I attended an interesting conference on “Health Care for All,” sponsored by Citizen Action at Rutgers University today, with a lot of breathless anticipation about how the 2008 elections were going to provide a mandate to finally get a national health plan. That is, if our policy-thinkers and policy-makers don’t compromise it to death. Dr. Oliver Fein, of Physicians for a National Health Plan, provided a spirited advocacy for universal single payer health care – “Medicare for All” – with a direct challenge to the for-profit insurance lobby and the compromisers. Too bad he’s not running for President. Representatives for Obama’s and Clinton’s campaigns were in attendance and said a whole lot about nothing, which does not bode well for voters’ supposed mandate for meaningful reform.
In the face of federal inaction, many states are putting together piecemeal, stop-gap programs. New Jersey’s slow move in this direction was the ostensible purpose for the conference. The state of Wisconsin is apparently close to enacting (or at least voting on) a pretty good plan that, nevertheless, demonstrates the pitfalls of statewide solutions. What Wisconsin would do, according to Dr. Robert Kraig of Citizen Action, is what most states do to insure their own employees. They spell out the terms of coverage – what procedures would be fully reimbursed, how much hospitalization, whether there would be co-pays or deductibles, that no one be denied coverage because of age, location or pre-existing condition, that no more than 15% of the costs go towards advertising and administration, etc. – and then contract out with various companies to provide the coverage. The Wisconsin plan would replace private insurance with a payroll tax to fund a statewide system and throw everyone into the same statewide pool, but allow individuals to choose between different insurance companies – Blue Cross, GHI and the like – or a state-run, non-profit plan. This idea of creating a state plan to compete with the private companies is apparently coming up often in these compromise plans. The thinking is that it’s a backdoor to single-payer health insurance, since a non-profit state-run plan would be cheaper and more efficient and would inevitably drive the private companies out of the market. At the very least, it is reasoned, they will keep the private companies competitive and “honest.” Call me a cynical socialist, but I assume the public plans will be sabotaged in some way so that the “superiority” of private plans will be proved.
Nevertheless, from an operational standpoint, the Wisconsin plan would work. It would provide good, comprehensive health care for everyone. However, I’m afraid it wouldn’t retain enough public support to survive the gauntlet of opposition it will receive from business and the insurance lobby. The problem is the funding formula. The plan calls for a ten percent payroll tax on employers, which is a good, suitable level (California’s Super Hero Governor is proposing a meager 6% payroll tax for his less-than-universal plan). A ten percent tax is less than employers pay for good health insurance, but more than employers pay for lousy or no insurance, helping even the playing field for companies than have been competing over health care costs (like Wal-Mart and the unionized supermarkets).
However, the plan also calls for a four percent payroll tax on employees, which, simply put, represents a pay cut for many workers for something they already have. Workers who have formed unions and bargained to gain and maintain good health insurance have already forgone higher wages in lieu of that insurance. To propose that they take a cut now, essentially to bail out employers who have shirked their responsibilities, is not only unfair, it is politically untenable. No matter what proposals come out for universal health care, the insurance lobby is going to spend tons of money on television and radio advertising to scare voters out of supporting the plan. Why give them a good, scary issue? Perhaps I see this more clearly as a union organizer. During a union recognition vote, an employer campaigns to convince his employees to vote against forming a union. The employer never campaigns on his issues – his need to maintain “flexibility” and the ability to freeze or cut wages, increase hours and lay off employees as he sees fit – because these issues are obviously not in the interest of his workers. So, the employer instead campaigns on an issue that is in the interest of the workers: their paychecks. Every employer-run anti-union campaign makes union dues a main focus. The insurance lobby is not going to campaign on its need to maintain profits at the expense of people’s health, but they will campaign on issues of costs and taxes.
Wisconsin, like any other state, is limited in terms of its options for new revenue, so a payroll tax (the burden of which falls inordinately on working people) is one of its few options. The federal government, which ultimately should take up the responsibility of a universal plan, has many more equitable options. To fund a “Medicare for All” plan, Congress could and should implement a payroll tax on employers. But Congress could also repeal the Bush tax cut, which mostly went to the wealthy, or increase the capital gains tax, which is how the wealthy get obscenely wealthy. Congress could probably find enough money to fund the program in the billions that are currently being blown to smithereens in Iraq.
As Dr. Fein, of PNHP, remarked at the conference, a long-held saying in the movement for national health, has been “don’t let the perfect be the enemy of the good.” Meaning, don’t let our pipe dream of single payer health insurance stand in the way of a compromise that we can get now. Now, with health care reform definitely on the agenda, it’s all the more important to hold firm to our convictions that single payer health care is not a pipe dream. It is not merely a wonky distinction between a bunch of “equally good” compromise plans put forth by the candidates. It is the only plan that can coalesce and maintain a coalition of unions, community and advocacy groups, healthcare professionals and taxpayers that can survive the barrage of attacks that any plan – good, perfect or terrible – will inevitably face from the merchants of death in the insurance lobby.
