The Western Washington Chapter of Physicians for a National Health Program, which advocates for a universal, comprehensive single-payer national health program, held its annual public meeting last Saturday evening at Kane Hall on the University of Washington campus. The event provided a useful snapshot of things to come in healthcare politics nationally, but also here in Washington State.
The meeting, held before a nearly full house that included numerous practicing doctors and nurses, also provided its share of surprises. Here are some highlights:
There was consensus that a single-payer plan is at least several years away and that state- rather than national-level organizing efforts to institute one would bear the most fruit over the next two years.
The Affordable Care Act (a.k.a. Obamacare) allows states, beginning in 2017, to seek exemptions from its provisions provided they present a credible alternative plan to the U.S. Secretary of Health and Human Services. The meeting’s speakers agreed that between now and 2017 lobbying efforts to enact single-payer alternatives should focus on governors and state legislators. (Such HHS approvals, Rep. Jim McDermott pointed out, would likely occur only during the administration of a President sympathetic to the idea).
There was surprising dissatisfaction expressed toward Obamacare per se. McDermott, the ranking Democrat on the House Ways and Means health subcommittee, said he was "annoyed and disappointed" that President Obama, at the outset of his administration, had refused even to consider a single-payer approach for which many organizations had worked tirelessly in prior years. Dr. Phil Caper, a former senior staff member of Sen. Ted Kennedy's health subcommittee and co-founder of a Maine group which supports a single-payer approach, commended President Obama, Michele Obama and Rep. Nancy Pelosi for their intense efforts to pass the Affordable Care Act. (See video of his talk below.) But he characterized the legislation itself as "bad public policy" because it leaves many without coverage and shifts costs inequitably among various patient groups.
Seattle City Council member Kshama Sawant also was critical of Obamacare, arguing that the administration colluded with drug and insurance companies in framing it. Sawant spoke longest and most avidly at the meeting. (See video of her talk below.) She called on committed single-payer supporters to follow the example of those who sought a $15 minimum wage in Seattle, and bring tireless pressure to bear on Democratic officeholders in particular. She derided fellow City Council members, with the exception of Nick Licata, for bending almost automatically toward special-interest and corporate agendas. She solicited support for the defeat of sitting Washington State House Speaker Frank Chopp in upcoming primary elections.
Sawant is a committed socialist who often referred to "working class interests" and "corrupt corporations, banks, and hedge fund operators." Phil Caper, by contrast, noted that, unsurprisingly, drug companies, insurance companies and health-care providers had historically taken positions they considered to be in the best interests of their shareholders and/or bottom lines. Many of their interests, he said, could in fact be better satisfied under a comprehensive single-payer plan than through Obamacare or previous programs. No one's interest is served if health-care remains unaffordable to many, if a catastrophic illness can hurt individuals, families and their insurers and providers, and if the public and private costs of healthcare keep rising.
All conference speakers agreed that a single-payer plan that covers everyone should be financed by general tax funds. Caper reported that, in Maine, doctors required to deal with multiple health-insurance plans spent about three times as much money on administration as Canadian doctors who operate under a simpler single-payer plan.
Hospitals, he said, spent even more, because of the need for large billing departments with hundreds of employees. The same was true of insurance companies, which maintain large underwriting departments to create hundreds of "risk pools." Estimates in Maine of unnecessary administration came to $1,500 per year for every resident of the state. Affordable Care Act provisions, said Caper, will cause these administrative costs to grow.
My life partner and I attended the Saturday meeting mainly to see and hear Caper, an old Washington, D.C. comrade. But, at its end, it was impossible not to be impressed by the commitment and energy of the single-payer advocates on the podium and in the audience.
I was reminded of similar meetings in the 1960s in which healthcare reform advocates pledged to pass Medicare and Medicaid. That finally took place in 1965 after nearly two decades of ceaseless effort by a broad coalition of political, labor, business and health-sector leaders.
The difference between 1965 and now is that partisan and ideological lines were less harshly drawn back then and working across those lines was not so difficult. That said, time and reality are on the side of the single-payer advocates.
In 2008, I thought President Obama would begin a health-reform effort by introducing a universal, single-payer plan to cover major medical (catastrophic) expenses as one step towards a broader healthcare plan. He did not. Still, even with its imperfections, Obamacare may have served the eventual enactment of a single-payer model. Not because the latter conforms to Sawant's socialist vision. But because it best serves the needs of American citizens and taxpayers; insuring coverage for all and financed equitably, while removing present administrative redundancies and cost and eligibility disparities.
The next task for local Physicians for a National Health Program is its active political support for Health Care for All-Washington, which advocates at state level for s single-payer scheme.