Showing posts with label Ron Dellums. Show all posts
Showing posts with label Ron Dellums. Show all posts

Monday, October 22, 2018

"Single Payer", "Medicare for All": Good ideas and about time!


The call for a universal health care system in the US is probably greater than it ever has been. While, of course, the Republicans, whose only firm position is completely kowtowing to billionaires and major corporations, are opposed to it, many Democrats have signed on to the “Improved and Expanded Medicare for All” bill in Congress (120 at last count). Democrats running across the country have been calling for “single payer” as well as “Medicare for All”, from outspoken Democratic socialists like Alexandria Ocasio-Cortez in NY (and of course Bernie Sanders) to moderate Democrats running in states and districts that Trump won. They correctly see this as an issue that cuts across traditional liberal-conservative lines, and even racial lines, and may be their path to victory.

Many Republicans (although not the Republican congressional leadership) are reading the same tea leaves, and are hedging, trying to say that they favor the things that people like about the ACA (most important, the protection against insurers denying coverage for pre-existing conditions). Of course this often requires major dissembling for those who, like our Arizona GOP candidate for Senate Martha McSally, voted to gut the ACA, and even Texas senator Ted Cruz who authored the “Cruz Amendment” that would strip virtually all protections for people under ACA. President Trump, never one for nuance, has no difficulty having it both ways: he calls for the repeal of ACA while insisting that his health care plan will protect people’s ability to have health insurance, pre-existing conditions or not (it won’t).

It is in this context that the recent Sunday NY Times’ Magazine article by Elisabeth Rosenthal and Shefali Luthra, ‘“Don’t get too excited” about Medicare for All’ becomes important. For starters, “Don’t get too excited” is not necessarily the opinion of the authors but a quotation from Rep. Jim Cooper (D-TN). Rep. Cooper was responding to the surprise of one of his Nashville constituents, Dr. Carol Paris, President of the leading physician advocacy group for single payer, Physicians for a National Health Program (PNHP), that he had signed onto the Medicare for All bill. Nonetheless, the article does raise many cautions about the movement to single payer or Medicare for All, mainly about different interpretations of the meanings of this by different advocates, and incomplete and sometimes inaccurate understanding of them by regular people. The most important thing about it, however, is that it had to be written at all because there is such a movement; long-time activists, including PNHP physicians, remember that it was not too long ago that such an idea was poo-pooed, dismissed. Not now.

Clearly, the quantum step forward was the 2016 presidential campaign of Bernie Sanders. The establishment pundits of both parties were shocked at how popular and successful this old Jewish socialist from Vermont (ok, originally Brooklyn) was across the country. He didn’t win the Democratic nomination, true, but he might have won the general election against Trump. Certainly, his straight talk and the fact that he directly addressed the felt needs of regular people was the main reason for his popularity, and people’s fears about their health risks and costs were central to this (see A majority of Americans are worried about health care costs -- and a majority of Congress doesn't care, October 16, 2018). Bernie had advocated for single payer for decades, as had great leaders before him including the late Representative Ron Dellums of California (see Ron Dellums: Loss of a great leader and a job for the rest of us, July 31, 2018), but the visibility of his presidential campaign skyrocketed the visibility of single payer.

Rosenthal and Luthra utilize a good bit of ink describing what single payer is --the government is the only payer for health care, rather than multiple private insurers; Canada is the best example of this, and Britain has a government-owned national health service. They also note that Medicare for All means exactly that, that everyone, not just those over 65 and the blind and disabled, would be in the Medicare program. Of course, since Medicare is a single payer program, it would be single payer. They describe the misconceptions people have (“would I be able to keep my present plan?”), and also talk about other countries, such as France and Germany, that have universal health care without a single payer but with a heavily-regulated marketplace. They observe that partialist solutions do not generate the enthusiasm of single payer, but that the latter would be the hardest and thus (perhaps) most difficult to institute. Among the concerns they note are the displacement of insurance company employees and the decrease in doctors’ income.

But these are the most important points.
  1.       Our health care system is not working. Our life expectancy is much lower than other developed countries, about 43rd, and a recent article in Smithsonian Magazine covers work that projects that it will drop another 21 places by 2040, to 64! Other measures of access to care and quality of care are comparably poor. Yes, there are heroic and wonderful things that medical care can do for people, but if these are not accessible to everyone, and if the cost of them precludes spending on even basic care for everyone, it is not working.
  2.   Our health care system is incredibly costly. By far, we spend more, overall, as % of GDP, and per capita, than any country in the world, as illustrated by the graph from the Kaiser Family Foundation. It is more than twice as much as most of the developed countries, all of which have far better health status.
  3. Profit is the problem. Specifically, corporate profit made from providing health care services (or, in the case of insurance companies, not providing health care). This is how we manage to do both #1 and #2 – because the functional goal of the US health system is not to increase the population’s health but to make as much money as possible for insurers, hospitals, drug companies, and providers.


These are the core issues that need to be addressed, and what sets the US apart from all other developed countries. Yes, Canada has a single payer system such as we might have with Medicare for All (and they even call it Medicare). Britain has a National Health Service, with most hospital and health care facilities owned by, and some doctors employed by, the government. Britain, however, allows private insurance for those who can afford it, Canada does not. France and Germany and Switzerland have multiple insurers, but they are not unfettered to maximize profit by denying care. In Switzerland, for example, insurers have to be non-profit, have to offer the same benefits, and have to charge the same amount. They compete on quality of service! Can you imagine that here?

So, while Rosenthal and Luthra repeat the idea that single payer, although the most enthusiasm-generating, would involve the biggest change, it is also, in another sense, the least complicated. Trying to get to a system like that that evolved in these other countries over decades will be more complicated to understand and to implement. Many of the suggestions for incrementalism (“Medicare for More”, “public option”) will not solve the problems we have because they do not include everybody, and because they do not eliminate the incentive for making money on the back of denying care that is the core flaw in our current situation.

“Medicare for All” and “single payer” are popular among people because their core meaning is understandable, and they would address the needs that they have.

  • ·        Everybody in, nobody out!
  • ·        No profiteering!

Simple message. Needed solution.

Tuesday, July 31, 2018

Ron Dellums: Loss of a great leader and a job for the rest of us


On July 30, 2018, Ron Dellums, one of the giants of our era, died of cancer. As the obituaries in the New York Times and Washington Post make clear, he was a major progressive voice, inside and out of Congress, for many years. He was elected, largely on an anti-Vietnam war platform, in 1971 from “one of the most liberal districts” in the nation, Oakland and Berkeley, CA, and served until 1998. Over the decades he fought for women’s rights, civil rights, civil liberties, inclusion, anti-corporatism, fairness and equity, labor, and environmental goals. ‘He championed a progressive mantra: Stop war. Cut military spending. Help people. Address the nation’s social problems.’ He was a founder of the Congressional Black Caucus, and in 2007 was elected to a term as Mayor of the city of Oakland.
‘“So here comes this black guy from the Bay Area,” he told The Progressive magazine when he left Congress, “talking about peace, feminism, challenging racism, challenging the priorities of the country, and talking about preserving the fragile nature of our ecological system. People looked at me as if I was a freak. And looking back, I think that the only crime we committed was that we were 20 years ahead of our time.”

But, quite amazingly, neither the Times nor the Post obituaries, nor his extensive updated Wikipedia entry mention the issue that is the one that first comes to mind for progressives in the health care arena: his early and continuing support for a national health system, which he agreed was the most logical, effective, and cost-effective means of providing for the health care needs of the American people. The “Dellums Bill”, which was first introduced in 1972 and re-introduced at every session in which he served in Congress, would have created a national health system (not just a national health insurance plan) and was far more expansive than simply Medicare for All, although Mr. Dellums also supported that, and its current iteration, HR 676. Dellums’ United States Health Service Act actually proposed a comprehensive and rational health care system, with neighborhood health centers, larger multispecialty centers, local hospitals, regional hospitals, and referral centers, all joined to each other, all run by elected boards of consumers, and all funded by public funds. It would have been – and still would be – terrific for the health of the American people, and for controlling costs, to have such a system in place. Of course, it would not have been nearly as profitable for providers (which mainly means hospitals, but also doctors and others), insurance companies, pharmaceutical companies, device manufacturers, and other profiteers. So, of course, it never occurred. But Congressman Dellums continued to be a beacon for universal health care, and we should be ever thankful for his leadership in this arena.

Ron Dellums championed universal health care before Bernie Sanders was the spokesperson for it, although both supported each other, and remained a staunch advocate for it. Today we are still far from this goal, although the ACA did significantly expand access. Although its opponents have not succeeded in repealing it, they have done what they could to make it less effective in covering everyone, including removing the individual mandate, removing funding for many of its programs (such as navigators), limiting access to the individual marketplace (although as many people signed up in 2017-18 with only six weeks to do it as in 2016-17 with 12 weeks, attesting to its popularity), and other reactionary efforts. But the ACA was not universal health care, nor was it an effective way of controlling costs. It expanded coverage, but did not redesign the health system the way the Dellums Bill would have.

With control of the government in the hands of Republicans, including not only the self-designated populist and reality TV figure who is President, but a Congress and state governments in the hands of a GOP who manifest no semblance of humanity. As noted accurately by Thomas Frank in The Guardian
‘Republicans are a known quantity. Their motives are simple: they will do anything, say anything, profess faith in anything to get tax cuts, deregulation and a little help keeping workers in line. Nothing else is sacred to them. Rules, norms, traditions, deficits, the Bible, the constitution, whatever. They don’t care, and in this they have proven utterly predictable.’

Certainly they don’t care about the American people’s health, which is suffering worst in the reddest counties in the US, those that have also suffered the worst from stagnant wages coming from the pro-corporate policies of the GOP, as well as environmental degradation. We need to continue to work to change these policies, to un-elect Republicans, to elect people who stand for progressive change and not pro-Wall St status quo like the DNC.

While we will not be able to re-create him, we need more people who seek to be like Ron Dellums.

Stop war. Cut military spending. Help people. Address the nation’s social problems.




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