Stop Saying 'Single Payer'
Jerry Flanagan is health care policy director for the Foundation for Taxpayer and Consumer Rights . Judy Dugan is the group's research director.
Both sides knew their scripted parts late last month as the California legislature passed a sweeping bill to provide all residents of the state with health care. Governor Arnold Schwarzenegger was already inking up his veto pen and sharpening the fear factor with labels like “socialized medicine.” With the veto all but a done deal, Democratic legislators could vote for the bill and gain a little election-year traction without risking the loss of campaign contributions from the health care industry.
As bad as it sounds, the vote was real progress. The California legislature was finally responding to public unease and anger over the declining state of health care.
The task now is to get from legislative drama to real reform. Building voter support—either to push policymakers to pass a future bill or to vote on a ballot measure if the politicians still refuse to act—is the best hope for achieving universal coverage in California. To convince voters, universal health care advocates must give the policy meaning. We must imbue a branded universal health care plan with form and substance. And we should never say “single payer” again.
Building support for change gets easier every year, for good reason:
20 percent of Californians are uninsured. Millions more are just one premium increase or a layoff away from losing coverage.
According to a U.C. Berkeley study, by 2010 employers will provide health benefits to only about half of the state’s working adults.
Insurance premiums, driven by insurer and drug company bloat, are increasing two to three times faster than underlying medical inflation, such as hospital and doctor fees.
Emergency rooms are overloaded and underfunded because they are the provider of last resort for uninsured people who are forced to wait until illness is critical before seeking care. When the uninsured are finally allowed through the hospital doors, their conditions are more expensive to treat and good health outcomes are less likely.
HMOs and health insurers waste 25 percent of our money on overhead and profit. Including duplicative administrative tasks forced on doctors and hospitals, as much as 50 percent of every dollar spent on health care is wasted.
According to a state study, Californians could save $8 billion dollars a year by eliminating waste, even after insuring everyone in a nonprofit and publicly accountable insurance pool.
The health care industry has injected $4 million into Schwarzenegger’s re-election campaign, yet contributed a mere $120,600 (still a lot of cash) to Democratic challenger Phil Angelides.
Voters frustrated with big money’s roadblocks to better government—including better health care—will have a chance to fight back this November. On the same ballot with Schwarzenegger and Angelides, Californians will vote on Proposition 89. The ballot initiative establishes a “Clean Elections” system of public financing for candidates who reject industry money and reduces the maximum amounts for all kinds of campaign contributions, including those to fund and fight ballot initiatives.
Even with big money out of politics, California voters will support universal health care only if they can imagine it and trust it. To achieve that level of voter confidence, reform advocates must come up with a better name than single payer. For many people, eyes glaze over when the term is uttered. Even worse, to others it conjures up scary images of “DMV health care”—including underpaid government-salaried doctors. Many of those voters would support the goals of universal health care if they could just get past the name. “Medicare For All,” an early alternative that offers a familiar comparison, has now been sullied by the HMOs that are running the Medicare drug program into the ground.
The California universal health care concept is not a “socialized” health care system in which the government employs doctors and runs hospitals. Doctors and hospitals would remain private, but wasteful insurance-company middlemen would get the scalpel. Why take on the baggage of “single payer” when the name doesn’t fit? As one reform advocate has pointed out, we don't call other vital public services "socialized fire departments" or "single payer law enforcement."
The universal health care movement needs a new brand. Why not call it something simple like the “California Health Plan?” Wouldn't the public support a plan that allowed them to choose their doctors and hospitals, pay less for better quality and access, and not have to worry about losing coverage when they change jobs?
Why not help voters understand that under the California Health Plan the billions of dollars wasted by insurance companies and HMOs on middlemen, CEO pay, corporate profits, overhead and advertising would be redirected to providing care? What if voters knew that such a plan would pay for doctor visits, preventive screening, pregnancy coverage, hospitalization and emergency treatment?
The essence of the new brand is the cost efficiency of a health care system that will spend only 2 to 3 percent on overhead and prevent disease rather than treat it after it becomes chronic. Our advocacy must make the case for a government role in better allocating wasted resources and fixing crumbling infrastructure.
To advertise the advantages of such a plan in a less wonky format than the usual policy discussion, the Foundation for Taxpayer and Consumer Rights has designed a new online video game, “Nurse Avenger." Even Governor Schwarzenegger, who doesn’t like to read bills before he vetoes them, could learn something by playing.
In the game, players earn points for fighting mobster-styled insurance company reps trying to kill a patient in a hospital bed. Special weapons include Waste Whacker, Voice Mail Avenger, and Purchasing Power. These are the tools with which government can make health care more affordable and accessible.
Californians will fortunately have the final word on the issue because California, like many states, allows voters to make law by ballot initiative. To move from veto to victory, however, those fighting for reform need a new language.