In Arizona, conservatives target single-payer health reform with deceptive referendum

Stealth group, backed by drug and insurance companies, selects Arizona as testing ground for ballot initiative campaign against Medicare for All, government mandates
By Chris Gray

An Arizona ballot measure to forbid government-mandated health care was voted down two years ago, but it’s back as part of a much larger national campaign this time around. The proponents’ main target? Single-payer, universal health care.
A statement by the American Legislative Exchange Council denounces the insurance mandates proposed by Congress and the Obama administration, but the bulk of the group’s news release in pushing for “freedom of choice” makes it clear that the real target is publicly financed universal health care, commonly referred to as a single-payer system or an improved Medicare for all.
“ALEC’s Freedom of Choice in Health Care Act ensures a person’s right to pay directly for medical care,” states a release from the American Legislative Exchange Council or ALEC, a national right-wing, pro-industry group. “[The] Act will prevent patients from being enrolled in a single-payer health system that will simultaneously pay for everyone’s health care and limit access to it.”
The council’s “Freedom of Choice in Health Care” proposal was drawn up with the support of corporate supporters PhRMA (the trade association of the large drug companies), Johnson & Johnson, and the Blue Cross Blue Shield Association.
The Arizona ballot measure, which is also a concurrent resolution in the state’s House, has strong similarities to ALEC’s draft resolution, which was written with the guidance of Joan Gardner of Blue Cross Blue Shield, an insurance lobby group that publicly pressured Obama to mandate private insurance for all Americans. Even as it continues to support the federal mandates publicly (while arguing the penalties for noncompliance be higher), Blue Cross Blue Shield has been working to undermine the administration’s bill, along with the prospects for single-payer legislation, through the stealth campaign of the American Legislative Exchange Council.
The original “Freedom to Choose Act” in 2008 was boosted primarily by a group called Medical Choice for Arizona, headed by Eric Novack, an orthopedic surgeon in Glendale, Ariz., who had teamed up with conservative groups like the Phoenix-based Goldwater Institute. Its unsuccessful campaign received over $400,000 in donations, much of it from out of state.
The current measure is once again being backed by Novack’s group, which has been renamed Arizonans for Health Care Freedom, in alliance with ALEC and others. The statewide ballot initiative, which would amend Arizona’s constitution, will appear on the Nov. 2 ballot.
ALEC stepped in to support the second go-round not long after Americans elected Barack Obama president on a platform of health care reform. ALEC hopes to use Arizona as a model to block universal health programs across the nation.
The attack on single payer in ALEC’s campaign could be seen as a sign that ALEC views state-based single-payer campaigns as a credible threat to the private insurance companies that help fund the organization. Several states where the ALEC legislation is being introduced have strong single-payer movements that could greatly cut into private insurance company profits if a publicly financed health plan gets passed in those states.
Supporters of ALEC’s Freedom of Choice in Health Care Act argue that the bill is all about the “right to choose” one’s health care coverage. However, if such a bill were enacted in Arizona, its residents would still be unable to freely choose their doctor or hospital. Their choices would be restricted by the private health plan they belong to, plans which themselves are becoming increasingly unaffordable.
In contrast, one of the hallmarks of the single-payer proposal is the guarantee that patients will have full freedom to choose their doctor, hospital or other provider.
The Orwellian title of the bill — “Freedom of Choice in Health Care Act” — is another ALEC hallmark. Much of ALEC’s previous work has involved opposing environmental protection legislation. The deceptively named Environmental Good Samaritan Act, Groundwater Protection Act and the Environmental Literacy Improvement Act were all designed to weaken environmental laws in favor of industry and curtail the regulatory powers of the Environmental Protection Agency.
The council has managed to stay well under the radar of the mainstream media, passing as advocates of “limited government and free markets” in a recent New York Times article. But, in fact, the council is much less concerned with limited government than with bolstering the business interests that fund the tax-exempt organization and vote on its proposals, according to the Nieman Foundation at Harvard University.
ALEC was founded by Paul Weyrich of the Heritage Foundation in 1973 to offer sample legislation to conservative state legislators who would support ALEC’s industry backers. Legislators pay nominal dues to receive trips to conferences as well as model legislation, written courtesy of the big corporations that finance the council. Officially a legislators’ association, membership dues account for only 1 percent of the group’s funding, while donations come from corporations like ExxonMobil and Philip Morris make up much of the balance of the group’s $5 million budget.
Alan Rosenthal, a public policy professor at Rutgers University, told the Washington Post that ALEC is unique in state-legislature lobbying groups in that it allows corporations a direct vote on platform decisions.
In the Clinton era, ALEC championed the interests of tobacco companies R.J. Reynolds and Philip Morris. In the early Bush years, the organization pushed back against environmental regulation and climate change legislation that might hinder the business of key donor ExxonMobil. A recent expose in the Washington Post outlined how ALEC won state legislation in Virginia shielding a single asbestos company from liability in cancer-related deaths.
If the measure passes in Arizona, ALEC has stated that it has model legislation lined up in at least five other states (Indiana, Minnesota, New Mexico, North Dakota, and Wyoming). Bills have been introduced in 24 states to prevent single-payer health care and/or nullify Obama’s insurance mandate. A more limited version of the Arizona ballot measure already passed in Virginia on March 10.
Any state bill written to nullify a federal law such as the insurance mandate would be “constitutionally impossible” and serve as “political theater,” according to Timothy Jost, a Washington and Lee University law professor who wrote on the subject for the New England Journal of Medicine. But that’s not to say it would be shot down without a legal fight. Clint Bolick of the Goldwater Institute told the Boston Globe that he would like to test federal insurance mandates in the U.S. Supreme Court.
In order for a publicly financed, single-payer health system to work effectively and save on administration costs, it must cover everyone. By preventing such a system and enshrining into law the status quo, the “Freedom of Choice in Health Care” leaves Arizonans’ freedom of choice determined more by their income level or their luck than anything else.
Chris Gray is an intern at Physicians for a National Health Program (www.pnhp.org).