“I Prefer Single-Payer, But …. “

The Selling of Single-Payer Features

By HELEN REDMOND for Counterpunch

“Start off on high ground but end up somehow crawling…”
–Bruce Springsteen, The Big Muddy

The farce in Washington DC called health care reform makes the blood of single-payer supporters boil. That the Obama administration has crafted and is trying to push through an unfathomable, over one-thousand page piece of shit legislation that in no way ends the health care crisis, and in fact, strengthens the power and position of the private insurance industry, should not be surprising. Obama sold out on the single-payer solution the moment he decided to run for the presidency and accepted campaign contributions from both the insurance and pharmaceutical industry.

That the voice of single-payer (SP) has been blacked out nationally (documented by Fairness and Accuracy in Reporting) also makes our blood boil. It’s as if our movement doesn’t exist. But it does. There are hundreds of grassroots SP organizations all across the country engaging in public activism and protest, we just don’t get press.

Only John Conyers single-payer legislation, HR 676, The United States National Health Care Act, fundamentally restructures health care, guarantees it to the entire population (the undocumented, too) and is fully funded. No other piece of legislation is as comprehensive. How many Americans know about this amazing, life-transforming bill that delinks employment from insurance and abolishes the despised health insurance industry? Has there been a front page story or major magazine interview with Congressman Conyers? There’s been virtually no stories about labor’s support for HR 676, despite the fact it’s been endorsed by 554 union organizations in 49 states and by 130 Central Labor Councils. But we heard plenty when Andy Stern, the president of the SEIU sat down with Lee Scott, the CEO of Wal-mart to discuss solutions to the nation’s health care crisis. Those two are experts on providing health care to workers? What about the nurses and doctors who support single-payer and got dragged out of, and arrested in Max Baucus’s senate hearings in Washington, DC? If doctors and nurses had been arrested for any other political issue it would have been the lead story in every newspaper and online edition. Doctors and nurses never deliberately get arrested — that’s news!

The sea change in the public’s attitude toward government financed health care, however, has gotten press. A New York Times poll in June found that 72 percent supported a government-administered insurance plan – like Medicare for everyone under the age of 65. That poll also reported 64 percent believed the federal government should guarantee coverage to the entire population, i.e. health care should be a human right. Another interesting number: 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt. This is in stark contrast to President Obama’s position of tepid, incremental reform. Obama asserts if he was starting from scratch he might favor SP, but we aren’t so he can’t. He wants to build on the existing system and not “disrupt” the employment-based provision of health care. As if employment-based health coverage isn’t being massively “disrupted” by the economic depression that has laid off millions of workers and forced them down into the ranks of the 50 million uninsured.

But what is truly disgusting is how the “progressive” left has caved so quickly and cravenly, given up the fight for single-payer and support for HR 676. They have become the indignant foot soldiers, apologists and spinmeisters for Obama’s piece of shit legislation. They are betraying what they absolutely know to be true: the private insurance industry must be evicted in order to provide health care to everyone and end the fiscal crisis the multiple-payer system creates. Even the insurance companies know that according to revelations by Cigna whistleblower Wendell Potter. He reports the implementation of a single-payer health care system is what keeps the billionaire CEO’s of insurance companies and Karen Ignagni, the high priestess of America’s Health Insurance Plans (AHIP), awake at night cowering in fear and forced to spend 1.4 million dollars a day to make sure it doesn’t happen. They don’t fear a public option despite their protestations; they accept that due to the depth of the crisis, a few token compromises are in order to stay in business. It’s chump change and in exchange for perhaps losing a little market share, they’re going to get a mandate that legally obligates every person to buy their priced-to-make-profits “insurance products” or be financially penalized. If the Obama bill subsidizes the uninsured going into private plans, that’s millions of new customers to extract profits from and a transfer of taxpayer dollars into insurance industry coffers. The Massachusetts mandate madness gone nationwide.

First the “progressive” Democratic Caucus jumped the single-payer ship arguing without even launching a fight that HR 676 was not “politically viable.” A senior research associate with Physicians for a National Health Program (PNHP) told the following story. He gave testimony to the caucus on why the public option was flawed and to continue robust support for HR 676. He was appalled to learn staffers for caucus members were claiming the public option was the same as single-payer or would lead to single-payer. The staffers banned him from handing out information comparing the public option to single-payer. They tried to censor his speech but he gave it anyway. When members of the caucus asked questions staffers continually interrupted him.

Health Care for American (HCAN), Katrina Vanden Heuvel of The Nation, Robert Reich, Joshua Holland of Alternet, and a raft of other progressive political pundits are pumping out article after article attempting to explain away or marginalize the myriad problems with the public option: the gaps in coverage, the millions that will be left uninsured, and how to fund it so that it’s “deficit neutral.”

They often begin by declaring, “I’d prefer a single-payer system but…” But what?

Joshua Holland’s article titled, “We Need Clear Thinking: There Should Be No Clash Between Public Option and Single-Payer,” is the most recent and best example of giving up and selling out single-payer. He too confesses in the piece (three times!) he really is an advocate of single-payer, but … But what? Holland argues, “The public insurance/single-payer rift is a false dichotomy and is distracting us from the real fight.” Dead wrong. The so-called public option and SP as embodied in HR 676 stand in direct opposition to one another. The “real fight” is to pass HR 676. The “distraction” is the public option. Holland then goes on to undercut his argument even further by maintaining, “The proposal before us today, if done right – and the devil is most certainly in the details – achieve a hybrid public-private system with “some single-payer features…” Huh? We already have that system, it’s not working. Holland thinks eventually the public option will “achieve something approaching a single-payer system – through the back door.” I’m gobsmacked by Joshua’s naiveté or is it stupidity? Single-payer health care systems always come in through the front door. They don’t evolve into existence over time.

Secretary of Health and Human Services Kathleen Sebelius was asked about the public option, “Can you say flat out that it’s just never going to be single-payer health insurance?” She replied, “Oh, I think that’s very much the case.” She then went on to make the case which I won’t repeat here. When President Obama addressed the American Medical Association (AMA) he asserted, “What are not legitimate concerns are those being put forward that claim a public option is somehow a Trojan horse for a single-payer system…So when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they’re not telling the truth.”
We would do well to believe Obama and his fellow Democrats when they straight up tell us they are opposed to single-payer.

But Holland’s noxious line of reasoning goes even further. He posits the false notion that single-payer systems don’t really exist in other countries, but instead are “multiple-payers but with some single-payer features.” He cites Germany, Holland, Belgium and France as examples. This is simply not true. Elimination of U.S.-style private insurance, if it existed in the first place, has been a prerequisite to implementing a universal health care system in every country that has socialized health care. In each country the government guarantees coverage and pays for the majority of it, even though it might be privately delivered. Moreover, in none of these countries does the private insurance industry have the power, profits or influence they do in the United States. In some, they are allowed to feed around the edges of the system which can lead to problems. Ireland is an example. The private health insurer BUPA recently left the Irish market after a judge determined the company had unfairly skimmed healthier patients from the public system and ordered the company to make adjustment payments. Can you imagine that ever happening in the United States?

Holland thinks progressives need to “refocus the debate toward how much private sector involvement we want, what structure we might adopt for health care financed through the private sector in order to keep the insurance industry’s predations in check.” He acts as if all sides in the health care debate were sitting down as equals and had equal input. Progressive don’t even have a seat at the damn table. Holland sounds like Obama who tells us we have to keep the insurance companies “honest.”

This is a debate over fundamentals and ideology, not tactics on how to get to a single-payer system, despite Holland’s insistence it’s the other way round. Single-payer supporters aren’t fighting for a health care system designed to keep corporate killers predations in check, ensuring their honesty or “fair competition.” Why would anyone want to do that? Our movement is fighting to get rid of an industry that puts profits over patients once and for all and we have the audacity to believe we can do it.

We haven’t given up and we haven’t sold out.

It’s both better and honest to stand up and get arrested fighting for a piece of legislation you know will end unnecessary death and human suffering than to crawl and “advocate fiercely” as Holland is for a piece of shit legislation he knows will not.

Helen Redmond is a member of Chicago Single-Payer Action Network (CSPAN) and a licensed clinical social worker at Cook County Hospital and Clinics. She can be reached at: redmondmadrid@yahoo.com


  1. MaineBob on July 28, 2009 at 9:51 pm

    It’s So Clear, and Helen makes it even clearer that Single Payer is the way…Thanks. What is the best strategy at this point… The best that I’ve done is write my congresscritters and Pres Obama and call ’em too,… I’ve signed various petitions. etc… I was one of the ~400 people that wrote to NPR… and finally got a small story a few days ago. I feel frustrated… What is the best Single Payer Strategy so that it can become reality here in the US of A?

  2. Vashti Winterburg on July 28, 2009 at 11:13 pm

    Excellent. I’m having my own fight with local Democrats who are supposedly “for singlepayer” but are all up in arms with our local Democratic congressman (in Kansas, no less), Dennis Moore, who’s not ready to vote for the public option business. “Oh! It will kill Obama’s presidency!”, “Oh! Moore’s a Blue Dog Traitor!”. Give me a break. The major problem is that these are people who are clueless about the health care debate and how much money the insurance companies suck off the top every year.
    The most infuriating thing I hear is, “I’m for single payer, but it’s not going to happen.” Well, it will happen, but obviously not with your help.
    My favorite latest factoid? The amount of GDP that Canada now spends on health care has actually declined since they instituted single payer while their health outcomes now outstrip ours in the U.S. in almost every category.
    Keep the faith and keep on fighting. It’s grim solace to know that the public option will be a failure, even if it passes. It’s too expensive, too complicated and will be ineffective.

  3. MaineBob on July 29, 2009 at 9:19 am

    Here’s a great Youtube of Senator Bernie Sanders on Single Payer

    He was also on Rachel Maddow last night:

    These items should be their own story but there does not appear to
    be a link to submit story ideas on http://www.HealthCare-Now.com

    We need to “sing” messages like this out to the american people and not just the “Choir” here.

    -Bob O

  4. MaineBob on July 29, 2009 at 2:06 pm

    I just got an email from the president with a link to his Health Care Consumer Protection list: http://bit.ly/12DAY8

    When ins companies see this list, they’ll want to raise their
    premiums… Perhaps this will pave the way for “Single Payer” as
    the best way to deliver these consumer protections.

    Just curious… where are the Single Payer forums so we “Single Payer” advocates can chat and get inspired with moving OUR ball across the goal line.

    -Bob O

  5. Grinrevere on July 31, 2009 at 12:20 am

    In addition to ‘progressives’ who have sold out, so have some congress people. Waxman was a co-sponsor of HR 676 in the last congress—or as a fellow activist recently said, “unit he could do something about it!”

    Jan Schakowsky in the Chicago area, who was a single payer advocate and IS a co-sponsor, recently said on a real news video that she thinks we’re going to get a “Really strong” public option. And worse, she said, they did a poll and people are saying they don’t want single payer–they would ‘prefer’ a public option, that even medicare patients don’t want to lose what they have.

    Lose what they HAVE!! By extending medicare to all and ENHANCING their benefits?? Like LONG TERM and HOME CARE in HR676?? I called and asked what poll and her health person couldn’t tell me. Schakowsky is now scheduled at another rally with HCAN (she’s spoke at them before) on August 4th. Real single payer advocates are going there to rally for single payer and make sure people don’t get confused about it at this kind of event.

    The really sad thing is that EVEN the head of Waxman’s health committee In dc told me in a meeting that lobbying for single payer would HELP a public option. So even those selling out on the idea would do better to stand with us in one voice for single payer. How do you expect to start out with a pathetic compromise and end up with the reform we want.

    I’m beginning to think that progressives that are not FOR single payer, are working for the insurance and pharma and other vested interests. Their confusing the issue, like Obama does, has a similar effect as Republican and insurance industry lies. Actually PNHP had a good article about how companies higher people to infiltrate discussions and social networks on the web to pose positions as ordinary citizens when they are really hired hands.

  6. Grinrevere on July 31, 2009 at 12:23 am

    Friday (7/31): Crucial Vote on Single Payer Healthcare

    From Democrats.com Unity

    One week ago, we eagerly anticipated a crucial vote on single-payer Medicare for All ( H.R.676 ) in the House Energy & Commerce Committee, sponsored by Rep. Anthony Weiner (D-NY). But then seven BlueDogs waged a highly-publicized war against a “robust public option” and the vote was delayed for a full week.

    We just learned the vote will be tomorrow ( Friday ). Based on all of your calls, we have nine single-payer Democrats: Tammy Baldwin, Michael Doyle, Eliot Engel, Anna Eshoo, Gene Green, Edward Markey, Janice Schakowsky, Anthony Weiner, and Peter Welch.

    Lean Yes
    Diana DeGette CO01 202-225-4431
    Jane Harman CA36 202-225-8220
    Christopher Murphy CT05 202-225-4476
    Frank Pallone NJ06 202-225-4671 @FrankPallone
    Bobby Rush IL01 202-225-4372
    Five more Democrats are leaning single-payer but still uncommitted. Please call each one and give them one crucial reason to support single-payer from our petition:

    (Be sure to sign our petition and forward it if you haven’t already.)

    Be concise and practice in advance so you can speak quickly (or leave a voicemail) because they are getting swamped. Report the results of your calls here:

    Public Option Only (or Won’t Say)
    Rick Boucher VA09 202-225-3861
    Bruce Braley IA01 202-225-2911
    G.K. Butterfield NC01 202-225-3101
    Lois Capps CA23 202-225-3601
    Kathy Castor FL11 202-225-3376
    John Dingell MI15 202-225-4071
    Charles Gonzalez TX20 202-225-3236
    Jay Inslee WA01 202-225-6311 @RepInsleeNews
    Doris Matsui CA05 202-225-7163
    Jerry McNerney CA11 202-225-1947
    John Sarbanes MD03 202-225-4016
    Bart Stupak MI01 202-225-4735
    Betty Sutton OH13 202-225-3401
    Henry Waxman (Chair) CA30 202-225-3976

    If you have more time, these 14 Democrats support a “public option” at best. But that “public option” (a new government program to compete with private insurance) was disastrously weakened this week by the BlueDogs. They banned the use of Medicare pricing to reduce costs and thereby expand availability. Try to persuade these 14 to vote for single-payer instead of a worthless BlueDog “public option.”

    Don’t let anyone tell you single-payer can’t pass: the Kucinich Amendment for a single-payer “state option” passed by a shocking 25-19 bi-partisan majority in the House Education and Labor Committee on July 17. The Weiner Amendment will pass on Friday if enough Democrats vote for it!

    A victory on the Weiner Amendment would make a huge difference. Please call as soon as you get this – night or day.

    Thanks for all you do!

    Bob Fertik