“I happen to be a proponent of a single payer health care program.”
Senatorial candidate, Barack Obama, speaking to the AFL-CIO in Illinois, June 30, 2003

“If I were designing a system from scratch, I would probably go ahead with a single-payer system.” Presidential candidate, Barack Obama, town hall meeting, Albuquerque, New Mexico, August 18, 2008

“The only problem is that we’re not starting from scratch.”
President Barack Obama, town hall meeting, Rio Rancho, New Mexico, May 14, 2009

There is no doubt that President Barack Obama has done some serious back-pedalling on the issue of health care reform during his journey to the White House. It’s a well-worn path trod by, among others, Hillary Clinton during the 1990s and by Ronald Reagan during the 1980s.

The wind at their backs comes from the medical, pharmaceutical, hospital and insurance industries which together have spent more than US$4.2 billion on lobbying during the last 10 years. A recent report in the Washington Post says that, in the current battle against a government insurance plan, the health industry is spending $1.4 million a day lobbying key figures in the capital.

The fight over universal health care in the United States is being fought on three broad fronts reflecting three different positions: those for, those against, and those who are calling for a “private-public option” that would provide American consumers with “choice.” Canadians are probably most familiar with the divide between those on the first front who support a public, universal, national health insurance (single payer) scheme, and those on the second who are against any public involvement in the health sector.

Everybody in, nobody out

Advocates of a public single payer include Dennis Kucinich and John Conyers, the latter of whom brought a bill before the House of Representatives that would provide U.S. residents access to “all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services.”

The Conyers bill, taking a page out of Canada’s health care legislation, would prohibit private insurers from selling coverage for services already included in the public insurance plan. The bill, which now has 93 co-sponsors (20 per cent of House members), goes significantly further than Canadian legislation in prohibiting private, for-profit facilities from participating in a national, expanded and improved Medicare scheme. The plan would be financed with existing health care funds, as well as increased taxes on the top 5 per cent of income earners, a modest tax on stock and bond transactions and payroll and self-employment taxes.

In another departure from Canada, the Conyers bill would stream Native Americans in to the national health program. Support for the single payer option outlined in the bill is coming from the United Steelworkers, U.S. Physicians for a National Health Plan, the California Nurses Association and, according to polls conducted between October 2003 and February 2009, between 59 per cent and 75 per cent of the American public.

Public support for single payer was also strong when Hillary Clinton attempted to introduce modest reforms to the U.S. health system. What advocates learned then is being applied now. During the past several years, advocates have raised awareness about the benefits of a national, public health program — in spite of the heavy-handed propaganda from the health industry. Between December 15 and 31, 2008, for example, more than 4200 “house parties” were held across the United States largely at the encouragement of Obama’s legion of organizers. Ironically, while Obama has jumped off the single payer bandwagon, he has inspired a groundswell of support for “everybody in/nobody out” that is not only determined but knowledgeable as well.

The second front

The people campaigning for the U.S. status quo — private, high-priced, employer-controlled health insurance — include some notable Canadians, including Brian Day and David Gratzer, whose views we have seen reflected within the Canadian Medical Association (CMA) in recent years.

Among the significant voices opposing single payer are the American Association of Retired Persons, the Business Roundtable, The Lewin Group, Families USA, PhRMA and the American Medical Association, which argues that services should be “provided through private markets, as they are currently.” The AMA’s Principles for Health System Reform include a “robust private insurance market” and “sustainable public programs for vulnerable populations.”

That position, an echo of the one taken by the CMA nearly half a century ago, was rejected by the 1964 Royal Commission on Health Care as being too costly and too short of the goal post. But the corporate media is also doing what it can to support the status quo, sweeping any discussion of single payer under the rug (a repeat performance of 1993 efforts at health care reform). A March 2009 study by Fairness & Accuracy in Reporting (FAIR) found a virtual blackout in the mainstream media of any reporting about the single payer option, despite support among a large majority of Americans.

The take-forever option

The third front — those in favour of incremental progress — appears to be a tactical alliance between the health and insurance industries, on the one hand, and those with financial links to the health and insurance industries on the other. Senator Max Baucus, chair of the powerful Senate Finance Committee, is described as the Senate’s “point man” on health care reform and a leading opponent of a universal public program.

In June, the Standard, a leading newspaper in Baucus’ home state of Montana, reported that Baucus had received “$1,500 a day, every day, from January 2003 through 2008” from the health and insurance industries, more money than any other elected member. During the last two elections Baucus has also attracted almost $230,000 from the pharmaceutical industry, another strong opponent of a single payer system.

On June 2, Baucus announced that “everything is on the table” — everything, that is, except for single payer. “It cannot pass,” he told reporters, and could endanger any meaningful reform. During Senate Committee hearings on health care reform last month, single payer supporters showed up at a Finance Committee hearing to protest against their exclusion from hearings. They were arrested. But after hearing from angry, pro-single payer voters back home, Baucus softened his position — he has drifted to the incremental middle.

This is probably not surprising since one of the senator’s key paymasters, the insurance industry, has now decided that a pubic-private partnership might save its place in the health care pocketbook. On May 5, Karen Ignagni, head of America’s Health Insurance Plans (AHIP), announced that the lobby group had issued “a transparent call for a full-scale renovation and a complete overhaul of the existing regulatory mechanism” that governs the industry.

AHIP, representing some 1300 health insurers, has promised — not for the first time — to end its long-standing practice of claim denials, discrimination and premium-gouging. Industry observers are not holding their breath, but the “middle ground” is becoming crowded with health industry representatives, politicians on their payroll and the White House. Ironically, government funding to cover the 47 million uninsured, if channeled through subsidies to the private insurance industry, could significantly increase its revenues. What the industry does not want, however, is further government regulation. The goal of industry advocates of this so called ‘middle way’ is new public money without strings. Depending on the content of future legislation, it could be a bonanza for industry investors.

Sidelined in the entire debate is the AFL-CIO, which has remained mum on the single payer option supported by some of its affiliates. The labour movement’s key speaker on national issues, the AFL-CIO seems to have adopted the view that anything is better than nothing. Its website asks “What’s Wrong with America’s Health Care?” — but clearly “everybody in/nobody out” is not one of the solutions to the myriad of problems listed.

The Federation is a member of the Health Care For America Now coalition that supports a private insurance option.  At a June 25 demonstration in front of the US Congress, an unidentified AFL-CIO representative argued that single payer was “a kind of thing that throws everybody off the track,” articulating fears that even modest reforms like affordable premiums and coverage for the uninsured might be sacrificed to an unobtainable goal. “We feel that health care reform is the way to go,” she said, “because something has to be done NOW!”

So what does this have to do with us who live above the 49th parallel? The answer, for better or worse is “plenty.”

The Canadian and U.S. insurance markets are almost entirely integrated, thanks in part to the North American Free Trade Agreement. A quick look at the list of members of the Canadian Life & Health Insurance Association (CLHIA) shows some important overlaps with AHIP in the United States, including Manulife (through its subsidiary, John Hancock Financial Services), Aetna, Cigna (which purchased Great-West’s US subsidiary last year for US$2B), MetLife, New York Life Insurance, Prudential, State Farm, Transamerica and Zurich.

The CLHIA’s June 2009 report contains a number of recommendations to strengthen the industry’s role in the provision of insurance, including tax and financial incentives to enable Canadians to purchase of private insurance. The industry has already secured significant subsidies for private insurance coverage amounting to $5 billion in 2004, according to health economist, Robert Evans. The industry’s submission to the post-Chaoulli consultation in Quebec cautioned the province, “It is not enough to lift the prohibition on private insurance in the sectors financed by public plans in order for private complementary insurance products to spring into existence. Privates insurance must also be allowed to provide added value.” An example of “added value” would be queue-jumping.

But more to the point, Canadian governments are staging an assault on health care at the urging and with the support of insurers, employers, private providers, the media and right wing ideologues. Since 1995, for example, when Alberta became the first province to remove outpatient physiotherapy from the pubic insurance plan, a whole section of the health sector — outpatient rehab services — was privatized and delisted, reducing patient access but boosting insurance industry profits.

That was a short 10 years, and the privatization “train” is still going full steam ahead. But, like the ever-growing number of uninsured Americans, the number of people with private benefits in Canada is also falling and, of those who are covered, high deductibles, co-pays and claim denials are the order of the day. 

Whatever happens in the U.S. it will have an impact on our ability to not only protect medicare in Canada, but to expand it as well — an issue that is becoming more and more urgent.

We share a continent with Americans, and soon, if economic integration continues, we may share a health care system with them as well. It is in our interest to see Americans get what they have needed for so long: a national health system that provides universal coverage based on need, not on ability to pay.

Colleen Fuller is a health care activist with the B.C. and Canadian health coalitions. She is the author of Caring for Profit: How Corporations Are Taking Over Canada’s Health Care System (Canadian Centre for Policy Alternatives/New Star Books, 1998) and, with Diana Gibson, The Bottom Line: The Truth Behind Private Health Insurance in Canada (NuWest Press/Parkland Institute, 2006).