No Time to ‘Wait and See’ on Health Law

By Dr. Quentin Young

Building the Single-Payer Movement

Having just gone through a grueling, frequently raucous debate on health reform, capped by the narrowest of votes to pass the Obama administration’s bill, many activists are now tempted to adopt a “wait and see” attitude on how the new law plays out.

A few others are putting their emphasis on helping the administration implement the law, in some cases enthusiastically trumpeting their strange-bedfellow partnership with the profit-hungry health insurers and Big Pharma.

Still others – the hostile, noisy Know-Nothings associated with the Republicans and Tea Party crowd – continue to rail against President Obama’s “socialized medicine” plan (a misnomer if there ever was one), and pledge to obstruct or overturn it. Conservatives vow to make political hay out of the law in the run-up to the midterm elections.

Wall Street, on the other hand, is very comfortable with the new legislation. Mutual fund analysts now say it’s increasingly clear that the law is beneficial for health industry stocks, particularly for pharmaceutical and medical equipment companies, because there are no “onerous cost controls” in the law. And health insurance company stocks continue to a yearlong trend upward, and the industry’s CEO salaries continue to be astronomical.

After all, the health insurers wrote the bill. Sen. Max Baucus was recently caught on tape heaping effusive praise on his aide Elizabeth Fowler for her pivotal role in crafting the legislation. Fowler is a former vice president of WellPoint, the giant health insurer.

Baucus himself, a key actor in this bad movie, was surrounded by health industry lobbyists from the very beginning, and has received over $2.8 million in campaign contributions from these toxic sources over the past few years. That he earned his payoff was demonstrated when Karen Ignagni, the president of America’s Health Insurance Plans, congratulated him (during this week’s episode of “Frontline”) on his handling of the single-payer nonviolent disruption of his Senate Finance Committee hearing after single-payer advocates like Dr. Margaret Flowers were excluded from giving testimony.

Supporters of single-payer national health insurance face several challenges, the chief of which is how to transform the various efforts of single-payer Medicare-for-All activists into a movement for political and legislative success. Among the key tasks are these:

* Educating candidates for political office (and current officeholders) from all political parties about the merits of the single-payer proposal, and offering to advise them on health policy matters.

* Ensuring the reintroduction and largest possible legislative sponsorship for national single-payer bills like Rep. John Conyers’ H.R. 676 and Sen. Bernie Sanders’ S. 703.

* Supporting efforts (including a change in the new law) to permit states to experiment with their own, independent single-payer models of reform right away.

* Defending Medicare from harmful budget cuts and educating Medicare beneficiaries about their self-interest in improving and expanding the program to cover everyone, i.e. embracing the slogan, “Everybody in, nobody out.”

* Continuing our educational work about the merits – nay, the necessity – of adopting a single-payer system. The sooner we initiate a truly universal, egalitarian, humane and efficient system, the sooner the American people will enjoy the high-quality health care our nation and our health professionals are capable of providing.

A major burden the enactment of the new law imposes on single-payer advocates is its timeline. Specifically, major elements in the legislation do not kick in for two, four or even eight years’ time.

But “wait and see” is not an option for us. The legislation just passed is completely inadequate to the task at hand.

Under the new law, the suffering and financial hardship imposed on Americans by our private-insurance-based system will largely continue unabated for four more years, and only then be subject to very modest regulation. (Loopholes in the law abound.) Over 50 million people will remain uninsured each year until 2014, which translates into 50,000 preventable deaths annually. A comparable number will remain underinsured, with many vulnerable to medical bankruptcy when serious illness strikes, even after 2014.

Even if the new law works as planned, at least 23 million people will remain uninsured at 2019. So “universal health care” remains a dream deferred.

That spells human misery. This week a new Harvard-based study showed that people with migraine who lack health insurance, or who are on Medicaid, disproportionately suffer from their condition because they can’t get access to the standard medications they need to reduce their pain and other symptoms. And that’s just one example of the unnecessary suffering that lies in wait.

Meanwhile costs, including for health insurance premiums, will continue to escalate.

The unrelenting advocacy of single payer by Physicians for a National Health Program also stems from a careful study of repeatedly unsuccessful experiments with state-based reforms based on private insurance, including the Massachusetts plan (upon which the new law is modeled). The evidence is clear: incremental reforms of this type – based on the private-insurance model – will not work. They invariably succumb to skyrocketing costs.

Single-payer Medicare for All is the reform that’s required. Just like almost all other major areas of progress in American life, fundamental health reform requires a movement based on equity, justice, prudence and science that is free of market greed. That movement today is single payer.


  1. Jonathan Starr on April 15, 2010 at 1:46 pm

    I agree that there is no true substitute for the benefits of single-payer. I also agree that the recently-passed legislation is very flawed in many ways, particularly in its fundamental continued reliance on private health-insurance.

    However, short of single-payer, and in preparation for it, there other possibilities that are worth considering, including the “Starr Plan”. Basically, it is:

    1) Improve funding, reimbursement levels, and coverage standards for Medicaid.
    2) Establish a designated tax to support this.
    3) Open enrollment to everyone on a sliding fee scale basis, scaled by income level.

    This would bring affordable health-insurance within reach of all; create a specific and predictable funding basis for it; bypass private insurance companies and all of their extra costs and problems; increase the political constituency and participant pool for Medicaid; improve benefits for present participants in the program; utilize an existing administrative and programmatic structure for delivering these services; and use the existing federal-state compromise on funding abortion services. Also, it would be a step towards single-payer, preparing people for that prospect.

    Please consider supporting this. Thanks.

  2. Marcia on April 19, 2010 at 9:43 pm

    So now what? The Tea Party lit up Tax day April 15th. Do they get the last word? Have they been struggling for HUNDREDS OF YEARS, trying to get their government to do what they would like? They are just having a small taste of what it’s like. What it’s like to have

    The Supreme Court make you property: Dred Scott V. Sanford
    The Supreme Court deny you education: Plessy V. Fergusson
    The Supreme Court take away your land and rights: Cherokee Nation V. Georgia
    The Supreme Court interferes in your sex life: Bowers V. Hardwick
    The Supreme Court taking Public broadband and giving it to corporations: FCC v. Fox (?)
    The Supreme Court deciding that Corporations can participate in elections: Citizen’s United v. F.E.C.
    The Supreme Court deciding when a woman’s body is her own: Roe V. Wade
    The Supreme Court directly infringing on your privacy rights by supporting the Patriot Act
    With Prop 8 passing, and Don’t Ask Don’t Tell not getting repealed. With the Supreme Court denying millions of votes to be counted and over riding States Rights: BUSH V. GORE 2000
    And lastly the furor of states filing petition to take back the latest health care law…

    I think we ought to come out IN VERY LARGE NUMBERS with an EMERGENCY MARCH on International Labor Day and tell the country if we couldn’t get the REcount, you’re not getting the REpeal!!

    and then put the Supreme Court on a term limit like 20 years.

    Help Me spread the word and let’s show Fox and Friends how it’s done!


    1) Discuss the 2000 vote

    a) Disenfranchising of the African American votes especially in Florida

    b) violation of the law by the Supreme Court decision

    c) Subsequent Court decisions: Prop 8, D.A.D.T., FCC vs (FOX NEWS) Citizens United vs. FEC, failure to sign on to the KYOTO accord.

    2) Discuss the law we really wanted HR676/ Single Payer/ IMPROVED Medicare for All

    a) No Corporations “Because the PEOPLE say so, Insurance Companies gotta GO!”

    b) Workers built the wealth of this world and enjoy none of the wealth. Living Wages/Unions

    c) Support organizations that do not take Corporate support like LINK TV , the GREEN party, Citizens for Legitimate Government and CREDO etc.

    We want: Full Employment, Non- Profit health service, End to All forms of Discrimination, for the RICH to pay their taxes -ending loop holes. For our ECONOMY to be based on the GREEN revolution-Zero pollution- Zero waste. For Campaign contributions to be restricted to individuals ONLY- with a yearly max.

    Wanted: Speakers who want to address the Public on any of these subjects! MAY DAY! MAY DAY!

  3. Chris Hagel on April 20, 2010 at 2:19 pm

    Thanks to everyone who have contributed so much to grow this movement.

    I just have some points to make:

    *Congresswomen Carolyn McCarthy’s and other’s opposition to HR 676 was that (paraphrasing): “People can not be forced to give up their insurance to be in a Medicare for all system”.
    (If these people were actually informed on how much better off they would be from many different standpoints more of them (the middle class) would be cool with it. Also remember, when any law was passed there was never 100 % for it. The civil rights law, labor laws etc. )
    To the main point, conversely however, what this Bill has done is force the uninsured people to buy over-priced, low quality, low quantity health insurance subsidized with taxes; a give-a-way to the health insurance industry. They don’t even have to market and sell their shoddy product, it’s fallen right in their lap. (This is corporate welfare big time.)
    They wouldn’t force the people with good health care policies into HR 676 but this Bill ultimately forces the blue collar and poor to buy their shoddy products; these policies will not be like the ones the others with good policies have. This is all about making it appear that change and justice has been carried forward, when in reality the uninsured and underinsured have been totally taken advantage of; it’s an attempt to appease us.

    *So now our economy and people are burdened even more with a very expensive, fragmented, and bureaucratic health care non-system.

    *Also, generally speaking, this is all about the extremely class conscious mega rich elites (and upper middle class people) in this country who are simply repulsed by the concept of national health insurance for working class/blue collar people. Obama and his cohorts have courted these people during this fake health care reform.
    Playing that class card you say, well it’s all about class, it’s always been; you don’t have to play the class card.
    But when you watch TV, it makes it seem like we’re just one big happy family of Americans.
    American style fascism is on the march.

    *So now, with this Bill, what the 47 million uninsured are stuck with is musical chairs in health care. Who’s going to get the health care? Do we really know when the music stops who’s going to get a seat? And the uninsured have to fill out all kinds of forms and paper work and maneuver through all the channels just to get health care. All of this so Obama and his cohorts can protect their buddies in the health insurance industry and Big Pharma.
    With HR 676 we just show our national health insurance card and get treated. No hoops to jump through or fences to climb over.
    It’s a win-win for our country, economically, morally, and spiritually.

    *We should go on strike for one day and see what would happen. No taxis, no buses, no waitresses or waiters, no construction, no store clerks etc. Let’s see what would happen.
    We deserve the dignity of getting our ailments and injuries checked out without being reduced to health care beggars!!!

    *All those congressmembers screaming and turning red in the face about a big Government take over of health care are such phonies and bullies. Yeah, big government, give us a break, it’s just small enough to work in and get their A-Z health care, most of it paid for with tax payer money.
    This Bill is a corporate consolidation by the health insurance industry of our health care, with our tax payer dollars to subsidize the over priced low quality/quantity policies of those who can’t afford the policies.
    This is not socialized medicine. This is not socialized medicine. This is not socialized medicine. This is not socialized medicine. This is not socialized medicine.
    Is it getting through to them. Do they get it?

    *So now what we have more than ever is a government of, by, and for the health insurance industry and big pharma not of, by, and for the people.

    *Yeah, it’s alright for people to get rich (not how it’s been done in the past scandals and everyone deserves a living wage) but we are the only industrialized country to still have health care in the commodity and privilege column instead of the public necessity/service and human rights column, and that, fellow Americans is barbaric and evil.