As our health care “system” continues to fall apart in its crisis of access and affordability, new coalitions are popping up all around us, each espousing the urgent need for “ health care reform”. These are some of the bigger, more recent coalitions:

  • Divided We Fail (includes AARP, the Business Round table, and the ServiceEmployees International Union (SEIU); committed to a “search for solutions to health care” – – – by building on private insurance.
  • The National Coalition on Benefits (includes more than 50 of the largest corporations and most powerful lobbying organizations, including private health insurers, the Business Roundtable, and the U. S. Chamber of Commerce; they lobby to keep large employers’ insurance plans exempt from regulation)
  • Health Care for America Now (HCAN), a coalition of many national organizations, including the American Nurses Association,, and the Progressive Action Network; their common purpose is to promote “an American solution” which assures universal health coverage “through the largest possible risk pools” for affordable health care in an inclusive and accessible system leaving nobody out; it retains choice of a private health plan.
  • Five other organizations — the American Cancer Society’s Cancer Action Network, the American Hospital Association, the Catholic Health Association, Families USA, and the National Federation of Independent Business (NFIB, which represents small business); this group is co-sponsoring the latest Harry and Louise advertising campaign, which expresses concern about cost and access problems, urging that “health care should be at the top of the next president’s agenda. Bring everyone to the table, and make it happen”.

As usual, you can’t tell any of these coalitions’ real agenda by their names. But all of these are committed to preserving the private health insurance industry, and keeping single-payer national health insurance (NHI) off the table. Their message can be very effective by confusing the public, trivializing the debate over policy options, and most importantly, by calling for everyone to come to the table and working toward political compromises which look like reform but are not. Meanwhile, of course, America’s Health Insurance Plans (AHIP), the industry’s trade group, launches its own national propaganda effort Campaign for an American Solution, which argues for “choice” and fails to acknowledge single-payer as an alternative, while the AMA predictably supports continuation of multi-payer financing.

Behind the bland, even patriotic sounding names of these coalitions are conflicts of interest invisible to much of the public. Here are just two examples.

AARP is involved with a lucrative market of supplemental private Medigap plans through United Health; about 60 percent of its revenue (double that from members’ dues) comes from sales of Medigap policies, its membership list, and related activities. AHIP’s conflict of interest, of course, is obvious, but does not restrain its promotional efforts to put itself forward as part of the “reform” process. Since 1999, AHIP has been building its own coalition, the Coalition for Medicare Choices; it includes more than 400,000 senior activists who have lobbied Congress in opposition to cuts in government overpayments to private Medicare plans (already receiving 112 to 119 percent larger payments than traditional Medicare).

In each case, the rhetoric of change obscures the lack of concrete policy changes that could address system problems of health care. Private insurers would like to continue to fragment the market, cherry pick lower-risk healthier people, shift the sick to public financing, avoid regulation, and at the same time receive government subsidies to stay in business.

Alternative Financing Systems and American ValuesBut private insurers are the problem! As pointed out in previous posts, the private insurance industry and open markets have failed, after many incremental attempts over the last 30 years, to resolve system problems. The critical policy alternative before us is: Multi-payer vs Single-payer.

If we frame the alternatives for health care reform on traditional American values, as arguably we should, single-payer wins hands down. The accompanying graphic compares the two financing options by nine values, in each case with unambiguous results favoring single-payer, on the basis of track record and actual experience, not ideology or rhetoric. Health care is not a partisan issue. It is about every American having access to affordable necessary health care, regardless of age, gender, employment, health status, or race. It is about employers being able to compete in a global market with a healthy work force. It is also about pulling together with social solidarity rather than survival of the fittest (those who can pay).

These comparisons between public and private financing are well documented by many studies over the years. But the political process to date keeps allowing well -financed vested interests to change the subject and delay real reform. That happened in 2006 when the Citizen’s Health Care Working Group, created by the Medicare legislation of 2003 and charged with the task of formulating approaches to address health care system problems. Although almost one-half of the more than 800 participants in two years’ of community meetings around the country had supported single-payer NHI as by far the leading option for reform, the resultant document ignored single-payer and instead endorsed a system of private catastrophic coverage with deductibles as high as $30,000, an option not even discussed in community meetings and mostly opposed in online polls.

It is time to recognize distortional politics for what it is, and get on with making our voices heard. Momentum for single-payer NHI is gathering strength, as illustrated by these examples of growing support:

  • There are now 92 sponsors of HR 676 (The United States National Health Insurance Act ) in the House of Congress
  • A majority of Americans have supported publicly-financed NHI for at least 60 years, often as many as two out of three in some surveys; a 2005 national study by the Pew Research Center of the People and the Press found that this support crosses party lines, with 59 percent of social conservatives and 63 percent of pro-government conservatives favoring NHI, even if taxes increase.
  • 59 percent of more than 2,200 U. S. physicians now favor NHI in a survey earlier this year, as do about 60 percent of physicians in Massachusetts and Minnesota ; the American College of Physicians (the second largest medical organization in the country with 125,000 members) has endorsed the single-payer option, as has the American Public Health Association and the California Nurses Association.
  • Organized labor is getting behind single-payer as its employer-based health benefits continue to erode; the AFL-CIO nationally has endorsed the basic principles of single-payer, and a growing number of unions are backing HR 676

The health care crisis challenges our democracy to its core – – – will corporate dollars through deceptively named coalitions continue to trump individual and public will?