-existing condition, and insurance companies won't cover them. And of course, as Michael Moore's brilliant movie, SiCKO, showed us so well, millions of Americans who think they have health insurance are shocked to find that when they really need health care, their insurance company can deny their claims.

And so the American people have put the issue on the table - and now suddenly the politicians and the pollsters and the media are all talking about reforming health care once again. And the 2008 election campaign is almost sure to be a health care election - even before we've done much organizing at all.

So imagine what will happen once we get going.

People are ready for change, but…

Now I've been working with a group of people to make sure that this time we are successful when we do get in gear with our campaign for health care for all. The group includes Diane Archer (who you will hear from this afternoon), your colleagues at USAction (and Richard Kirsch who runs New York Citizen Action) and friends in the labor movement and other organizations like Moveon.org. We've been doing research to craft a positive plan that makes sense to Americans - and to forge a message that puts our enemies on the defensive.

We've discovered that most Americans - about two-thirds of all voters - support major changes to provide good insurance for everyone, even if that means raising taxes. But we also know that different people experience health care problems in different ways. Over half the voters like their current health insurance plan, and while they may altruistically want to cover everyone, their self-interested concern is about keeping costs from rising - and making sure they personally don't lose their good coverage. [We've looked at polling by the AFL-CIO, Stan Greenberg and his Democracy Corps, SEIU, Hart Research, Celinda Lake and American Environics.]

The good news is that people are ready for big change. But the hard reality, from the point of view of all of us who understand the efficiency and simplicity of a single-payer system, is that our pollsters unanimously tell us that large numbers of Americans are not willing to give up the good private insurance they now have in order to be put into one big health plan run by the government.

Pollster Celinda Lake looked at public backing for a single-payer plan - and then compared it with an approach that offers a choice between highly regulated private insurance and a public plan like Medicare. This alternative, called "guaranteed choice" wins 64 percent support to 22 percent for single-payer. And even the hard core progressive part of the population, which Celinda calls the "health justice" constituency, favors "guaranteed choice" over single-payer.

Now I tell you this as someone who understands the wastefulness and downright immorality of our private sector health insurance system. I know that if we let private insurance companies offer policies as part of an expanded system of health care for all, we are going to have to regulate them so much that we force them to change their business model - insuring everyone who applies for coverage and not cherry-picking to insure just the young and the healthy - and preventing them from denying coverage to those with pre-existing conditions. And I know full-well that even in the best of circumstances these companies will never be able to match the low overhead and cost controls that a public system like Medicare has historically achieved.

Health Care for America

The model for the simple "guaranteed choice" plan that we've been testing with the pollsters is the "Health Care for America" plan written by political scientist Jacob Hacker at Yale. For more than a year, Richard and Diane and I have been working with Hacker to refine his ideas - and to use them to engage the Presidential candidates.

Hacker's "Health Care for America" would guarantee health care for everyone. He would require employers to provide health insurance for their workers (with a good benefit package) or pay into a public fund to cover their employees. Individuals and families would be able to choose between several private insurance plans - all with a regulated set of benefits and costs -- or a public plan, similar to Medicare, that would compete with the private insurance companies. An analysis of the Hacker plan by the Lewin Group found that at least half the population would eventually choose the public plan, due to its better efficiency and better benefits.

Starting in January, we began to take Jacob Hacker to see the presidential candidates. We started with John Edwards and his advisers -- who quickly understood the value of Hacker's public plan, and when he announced his health proposal on Meet The Press, he was very clear that his public plan could become the dominant part of his new health care program, if enough people choose it.

Edwards got a lot of credit for being the first top-tier candidate with a comprehensive proposal. But, in a virtuous competition, Barak Obama soon matched him with a remarkably similar plan, developed (with our advice) in a process guided by Mark Alexander, who will speak on the next panel. Obama was even more explicit that, while his plan is also full of choice, people would be automatically signed up with his public plan, unless they specified one of his private insurance options. And then on September 17, we sighed a sigh of relief when we heard Hillary Clinton roll out her health care package.

Perhaps still cautious from her experience in the early 1990s, Hillary had started this campaign for the White House talking vaguely about insuring all kids in her first term and trying for universal health care only in her second term. Thanks to our prodding, and the competition of her democratic opponents, she is now talking about a major push for health care for all in her first term, with a plan with all the key elements outlined by Edwards and Obama - and Jacob Hacker.

Making the problem worse

Now, you won't be surprised that none of the Republican presidential candidates have responded to our offer to brief them or their advisors.

But they do their own polling and they know that voters want to hear health care solutions from all candidates. But all of the Republicans have adopted an ideologically blind right-wing posture that is completely in keeping with George Bush's opposition to government and friendliness to the drug and insurance industry.

Romney and Giuliani and McCain and all the rest of them have adopted proposals that sound good on first blush - until you realize they will actually make our health care problems worse.

They all talk about tax deductions to help individuals and families pay for health insurance. Not tax credits that would go to everyone - or refundable tax credits that would go to low income people who don't pay income taxes. So far all the GOP health tax proposals would only benefit higher income people who want to reduce their taxable income.

But there is another side to their tax proposals, they would all get rid of the tax deductions that businesses now get for providing health insurance for their employees. This kind of shifting of tax breaks would accelerate the already growing trend of companies getting rid of their health care responsibilities and dumping them on their workers. Now you may think that we should rethink the World War II American system that depended on companies to provide health care, but the Republicans would force that transition very rapidly. [And although it is a declining percentage, still 60 percent of workers still get their health care from their employer. Imagine them all having to fend for themselves in the private insurance market.]

You see, the problem is that the conservative world-view sees no role for government.

In fact, the conservative ideology sees high costs for families as a good thing, as a way to discourage excessive or wasteful health care spending by forcing people to be smarter "health consumers."

Of course, what it means in practice is that families put off needed preventive doctor visits until health conditions get really bad - and by then, when you are in an ambulance to the hospital, it is pretty hard to ask which hospital has the lowest-priced surgeons for your emergency.

So to summarize, in the pithy words of American Prospect blogger Ezra Klein:

"The Republican vision is for a world in which the sick and dying get to deduct some of the cost of health insurance that they don't have -- and can't get -- on their taxes. The democratic vision is for every American to have health insurance." Are we clear?

So the 2008 election debate has begun. Iraq will be number one on voter's minds - but health care will be a strong number two. But to put things in context, listen to pollster Stan Greenberg summarize a national polling conducted just last month:

If Americans have ever been angrier with the state of the country, we have not witnessed it. The scale of today's discontent is evident in the 70 percent who now say the country is off on the wrong track and in George Bush's job approval ratings, now at their lowest levels ever. But that number is a superficial read of the contempt and deep frustration with the leaders of the country and our times; a period that leaves America trapped in an unnecessary war, while neglecting to take care of things at home and protect its own jobs and living standards; a period that leaves the average middle class person struggling with rising costs, medical and gas bills, while politicians and big business special interests take care of themselves, not the country. They believe America is losing ground to countries around the world, while our leaders are rudderless. The biggest challenge and opportunity one year out from the 2008 election is whether the Democrats will become the voice of that change.

Now I didn't intend for this presentation to be partisan. I guess I feel a little like Harry Truman when someone yelled, "Give 'em hell, Harry." He said, "I just tell the truth and it sounds like I'm giving them hell."

But the point is, if you care about health care for all, we need to tell the truth about the state of our health care system and the public will know what we are talking about - because everybody has a story about how dysfunctional it has become.

What we are doing

The most nonpartisan of 501c3 organizations can simply report accurately about what the various politicians are promising, and the pattern becomes very clear to potential voters. And while it is easy to engender feelings of fear when we talk about our health care system - it is more important to motivate anger and a proud and righteous feeling that "it doesn't have to be this way in America, the land of the free and the home of the brave." And we can do something about health care.

And it is in that spirit that my organization, the Campaign for America's Future, is joining with other organizations, national and local, to build a powerful coalition that can empower the American people to take charge of the debate about health care.

We are reaching out to statewide citizens groups, like New Jersey Citizen Action, who will anchor our grassroots outreach and contact with your congressional delegations. And state and local health care coalitions.

But the campaign for health care for all can and will include everyone who needs change in the US health care system - everyone who isn't part of the problem. Organizations representing women and Hispanics and African Americans and young people. Doctors and nurses and small business people. Seniors and religious congregations (including the evolving evangelical movement) and civic empowerment groups like the League of Women Voters. We envision a broad and powerful coalition of forces, each of which will work in their own way - together where appropriate and separately where necessary, to make sure that we give a strong voice and constant visibility to the growing public demand for health care for all.

Phyllis, in some ways this campaign to change the health care system is much more ambitious than our victory against Social Security privatization. But when we started, the media portrayed some form of privatization as inevitable - and they kept reporting that young people were all for it.

With health care, even though we are talking about restructuring 16 percent of the U.S. economy, everyone - even the mass media - understands that the country wants change.

And we can be pretty confident that the nominee of one political party will be campaigning on a health care plan that we can rally behind. And the other party's candidate will go to the voters as the friend of the unpopular insurance industry, and the drug companies and the super-wealthy. That's a contrast we can work with.

So our job is to give voice to the powerful majority that wants real health care change. Mostly, we can be positive, showing how we can cover everyone while reassuring those who have good health care that they won't lose it if they want to keep it. But some of our campaign goes on the offensive against the special interests and the politicians who support them - and we can expose the enormous costs and human suffering that will result from continuing to base our health care system on unregulated private insurance companies.

And we have to demand that every candidate running for office - Republican and Democrat and Independent - tell us very clearly whether they will support our plan for health care for all - if they are lucky enough to get our votes.

Harry and Louise today

We hope to have funds for TV spots and sophisticated media, but the real model for this big campaign is the way you got all New Jersey Democrats - and all but three of the New Jersey Republicans in Congress to abandon Bush - to vote for an expanded SCHIP. And I can't help but note that of those three, Jim Saxton has decided to retire, and Garrett and Frelinghuysen have strong opponents running against them.

Our job is the job of creative and aggressive organizers: building on where public opinion already is on health care, we've got to hold public events, release reports and generate news stories, and confront and question candidates in their offices and on the campaign trail. And if we do our job well, the mass media will report that the 2008 elections represent a mandate for the new president and the next Congress to pass legislation to achieve health care for all. And after that health care mandate election, that's when our heavy lifting really begins.

I want to leave some time for discussion, but I want to leave you with an encouraging image.

Most of you remember Harry and Louise. They were the characters in the TV ads against the Clinton health care plan in the 1990s. In those ads, Harry and Louise claimed the Clinton health care plan would force them to lose their good insurance coverage, change doctors, and force them into a government program.

A friend of ours has found the actors who portrayed Harry and Louise. Several years ago they did a TV spot in favor of stem cell research. And Louise is supporting Hillary Clinton. It looks like they might be ready to completely change sides. So imagine the new spots. Harry is 59 and has just lost his job in a corporate downsizing and he's not sure how long he can keep up their COBRA payments. Louise has developed a chronic condition and is terrified that if they lose their coverage, she will never get health insurance again. They talk excitedly about the new progressive Health Care for All plan as something that might save them. And they ask each other how health care in America ever got so bad. Finally, they look into the camera and repeat the tag line of that TV spot they starred in twenty years ago: "There's got to be a better way."

The American people now understand how the conservative agenda for health care in unhealthy for our whole society. And they are looking to us to show them that better way.