MSNBC’s Lawrence O’Donnell explains how President Obama’s healthcare bill traded old problems for new problems by keeping the employer-based insurance system in place.

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Mention “socially responsible investing” and most people think of a stock-picking strategy that involves abstinence—that is, avoiding industries or companies whose ethical, environmental or governance practices fall short of certain standards.

The mutual-fund industry began offering products based on this idea in the 1970s, and Morningstar Inc. recently identified 199 mutual funds and 23 exchange-traded funds as socially responsible. Among the industries these funds typically shun are those connected to tobacco, alcohol, pollution, weapons and authoritarian regimes.

But some involved in socially responsible investing, or SRI, say two recent developments—a long, acrimonious debate about health-care finance and the worst financial crisis in 80 years—may prompt some socially responsible investors to take a closer look at two other sectors: for-profit health insurers and too-big-to-fail banks.

Both groups “put the customer at odds with the corporation, and that is very problematic,” says Amy Domini, founder of Domini Social Investments LLC, which refuses to invest in certain banks and insurers for precisely that reason.
[SRI]

Both industries have drawn the wrath of the Occupy movement. To protest the power of Wall Street banks, many Occupy sympathizers have moved their deposits from large financial institutions to smaller banks and credit unions.

What if investors wanted to do something similar and move their money to funds that refuse to invest in big banks and for-profit health insurers?

Turns out it might not be so easy.

While there are a few exceptions, SRI managers generally haven’t painted big banks and for-profit insurers with the same broad brush as, say, tobacco and gambling. Indeed, some of the most prominent names in both industries can be found in some of the best-known SRI funds.

Hazardous to Health?

Unlike products and services widely considered to be harmful to the greater good, the health-insurance industry’s impact on society is a matter of debate.

Critics contend there is a fundamental conflict between the profit goals of insurers and the public-health goals of everyone else. This owes largely to the tendency of for-profit carriers to avoid the sickest individuals to the extent that they can, a problem the Patient Protection and Affordable Care Act of 2010 aims to address.

Insurers, of course, deny they add cost but no value to health care. “Health plans have pioneered the programs and services that are needed to help patients navigate the complicated delivery system to get the care they need,” says Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group that represents for-profit and nonprofit insurers. And as required by state law, 90% of policies already are sold on a “guaranteed issue” basis, meaning no applicant is turned away, he says.

The $20 million Eventide Gilead fund has avoided for-profit health insurers since its inception in July 2008, citing the industry’s basic business model. “It’s a huge financial game that these guys are playing to maximize their profits, by bringing in the most healthy people and trying to turn the screws on people who are sick,” says Finny Kuruvilla, a former practicing physician who manages the Boston-based fund. “I’ve never seen a single [for-profit insurer] that I’d feel proud about owning.”

His stance, however, appears to be the exception rather than the rule. Indeed, some of the health-insurance industry’s biggest names figure in many socially responsible funds, and they’re also in one of the oldest and best-known SRI reference indexes, the MSCI KLD 400 Social Index.

The index, formerly known as the Domini 400 Social Index, excludes companies with significant business in six industries: tobacco, alcohol, gambling, nuclear power, firearms and military weapons. Outside of those six excluded industries, companies are evaluated using metrics that attempt to gauge the company’s “social utility,” says Thomas Kuh, an executive director at index compiler MSCI.

At least three private health insurers—Cigna Corp., Humana Inc. and WellPoint Inc.—have made the cut: They represented 0.93% of the index as of Jan. 31.

Erin Gray, head of marketing for Green Century Capital Management, whose Green Century Equity portfolio tracks the MSCI KLD 400 index, says that while “it wouldn’t surprise me if individual investors want to stay away” from for-profit insurers, “I don’t see us currently taking that next step within the SRI sector—to screen out these types of companies.”

Indeed, Calvert Investments, one of the largest SRI firms in the U.S., says it holds insurers Cigna, WellCare Health Plans Inc. and Aflac Inc. in several of its SRI funds, and it holds WellPoint in a separate line of funds it calls SAGE (Sustainability Achieved through Greater Engagement).

While conceding that the U.S. way of health insurance is “imbalanced” and “imperfect,” Calvert Senior Vice President Bennett Freeman says Calvert is “just not going to fence off a whole industry.”

“Oregon’s current health care system is neither humane nor cost-effective.”

(PORTLAND, Ore.) – Delegates from 28 unions, nonprofits and grassroots organizations gathered in Portland on Friday, January 27, to form a new coalition that will advocate for universal health care in Oregon and the U.S. Seven labor unions joined with 21 community organizations to sign the membership agreement, approve bylaws, and elect an interim executive committee.

The coalition grew out of a partnership between four organizations–Health Care for All–Oregon, Portland Jobs With Justice, Mad As Hell Doctors (MAHD) and Physicians for a National Health Program (PNHP). Two years ago these organizations formed the Oregon Single Payer Campaign (OSPC), which last year organized a conference at the First Unitarian Church in Portland attended by 500 people. OSPC also spearheaded the introduction of HB 3510 last year in the Oregon legislature by Rep. Michael Dembrow (D-HD 45). HB 3510 would create a single-payer financing system that guaranteed universal access to health care for all Oregonians, including the more than 600,000 Oregonians who do not have health insurance. Rep. Dembrow was in attendance at the founding meeting of the coalition.

The goal of OSPC was to get the issue of universal access health care on the table, since its advocates had been shut out of the federal health care reform debate,” said Michael Moore, delegate from Sisters of the Road and newly elected interim president of the coalition. “The goal of the new coalition is to engage all communities across Oregon in a conversation about what we can and should expect from our health care system. We think providing universal access, as almost all other industrialized nations do, is the only truly humane and cost-effective system available. We need a broad and diverse coalition of organizations to help us understand how to take that message to all the constituencies we need to reach.

Oregon’s current health care system is neither humane nor cost-effective. The only health care resources available to many uninsured adults are hospital emergency rooms and pay-for-service options at some clinics. Even in communities such as Scappoose, only 21 miles from Portland, the Oregon Health Sciences University clinic does not accept uninsured patients. In Oregon, it is estimated that the cost of uncompensated care for uninsured and under-insured adults and children will exceed $1.1 billion in 2012.

Rosalie Pedroza, delegate from the Rural Organizing Project, said, “In rural communities, many areas don’t have insurance options, and facilities are limited. Current cost increases are unsustainable; we need affordable health care for all.”

The unions signing on to the coalition’s founding are: American Federation of Government Employees Local 2157, Communication Workers of America Local 7901, Laborers Local 483, National Association of Letter Carriers Branch 82, National Association of Social Workers ­ Oregon, Oregon Nurses’ Association and Service Employees International Union Local 49. The nonprofits joining them are: Alliance for Democracy, Center for Inter-cultural Organizing, Community Alliance of Tenants, Elders in Action, Fellowship of Reconciliation, Health Care for All Oregon, Health Care for All Oregon–Eugene, Jobs with Justice-Central Oregon, Jobs with Justice–Portland, Jobs with Justice–Southern Oregon, Mad as Hell Doctors, Mid-Valley Health Care Advocates, Oregon Action, Oregon Latino Health Coalition, OSPC-Florence Organizing Committee, Physicians for a National Health Program–Eugene, Mid Valley and Portland, Rural Organizing Project, Sisters of the Road. The Tree Institute, and Universal Health Care for Oregon. Six affiliated or pledged organizations were unable to attend, and ten organizations sent delegates as observers.

The coalition does not plan to introduce legislation this year. In the near term, it will focus on grassroots community organizing and outreach. It plans to meet again in six to eight weeks to elect a full board of directors, develop a strategic plan and finalize the selection of a name.

You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000.

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need.

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Looking at millions of individual bills that makeup the 2.7 trillion dollars of annual health care costs opens a gigantic window on the massive waste, redundancy, profiteering, fraud and sometimes criminal over-billing.

Here is a partial example of what I mean, in the words of Philip M. Boffey, the estimable science writer for the New York Times:

“Why does an appendectomy in Germany cost roughly a quarter what it costs in the United States? ($3,285 compared to $13,123). Or an MRI scan cost less than a third as much, on average, in Canada? ($304 compared to $1,009).”

“Americans continue to spend more on health care than patients anywhere else. In 2009, we spent $7,960 per person, twice as much as France, which is known for providing very good health services. And for all that spending, we get very mixed results–some superb, some average, some inferior–compared with other advanced nations.”

Moreover, France and Germany, Italy, England, Canada, Belgium, Sweden and all other western countries plus Japan and Taiwan cover almost all their citizens, unlike the U.S. where 50,000,000 people are uninsured.

Boffey, who wrote a book on the National Academy of Sciences, (The Brain Bank of America: An Inquiry into the Politics of Science), under our sponsorship in 1975 goes on to cite the comparative price report of the International Federation of Health Plans in 2010. They are stunning! For Britain, Canada, France, Germany and the U.S. respectively, the average cost in dollars for bypass surgery is $13,998, $22,212, $16,325, $27,237 and in the U.S. $59,770. For cataract surgery the bill is $1,299, $927, $3,352, N.A. and in the U.S. $14,764.

Boffey adds other explanatory factors. These include higher administrative costs to deal with insurance paperwork, higher insurance company profits and executive compensation and less developed electronic health records leading to costly errors.

Except for Germany there are somewhat longer waiting times for some patients to see a specialist in these countries. But in the U.S. seeing specialists is often prohibitively expensive, and if you cannot afford such services, that is the longest waiting time of all.

A recent commentary in the Mayo Clinic Proceedings last August by Charles. W. Slack and Warner V. Slack, MD suggests another compelling comparison–between outcomes in different states in the U.S. They ask “why, for example, do Mississippi, Louisiana, and Georgia have such a high rate of mortality amenable to health care when compared with Idaho, Oregon and Washington.” Wide differences between states and counties have been documented regarding the cost of identical operations, frequency of operations such as cesarean sections or hysterectomies and other surgical disparities studied under controlled variables.

Health care bills come with hefty levels of fraud. From the historic study twenty years ago by the then General Accounting Office of the Congress to the present estimates by the nation’s leading expert in this field, Professor Malcolm Sparrow at Harvard University, fully ten percent of all health care expenditures are the result of computerized billing fraud and abuse. That will be $270 billion this year.

Dr. Sparrow, an applied mathematician, says it could be higher if the federal government would simply do a more detailed study. He adds that the enforcement budget should be one percent of the estimable volume of fraud. In actual practice, the enforcement budget is less than one/tenth of one percent, even though every dollar of enforcement brings in at least seventeen dollars back. (See Dr. Sparrow’s website: http://www.hks.harvard.edu/fs/msparrow/)

Obviously the corporate fraud lobby is stronger than the taxpayer/consumer lobby in Washington, D.C. But why the health insurance companies, a formidable force in their own right when it comes to protecting its turf against single payer or full Medicare insurance (see singlepayeraction.org) do not do more to stop fraudulent billing practices, is a puzzle.

All in all, the health care industry is replete with rackets that neither honest practitioners or regulators find worrisome enough to effectively challenge. The perverse economic incentives in this industry range from third party payments to third party procedures. Add paid-off members of Congress who starve enforcement budgets and the enormous profits that come from that tired triad “waste, fraud and abuse” and you have a massive problem needing a massive solution.

So, voters, why not start challenging all candidates for elective office to make this vast daily heist a front burner campaign issue?

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book – and first novel – is, Only The Super-Rich Can Save Us. His most recent work of non-fiction is The Seventeen Traditions.

Most of you have likely heard the disappointing news that our bill, SB 810, the California Universal Health Care Act, failed to move off the Senate Floor by January 31st, meaning it cannot advance further in the legislative process this year. Despite our unwavering advocacy, too few members were willing to cast votes in favor of SB 810 this year, including several members who had voted for the legislation before. Unfortunately this means that Californians will continue to have a broken health care system in dire need of change, but that is not for lack of effort.

I want to thank and recognize the valiant efforts of the many groups and individuals who worked so hard to make our universal health care bill a reality. First, the California School Employees Association and California Nurses Association led lobbying efforts on behalf of SB 810 all year. Also, Campaign for a Healthy California, Health Care for All, California Physicians for a National Health Plan, California One Care, Single Payer Now, California Alliance for Retired Americans, California Health Professional Student Alliance, League of Women Voters and many other groups organized their members to advocate on behalf of the bill.

Finally, thousands of individual advocates made phone calls, attended meetings, marched and held signs at rallies, and sent letters, faxes and emails in favor of SB 810. Together, these efforts sent a strong message to legislators that the single-payer health care movement is here to stay. I thank all of these passionate supporters from the bottom of my heart.

The single-payer movement is based on a long-term vision and strategy. This setback does not change our work to advocate for universal health care. We have always found the courage to speak out for health care for all, even when others around us told us it was not the right time. Ultimately, the powerful interests that favor doing nothing to repair our health care system can only be overcome by courage and determination – something our movement has in abundance.

I encourage you to continue building support for universal health care at the grass roots level within your communities. Reach out to your co-workers, neighbors, friends, and family members about why their elected officials should vote for Medicare for All. Help build our case to the governor, other elected officials and those who are currently seeking office so that they know the people of California support single-payer legislation.

As the author of SB 810, I share your deep commitment to this cause, this movement, and the people behind it. We will not stop fighting until we have comprehensive health care for every Californian.

California’s “Medicare for all” universal health care legislation fell short of the 21 votes needed to pass the state Senate today.

Senate Bill 810 failed on a 19-15 vote during this morning’s floor session, with four moderate Democrats abstaining and one voting no.

Democratic Sen. Mark Leno, who authored the bill, said the proposal would stabilize health care costs and expand access to coverage.

He called the bill, which does not include funding to cover the projected $250 billion annual cost of running the single-payer system, the first step in a “many year project” that will likely require asking voters to approve financing. He encouraged members to support the bill to allow the policy discussion to continue.

No Republicans voted for the bill. Sen. Tony Strickland, R-Moorpark, criticized the proposal as an attempt to create “another costly and inefficient bureaucracy.”

“There’s no doubt that we need health care reform, there’s no doubt that we need to improve our health care system, but members, this is not the bill to move forward,” he said.

The bill faces a Tuesday deadline for passing the state Senate in the current legislative session. Several similar bills have cleared one or both houses in recent years. The last version to win legislative approval was vetoed by then-GOP Gov. Arnold Schwarzenegger.

The 2,000 member Local 83761, IUE-CWA, in Louisville, Kentucky, has endorsed HR 676, the national single payer legislation, Expanded and Improved Medicare for All, introduced into the House of Representatives by Democratic Congressman John Conyers of Michigan.

Local 83761 members make General Electric refrigerators, washing machines, dishwashers, and other major appliances. The local is growing and expects to add another 460 members by the end of February.

Steven Wimsatt, Chairman of the Local’s COPE committee and State Political and Legislative Director of the Kentucky IUE-CWA, introduced the resolution to endorse HR 676.

“Health care is important to our members and one of the biggest benefits that you can get from a company,” said Wimsatt, “but it’s getting harder and harder to negotiate a contract with health care in it.”

Explaining why the local took this step, Wimsatt said, “So, very simply, if we had a national health care plan that all members could be in, then we wouldn’t have to be in a confrontational position over health care with GE during the contract negotiations.”

Wimsatt added, “There is an excise tax that will come in a few years under the health reform that passed that will make it almost impossible to afford a plan, and it would be a penalty for having a good health care plan. Because of this it’s even more important that we win single payer health care.”

The endorsement of HR 676 was passed unanimously at the December Executive Board and membership meetings.

In the current Congress, HR 676 has 74 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 587 union organizations including 139 Central Labor Councils and Area Labor Federations and 40 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV & MA).

SACRAMENTO – The Senate Appropriations Committee today approved the California Universal Health Care Act, authored by Senator Mark Leno (D-San Francisco). Senate Bill 810 guarantees all Californians comprehensive, universal health care while reducing the state’s ballooning health care costs and improving the quality of care and delivery of health services statewide. The legislation passed with a 6-2 vote.

California currently spends about $200 billion annually on a fragmented, inefficient health care system that wastes 30% of every dollar on administration. Under Senate Bill 810, that wasteful spending is eliminated. The bill redirects the funds Californians already spend on health care to allow comprehensive coverage. In fact, studies show that the state would save $8 billion in the first year under this single-payer plan.

“California is being overrun by out-of-control health care costs, which have a significant impact on families, businesses and the state budget,” said Senator Leno, D-San Francisco. “Health care premiums in the last few years have grown five times faster than our economy. Consequently, fewer employers are providing health benefits to their employees, and those workers who are fortunate enough to receive coverage are paying higher premiums for diminishing services. By guaranteeing universal access for all Californians, our single-payer plan will reduce the health care burdens that are hurting families and our state’s economy.”

SB 810 creates a private-public partnership to provide every California resident medical, dental, vision, hospitalization and prescription drug benefits and allows patients to choose their own doctors and hospitals. This single payer, “Medicare for All,” type of program works by pooling together the money that government, employers and individuals already spend on health care and putting it to better use by cutting out the for-profit middle man.

“SB 810 is the only proposed solution to the continuing patient care crisis that guarantees healthcare for all Californians and controls costs while eliminating the denials of care and restrictions of provider choice imposed by private insurance companies,” said DeAnn McEwen, a registered nurse at Long Beach Memorial Medical Center and co-president of the California Nurses Association. CNA is one of the co-sponsors of SB 810.

“Health is a right, not a privilege,” said Maria Lemus, executive director of Vision y Compromiso, a co-sponsor of SB 810. “All Californians, without exception, need access to quality medical services. Senator Leno’s single-payer proposal would provide California residents access to health services with an opportunity to prevent illness, the right to choose their doctor and control inflation without increasing health care costs in California.”

SB 810 is sponsored and supported by a broad coalition of patients, nurses, doctors, teachers and school employees, small businesses, faith community members, retirees, local governments and school districts. These groups represent more than 2 million Californians. The bill is co-sponsored by the California Nurses Association, Health Care for All California, California One Care, California School Employees Association, Physicians for a National Health Program-California, Single Payer Now, Campaign for a Healthy California, California Federation of Teachers, California Alliance of Retired Americans, Amnesty International, League of Women Voters, California Council of Churches, Progressive Democrats of America, California Consumer Federation, National Organization for Women-California, Vision y Compromiso, Wellstone Democratic Renewal Club, Dolores Huerta Foundation, California Health Professional Student Alliance and Courage Campaign.

By Amanda Waldroupe for TheLundReport.org –

January 19, 2012—Healthcare advocates, medical professionals, and legislators are developing a state-wide grassroots campaign to start educating the public about a single payer health system to provide universal coverage for everyone.

“It’s really the only way that we can assure affordable, high quality healthcare for all,” said Rep. Mike Dembrow (D-Portland), who introduced such legislation during the 2011 session which received a courtesy hearing in the House Healthcare Committee, but never came up for a vote.

Dembrow doesn’t plan on introducing a similar bill when the Legislature meets next month. Legislators can only introduce two bills each, and a single payer bill wouldn’t get any further than another public hearing. “There’s not that much value in having another public hearing,” he said.

But Dembrow does intend on reintroducing such legislation during the 2013 session, and anticipates that bill will be referred to the voters for approval. “If it involves funding, it will inevitably go to the ballot,” he said.

Meanwhile, advocates continue to support and discuss how a single payer system would work in Oregon because of their strong belief that it’s the best way to reform healthcare, lower costs, and ensure that all citizens receive adequate health care.

“Single payer is always going to be a topic when people talk about making healthcare better,” said Dr. Sam Metz, an anesthesiologist who belongs to an advocacy group known as Mad as Hell Doctors. “Nothing has happened to change the crisis that is before us that is American healthcare. The Affordable Care Act will change very little. It has consumed political capital, and allowed people to think we’ve solved the problem.”

Metz thinks Oregon might be in a better position than other states to implement a single payer system. He points to large employers such as Intel and Nike that are self-insured, as well as Providence Health System and Kaiser Permanente which cover their employees with the insurance offered by them — all versions of single payer. Medicaid, Medicare, and healthcare for veterans are also variations of single payer. “So many people are already half way there,” Metz said.

But major obstacles continue to loom. “The current system has a lot of momentum.” according to Larry Steward, a retired professor at Portland State University. “A lot of people believe in it. There’s a whole lot of money involved in it, and a lot of institutions and private industry. There’s a whole infrastructure. All of that needs to be overcome to create a better system.

Private insurance companies are one of the greatest obstacles to creating a single payer system. “If we go to a single payer, they go out of business,” Metz said. It is thus highly unlikely that insurance companies would support legislation or any effort that would “lure the insurance industry to its destruction.”

The complexity of the insurance and healthcare system also make it difficult to educate consumers. “It is going to be a real struggle,” Dembrow agreed. But public education and getting people to “start agitating” will go a long way, he said, to helping people understand that “there are other models out there.”

Recently, Mt. Hood Community College hosted a forum on single payer and the topic was also discussed at a conference held by an organization known as We Can Do Better.