'SiCKO' Builds A Movement

Americans want big changes in our heath care system. And now Michael Moore's great new film, "SiCKO," is helping to turn a desire for change into a crusade for change.

Now breaking box office records in its second week in theaters, "SiCKO" conveys powerfully emotional stories of Americans trapped in a system controlled by insurance and drug companies that deny care and destroy lives in order to maintain their profits. We walk into the movie house as individuals with our particular gripes about the health care system. And we walk out wanting to be part of a national movement for health care for all. For example, read this great account [1] of how spontaneous organizing literally occurred in the theater lobby—at a Dallas, Texas suburban cineplex.

So, what kind of movement should we be building?

Unlike this weekend's very expensive Live Earth rock-and-roll extravaganza, whose major message (in the face of looming global environmental catastrophe) seemed to be to make personal life changes—"Buy better lightbulbs, unplug your cellphone chargers, and run your tour bus on bio-diesel"—the thoughts of people who see Moore's movie turn immediately to institutional and political change.

After seeing Moore's film, most people want to pose a big question to all politicians: Will you work to guarantee health care for all, not incrementally—one disease at a time, or one group (like kids) and then another group (like their parents) in another program—but through a universal system of health care for everyone?

Here's a second crucial question we should ask politicians: Will you pledge to cut the big insurance and drug companies out of a central role in the design of your universal health care plan?

Last week the Campaign for America's Future joined with MoveOn in a campaign to urge our members to take friends to see "SiCKO" and then to communicate with all the candidates for president, asking them to reject contributions from big insurance and drug companies. We will publicize the answers.

The good news for those of us who come out of "SiCKO" inspired to change our health care system: Several of the presidential candidates—John Edwards, Barack Obama, and Dennis Kucinich—have already pledged not to take contributions from the insurance and drug companies, their political action committees and their lobbyists. And each of those Democratic candidates has already put forward a plan to achieve health care for all. Hillary Clinton has announced she will come forward with a plan for universal health care in the coming months—a big step forward from her original posture of just covering children first. It appears that Clinton's campaign is taking insurance and drug industry money, but she is under pressure to change that—which is the one of the goals of our email campaign. (Click here for information on how to reach her campaign and others.)

This is where two different tendencies in the health care movement diverge. Some people want to understand which of the possible nominees has the best plan—or discuss how we put pressure on him or her to get better. The other reaction—which I've gotten in person and in angry emails—says don't even bother talking about the promising proposals coming from politicians like Edwards and Obama. They are just not as good as Kucinich's plan (H.R. 676) which would create one national public (single-payer) health plan for everyone. Michael Moore, although he has generally wisely stayed above the details of specific policy, has given a few interviews dismissing Edwards and Obama as fatally flawed because they preserve a role for private insurers.

Now, there is nothing wrong with unremitting public pressure. If everyone who sees "SiCKO" is enlisted in the Kucinich campaign—and if everywhere the other candidates go, they are confronted with crowds chanting for single-payer, it could (in theory) convince Obama or Hillary or Edwards to embrace H.R. 676. Or failing that, if a Democrat gets to the White House anyway, he or she (or the more progressive new Congress) might be forced to support a pure single-payer plan sometime after the election. The debate about health care for all won't be over on Election Day, it just begins. And everyone should energically raise their voices. Tell the politicians that we want a comprehensive health care plan that covers everyone. And those who think HR 676 is the only way to achieve that goal, should be vociferous—and they will. That kind of democracy in action is good.

But one big problem with "single-payer or nothing"—or Dennis Kucinich or nobody—is that it runs the risk of ignoring potentially important differences between the candidates who actually have a chance to win the nomination—and it takes the pressure off those candidates to try to improve their health care plans if they think that all the ""SiCKO" voters" are going to give our votes only to Kucinich.

Now, I happen to think that the health care plans put forward by Edwards and Obama represent pretty important proposals—much more understandable than Clinton's 1993 plan or John Kerry's undecipherable health care proposals in 2004. The prospect of debating Kucinich before audiences of progressive primary voters probably made Edwards' and Obama's plans somewhat more progressive—but they also got better because some of us paid attention to the details of what they and their advisers were saying—and pushed them in the right direction. (See links below.)

Do the Edwards or Obama plans remove the private health insurance industry from any and all roles in expanding health care coverage? No. But both Edwards and Obama create a public program, similar to Medicare, that would play a central role in making sure all Americans have coverage. Here's a description of Obama's plan from David Cutler, one of his key advisers:

If you don't have health insurance through your employer, you will be enrolled into a new, comprehensive public health insurance plan that emphasizes prevention, chronic care management and quality care. This plan will enjoy the great efficiencies we see in public plans like Medicare but, if you still cannot afford it, you will receive a subsidy to pay for it. Of course, you can choose private insurance if you prefer but the private plans will have to compete on a level playing field with the public plan—without the extra payments that tip the scales in favor of private Medicare Advantage plans today.

It ain't pure single payer, and people have a choice of regulated private insurance, but the plan people are automatically enrolled in would end up being a pretty big single-payer public insurance program—like Medicare.

Edwards has a similar public insurance plan, and when he rolled it out for public discussion (well before Obama), he told Tim Russert of "Meet the Press": "One of the choices . . . is the government plan. So people who like the idea of a single-payer insurer health plan, that is actually one of the alternatives that people can choose."

We don't know what Hillary Clinton's plan will look like. She could cautiously aim at covering everyone only if she is re-elected for a second term (as she has hinted). And she could aim at achieving that goal incrementally, insuring all poor children first in one program, and middle-class children in a separate program, and all adults in a third program. That would be a disappointment. And people who think of themselves as "health care voters" should be letting her know that RIGHT NOW.

In this crucial primary season, some in the movement for health care for all will dismiss the differences between candidates, embracing only Kucinich and single-payer. But the rest of us, more realistically, should emphasize the most progressive elements of the Edwards and Obama—and Kucinich—proposals, while trying to use them to leverage a better, more progressive plan out of Hillary Clinton.

The single-payer advocates get the diagnosis of what's wrong with American health care correct: The for-profit drug and health insurance industries who profit by denying people care and by manipulating the system. But even if you would like to completely cut these corporate interests out of our basic health care system, it would be real progress to achieve a public health insurance plan like Medicare that covers over half the population. And some of us think there could be a political advantage—and a good reply to the "Harry and Louise" propaganda from the insurance companies—if we can show that people who like their private insurance plans will get to keep things just the way they are.

Michael Moore has generated a lot of very productive emotion by exposing how the insurance industry denies care to people who thought they were covered or keeps sick people from getting insurance. But we all need to get used to another populist attack on the private health insurance industry—but one not designed to take them out but to regulate them. You can see it in California, where Arnold Schwarzenegger is trying to cover everyone without a public plan, so he has to try to put strong new restrictions on private insurance companies (who want to participate) to get them to insure all comers—even people with pre-existing conditions—and to do it at affordable premiums.

If any of the leading Democrats—Edwards, Obama, or Clinton—get elected president, we are likely to see two parallel experiments with the insurance industry: displace them as much as possible with the best possible public plan AND regulate the hell out of them to try to get them to change the business model so well described by Clinton at the Las Vegas health care debate: "Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you're insured, they try to avoid paying for the health care you receive."

Our most important job is to build a strong movement with a clear goal: good health care guaranteed for all. And then we have to explain and re-explain how the business practices of the big health insurance and drug companies actually prevent us from achieving that goal. If we keep up pressure for strong reform and not just weak reform—perhaps we can build a health care system that puts people ahead of profits: the kind of system that—as Michael Moore showed us—the Canadians, the British and the French have enjoyed for decades.

Roger Hickey is co-director of the Campaign for America's Future.

The Great Rick Shift: Health Care For All [2]

Health Care For America [3]

Health Care For America Blog Roundup [4]

Edwards Gives A Nod Toward Health Care For America [5]

Blog Reaction To Edwards' Health Care Plan [6]

The Universal Health Care Debate Is Over [7]

Where The Health Care Debate Is Going [8]

The Health Care Answers We Need [9]

Universal Health Care: Getting The Right Mix [10]

Obama's Health Care Plan [11]

Obamacare: Clearing Away The Fog [12]