A Difficult Pill to Swallow

The path to single payer health care through challenging concentrated wealth

By Margaret Flowers, M.D.

The efforts in recent years to pass health care reform at the state and national levels have provided important lessons for the single payer movement. Corporate control of the political process and media message has proven to be a primary obstacle to effective health reform at the federal level. These obstacles also exist at the state level and are compounded by the need for federal waivers in order to implement a single payer system in the states. We need to confront concentrated corporatism that blocks real health care reform together with those whose work for a fair economy, environmental protection and a non-military foreign policy is blocked by the same obstacle.

The recent census data reveal that our health care crisis continues to deepen. This past year we added one million more uninsured people, most of them adults in the 35 to 64 year age range. The number of people with employer-sponsored health insurance plans continued its eleven year decline. And recent surveys show that the number of people with high-deductible plans continues to rise. These plans cause patients to self-ration care because of cost and leave patients at risk of bankruptcy in the face of a serious illness or accident. In fact, 75 million people went without needed care in 2010, and 29 million people used their entire savings to pay off medical debts.

The above scenario is situated within a grave financial situation. Unemployment rates remain high, and many of those fortunate enough to have a job are accepting lower pay and benefits and fewer working hours than they desire. Job growth was zero last month which really means a decline because we need to create hundreds of thousands of jobs each month simply to keep up with demand. Students are graduating with record levels of debt, leaving them financially disadvantaged from the start of their careers. Household income is declining. A third of people with middle income have now fallen into the low income bracket. And nearly two-thirds of people in the U.S. cannot afford an emergency costing $1,000. Our wealth divide is growing with the top 1% in possession of more wealth than the bottom 95%. 

At the state and federal levels, people are being told by corporate media and politicians that public debt is threatening important social safety net programs and public employee jobs, wages and benefits. Even though these deficits were manufactured in many cases, even though they would disappear if we raised taxes on the wealthy and corporations or created a single payer health system, even though supermajorities of the public support these solutions, we are told that it can’t be done. It isn’t politically feasible.

Those in the movement for single payer are accustomed to hearing that evidence-based solutions that have majority public support are not politically feasible. A cover of the British journal, Lancet, in December, 2009 explains the reason in this quote from an article in the issue:

“The health-care reform process exposes how corporate influence renders the US Government incapable of making policy on the basis of evidence and the public interest.”

This same article states that social movements are a necessary component of the work for universal health care.

One of the positives of the 2009-2010 health reform process is that a larger single payer movement emerged. The efforts of the movement have not been entirely cohesive, different groups are trying different tactics, but it is significant that the single payer movement did not disappear after reform passed. Unfortunately, much of the focus of the single payer movement has had to turn to simply trying to protect our important public health insurances, Medicare and Medicaid, from privatization and cuts by both the Democrats and Republicans.

Another positive of the recent reform process was that the single payer movement witnessed the power of nonviolent civil resistance. We saw that the traditional tools of advocacy, lobbying, petitions and elections, were not sufficient alone to move single payer forward. Strategic nonviolent resistance actions assisted in exposing corporate influence on the reform process, having our voices included in hearings and gaining national attention for the benefits of single payer.

Despite these positives, the single payer movement is not in a position to counter the corporate stranglehold on our political process. And, in reality, winning single payer in isolation will not accomplish much towards improving the health of our population if we do not also address the social determinants of health such as education, the environment, housing, violence, jobs and equal rights.

Under our current political system, one in which Democrats and Republicans are controlled by concentrated corporate power and in which independent parties have no opportunity to succeed, all who advocate for peace and social, economic and environmental justice face the same barriers. Together these movements have the strength to take on corporate power. We will never match corporate power with our collective dollars when the richest 400 people  have more wealth than 154 million people, but we can defeat them with our collective voices.

We live in a corporate dictatorship and dictators have time-tested tools to maintain their power. They use division. We see this played out in ‘lesser evilism’ voting. Both Democrats and Republicans vote for candidates who don’t support their agenda because they are made to feel afraid that the other party would be much worse. We saw this during the health reform process when ‘progressive’ groups divided those who support health reform, an overwhelming majority of which support single payer, by convincing people that they had to support a public option and then convincing them that they should keep supporting the President’s health bill even without a public option because it would mean that the President had failed if health reform was not passed. They worked closely with the White House and did not tell their constituencies the truth: that the President was failing the people by not pushing for real health care reform.

Dictatorships also use sanctions to control the population. In the U.S. these sanctions are manifested in cuts to our basic human services such as education, health care, housing, jobs and food programs. We see increasing imprisonment of our population. We have the wealth in this country to meet all of our human needs, to do what a government is supposed to do, empower and truly protect its people. Protection does not mean increased security. True protection means that our fundamental needs are met.

Dictatorships can be weakened. We know that there are time-tested ways of shifting power. In order to shift the power, we must unify. We must see that all who advocate for peace and justice face a common obstacle and that all of our issues are connected. Solidarity, not division, is the solution to confront the tiny percentage of people that are the power elite.

If we truly want a healthy population, we are going to have to fight for it, and this will be difficult. We must build a broad-based peace and justice movement that uses the tools of change effectively. We must be independent of political party. We must undermine the pillars that hold the dictatorial system up. We are the majority. We must believe in ourselves.

This is why I have turned most of my attention to the October2011 Movement. Inspired by the uprisings across the country and around the world, we are building an independent social movement and an independent media. We are beginning with an occupation of Freedom Plaza in Washington, DC on October 6. We will use strategic nonviolent resistance. We will educate ourselves about concrete actions which include democratizing our institutions and using methods of noncooperation. We will develop a specific platform based on 15 areas of crisis in our nation, such as healthcare, housing, jobs and education. And we will create the type of community we wish to see in the world – one that is peaceful, respectful and cooperative.

I hope you will join me and the thousands of others who are gathering in Freedom Plaza. If you can’t stand with us physically, then I hope you will join the online community at October2011.org and support the movement through donations and local solidarity actions.

History is knocking. How will you answer?


  1. James Salsman on September 26, 2011 at 2:49 pm

    This looks like a good start, but we need a grassroots focus on ten specific areas of mobilization:

    1. Healthcare-Now.org/PHNP.org members to visit their congressperson’s office and discuss their support of H.R. 676, using the medicare austerity issue as a starting point;

    2. Members to organize house meetings;

    3. State legislators, so save money, using the CBO and related agency cost savings findings listed on the PNHP.org web site: http://bit.ly/1payerCost

    4. Unions, using the cost savings document above and the documents showing 40% savings of preventative care from Canada: http://www.biomedcentral.com/1472-6963/5/20

    5. Industry leaders, asking them to resolve the cost contradiction;

    6. Shareholders, to ask at shareholder meetings why corporations are not lobbying for the savings inherent in single payer;

    7. Churches;

    8. Evangelical policy makers, using the moral high ground argument;

    9. The dispossessed, and their wards;

    10. The bankrupt.

  2. jacksmith on September 26, 2011 at 6:40 pm


    ( http://my.firedoglake.com/iflizwerequeen/2011/05/16/how-about-a-little-truth-about-what-the-majority-want-for-health-care/ )

    ( Gov. Peter Shumlin: Real Healthcare reform — http://www.youtube.com/watch?v=8yFUbkVCsZ4 )

    ( Health Care Budget Deficit Calculator — http://www.cepr.net/calculators/hc/hc-calculator.html )

    ( Briefing: Dean Baker on Boosting the Economy by Saving Healthcare http://t.co/fmVz8nM )


    As you all know. Had congress passed a single-payer or government-run robust Public Option CHOICE! available to everyone on day one, our economy and jobs would have taken off like a rocket. And still will. Single-payer would be best. But a government-run robust Public Option CHOICE! that can lead to a single-payer system is the least you can accept. It’s not about competing with for-profit healthcare and for-profit health insurance. It’s about replacing it with Universal Healthcare Assurance. Everyone knows this now.

    The message from the midterm elections was clear. The American people want real healthcare reform. They want that individual mandate requiring them to buy private health insurance abolished. And they want a government-run robust public option CHOICE! available to everyone on day one. And they want it now.

    They want Drug re-importation, and abolishment, or strong restrictions on patents for biologic and prescription drugs. And government controlled and negotiated drug and medical cost. They want back control of their healthcare system from the Medical Industrial Complex. And they want it NOW!


    For-profit health insurance is extremely unethical, and morally repugnant. It’s as morally repugnant as slavery was. And few if any decent Americans are going to allow them-self to be compelled to support such an unethical and immoral crime against humanity.

    This is a matter of National and Global security. There can be NO MORE EXCUSES.

    Further, we want that corrupt, undemocratic filibuster abolished. Whats the point of an election if one corrupt member of congress can block the will of the people, and any legislation the majority wants. And do it in secret. Give me a break people.

    Also, unemployment healthcare benefits are critically needed. But they should be provided through the Medicare program at cost, less the 65% government premium subsidy provided now to private for profit health insurance.

    Congress should stop wasting hundreds of millions of dollars of taxpayer money on private for profit health insurance subsidies. Subsidies that cost the taxpayer 10x as much or more than Medicare does. Private for profit health insurance plans cost more. But provide dangerous and poorer quality patient care.



    This is what the American people are shouting at you. Both parties have just enough power now to do what the American people want. GET! IT! DONE! NOW!

    If congress does not abolish the individual mandate. And establish a government-run public option CHOICE! before the end of 2011. EVERY! member of congress up for reelection in 2012 will face strong progressive pro public option, and anti-individual mandate replacement candidates.

    Strong progressive pro “PUBLIC OPTION” CHOICE! and anti-individual mandate volunteer candidates should begin now. And start the process of replacing any and all members of congress that obstruct, or fail to add a government-run robust PUBLIC OPTION CHOICE! before the end of 2011.

    We need two or three very strong progressive volunteer candidates for every member of congress that will be up for reelection in 2012. You should be fully prepared to politically EVISCERATE EVERY INCUMBENT that fails or obstructs “THE PUBLIC OPTION”. And you should be willing to step aside and support the strongest pro “PUBLIC OPTION” candidate if the need arises.

    ASSUME CONGRESS WILL FAIL and SELLOUT again. So start preparing now to CUT THEIR POLITICAL THROATS. You can always step aside if they succeed. But only if they succeed. We didn’t have much time to prepare before these past midterm elections. So the American people had to use a political shotgun approach. But by 2012 you will have a scalpel.

    Congress could have passed a robust government-run public option during it’s lame duck session. They knew what the American people wanted. They already had several bills on record. And the house had already passed a public option. Departing members could have left with a truly great accomplishment. And the rest of you could have solidified your job before the 2012 elections.

    President Obama, you promised the American people a strong public option available to everyone. And the American people overwhelmingly supported you for it. Maybe it just wasn’t possible before. But it is now.

    Knock heads. Threaten people. Or do whatever you have to. We will support you. But get us that robust public option CHOICE! available to everyone on day one before the end of 2011. Or We The People Of The United States will make the past midterm election look like a cake walk in 2012. And it will include you.

    We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for profit medical industrial complex that threatens the security and health of the entire world. They have already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.

    Spread the word people.

    Progressives, prepare the American peoples scalpels. It’s time to remove some politically diseased tissues.

    God Bless You my fellow human beings. I’m proud to be one of you. You did good.

    See you on the battle field.


    jacksmith – WorkingClass :-)