Update on Single Payer from Dr. Margaret Flowers

An interview with Dr. Margaret Flowers from OpEdNews.com by Joan Brunwasser

My guest is Dr. Margaret Flowers, congressional fellow of Physicians for a National Health Program [PNHP]. Welcome back to OpEdNews, Margaret. Republican lawmakers, fresh from their November victory, are pledging to move immediately in the new Congress to dismantle the health care law that President Obama gave so much attention to. What’s your take on that?

Thank you for inviting me back, Joan. As you know, Physicians for a National Health Program does not support the new health law. Overall we find that it does more harm than good by further privatizing our health care and failing to address the fundamental problems of rising health care costs and lack of access to care for tens of millions of people. That said, we find the Republican plans to dismantle the health law reprehensible given that they are willing to remove what coverage was gained under the law and offer no effective alternative to our growing health care crisis.

The Republican calls to repeal the law are mere political posturing and will not succeed. In fact the health industries, which contributed more heavily to Republican campaigns in the last election cycle than to Democrats, do not want the full law repealed. The Republicans will more likely succeed in defunding portions of the bill and relaxing regulation of the health insurance industry. This will escalate our health care crisis.

The health law passed in 2010 has already begun to unravel as the Department of Health and Human Services has had to issue multiple waivers excusing businesses and insurance companies from complying with provisions in the law that they refused to meet. A large part of the increase in coverage under the law was based on an expansion of Medicaid, however, states are facing severe budget deficits which will prevent them from implementing the expansion. Republican efforts will likely accelerate the unraveling.

This is why PNHP and the many other organizations which advocate for single payer/improved Medicare for All continue to push forward in educating and building the grassroots voice for single payer. We recognize that our health care problems have not yet been appropriately addressed or solved.

There are millions of us out there who share your concern about the current health care crisis. But this is a little tricky. Those of us who feel that the law passed was less than stellar need to fight back against its repeal, its unraveling or being whittled away altogether by Republicans or strained state budgets. At the same time, we need to be agitating for something that will really do the job. That’s a little complicated. And voters and the public in general have had a notoriously short attention span. How do you channel that very real public distress to bring about meaningful and positive change?

As you are aware, civil unrest in this nation is growing. It is an expression of the very real public distress that you mention. Although information about this unrest is largely censored from the mainstream media, we see that non-union workers and anti-poverty movements are growing as are more organized actions such as the prison protests in Georgia, nurses’ strikes and the veteran-led antiwar civil resistance. This type of unrest is to be expected if we look at what happens historically in nations which experience such severe wealth inequalities as we have in the United States.

Some of the civil unrest is turning to violence. In the absence of constructive and nonviolent avenues for social change and as unemployment, lack of access to health care, homelessness and poverty grow, the level of violence may increase. This is why, now more than ever, we must educate, organize and engage in actions that change the balance of power away from corporate interests and to the needs of people.

There are three important principles that will guide effective action. First, our movements, whatever the issue, must be independent of political parties. The Republican and Democratic parties are both controlled by concentrated corporate power. There are some differences between those parties but overall they serve corporate power and not the people. We must be willing to hold all legislators accountable to act on behalf of people even if that means that they lose a few elections until the shift occurs. And independence also includes the media. We will have to make our own media because mainstream media is also controlled by corporate interests.

Second, we must be clear about what we ask for and that is where education comes in. We have the solutions to all of our problems. For health care it is a national single payer health system. For unemployment and the environment, it is investment in green jobs and ending oil and coal dependence. For the economy, it is developing sustainable local economies and ending Wall Street bailouts. And so on. We must educate the public through local events and independent media about these solutions.

And third, we must be uncompromising in our demands. We are too often willing to accept partial or non-solutions to our problems because we are told that what we want is politically infeasible. When we look at health care, we are constantly told that single payer is not politically feasible. We have heard this for decades. However, the legislation that passes which is politically feasible fails to be feasible from a practical standpoint. It simply doesn’t work. The number of un-insured continues to grow and soaring health care costs are destroying our families and businesses. At some point, we have to realize that we determine what is politically feasible because we hold the power of the vote. We must learn to use that power.

Of course, these are difficult times and many of us are struggling. However, each of us can contribute in some way. We can weaken corporate power by supporting local goods and services. We can educate ourselves and those around us. We can donate to non-profits. We can expose injustice that we see and work with others in our community to end it. We can treat each other with love and respect so that we model what we want to see for others. And for those who are able, we must join together and engage in acts of strategic non-violent resistance.

It is important to realize that work for peace and for social and economic justice is all related. The various movements need to join together in our actions to create a healthy, prosperous and just country. For me, this means that we must organize large acts of non-violent resistance together that focus on weakening corporate power and letting legislators know that business as usual cannot continue. This is why I joined the veterans in their action against war at the White House in December. I believe as we continue to educate, organize and act, more people will join us in any way they can.

Wow, Margaret! This is a lovely, well fleshed-out plan of action, with something for everyone. What can you tell us about specific efforts going on now at the state level for single payer? We don’t hear much about it through the corporate media so it feels like nothing is happening.

Yes, Joan. There is a lot happening at the state level when it comes to single payer. Currently, twenty states have single payer health bills in some phase of the legislative process.

As you may know, California has passed a state single payer bill twice in 2006 and 2008. I just returned from a large health professional student-led march, rally and lobby day at the state capital in Sacramento. The California single payer coalition is continuing to move forward to pass single payer and have it signed by the new Governor. California faces such a serious budget crisis that I was told the legislature will be basing their cuts on what will result in the least number of lives lost.

We are particularly enthusiastic this year about Vermont. They are poised to pass a single payer health bill this legislative session. The state hired Dr. William Hsaio from Harvard to design their health system. He has designed health systems for five countries, the most recent being the single payer system in Taiwan. The new governor of Vermont, Peter Shumlin, ran on a strong single payer platform. And, of course, Vermont has Senator Sanders, who has been a long time proponent of single payer.

Even with all of the stars seeming to be aligned, it is going to be a difficult process to get single payer passed in Vermont. The forces who oppose this, primarily the corporations who profit from the status quo, will be putting tremendous resources into that state to stop single payer. For that reason, many of the organizations that support single payer are working to assist the state single payer movement. Single payer advocates from across the nation are volunteering or helping to raise funds for Vermont.

I encourage your readers to visit www.vermontforsinglepayer.org to learn more about the efforts there and to support them.

Legislation will also be introduced at the national level again in both the House and Senate this year. It is important to work at both the state and national levels because we cannot predict where we will be successful first. Of course, the ultimate goal is a national single payer health program so that all people living in our country will have access to care and so that we can control our health care costs at the national level. Health care costs are a significant cause of our national debt.

Agreed. Tell us about the national deficit and the commission and efforts to cut social insurances like Medicare and Medicaid. How does that fit into the mix?

You are probably aware that the President appointed a commission to look at our national deficit last April. This commission, the National Commission for Fiscal Responsibility and Refom, was composed of 18 people, 14 of whom were fiscal hawks. The commission received support and staff from the Pete Peterson Foundation which has advocated for cuts to our social insurance programs for decades. It was interesting that the President created this commission despite opposition coming from within the Democratic party.

During the summer and fall, there was a considerable effort by the Peterson Foundation and in the media to convince people in America that Social Security and Medicare/Medicaid were to blame for the deficit and that they would need to be changed by either raising the age of eligibility or otherwise placing more of the cost onto the individual.

Members of the single payer community testified before the commission ( read my testimony here ), educated staffers in Congress and built a public education campaign called Handsoffourmedicare.org to counter the misinformation coming from the deficit commission and the media.

The commission was required to vote on recommendations to reduce the deficit by December 1st. They missed the deadline and were not able to gain enough votes to pass a package of recommendations. However, many believe that their proposed actions will turn up in legislation being put together in the coming year.

It is commonly accepted that the rising cost of health care is a fundamental cause of our national deficit, as well as the wars and financial catastrophe. Several members of the commission rightly said that we must deal with the cost of health care in order to effectively resolve the deficit.

Unfortunately, while the commission has made the correct diagnosis, they are ordering the wrong treatment. The commission proposed some initial cuts to Medicare including the Medicare funds that help to pay for the training of doctors, and proposed that more drastic measures be taken if the initial steps are not effective. Of course the initial steps will not be effective because they miss the cause of Medicare’s difficulties.

Medicare and Medicaid are not the causes of our national deficit, they are the victims of a broken health system. As our overall health care costs rise, so do the costs of Medicare and Medicaid. The most effective way to control our health care costs would be to expand and improve Medicare and put everybody in the country on Medicare instead of using hundreds of different health insurances as we do now.

The administrative savings alone of a single payer national health program would be around $400 billion. There are other ways that single payer/Medicare for All controls health care costs such as giving hospitals and other medical institutions a global budget and negotiating for the prices of pharmaceuticals, medical devices and services.

We will need to watch carefully to make sure that Congress does not chip away at Medicare and Medicaid over the next few years. These social insurance programs have been effective in improving the health of the populations they serve and on lifting people out of poverty. It is imperative that we preserve and protect them as we continue to push for improved Medicare for all.

Thanks for bringing us up to date on single payer, Margaret. It was a pleasure talking with you again.


  1. John Barker on January 18, 2011 at 11:51 am

    Republicans have staged a coup d’etat on health care reform. Republicans have put their finger in the political wind and sensed political advantage that has come from public confusion and discontent with Congress to enact meaningful health care reform. But are Republicans serious about repeal of even a part of the Patient Protection and Affordable Care Act (PPACA)? There is good reason to think not.

    First of all, PPACA is everything a market forces Republican could desire. Mandated health insurance is a Republican idea to achieve universal health insurance going back to Nixon’s Comprehensive Health Insurance Plan to Mit Romney’s Massachusetts Plan which is currently in effect there and the model on which PPACA is based. PPACA was the Obama administration’s attempt to incorporate Republican ideas into health care reform.

    A second reason is that health care profiteers like this bill, they helped write it. They like the corporate welfare that the bill will provide when millions of people will be mandated to buy health insurance and they like the $447 billion in subsidies that government will provide for those who cannot affor the ever increasing cost of hospitals, insurance premiums and pharmaceuticals.

    A third reason is that Republicans (and some Democrats, notably Baukus, Lieberman and Obama) have received millions in campaign contributions from the health care industry. Republicans are not going to kill the goose that laid the golden egg.

    Republicans know they cannot repeal the law and can safely stage a great show of PPACA repeal to take advantage of public discontent with the law and at the same time satisfy their corporate benefactors. It is likely that Republicans are confident that the ballyhooed state actions to repeal PPACA will fail also, that the Supreme Court will not rule the mandates unconstitutional. They are willing to gambol for political advantage. At the same time a law that incorporates Republican ideas for universal health care coverage remain on the books while Democrats get the blame for enacting these same unpopular ideas. You have to admit it was a brilliant coup d’etat over Democrats if ever there was one!

    the bi

    • John Barker on January 21, 2011 at 2:49 am

      Some additional thoughts on PPACA. We should be grateful, for now, for the advances that this bill provides. Ultimately though, it is not what Republicans or Democrats do to repeal the law. PPACA has a fatal flaw and that is that it’s an ATM machine for health care profiteers whose greed will eventually cause the law to unravel. We will revisit health care reform perhaps long before some of PPACA’s provisions take effect. Winstin Churchill will have been proven right once again–Americans can be trusted to do the right thing, once they have tried all other options.

  2. Vashti Winterburg on January 18, 2011 at 10:21 pm

    Dr. Flowers, Thanks for the vermontforsinglepayer.org website. I’m really looking forward to Dr.Hsiao’s plans. I like to think it will be like Canada, All we need is one good demonstration state.

    Vashti Winterburg

  3. TerryFlowers on February 24, 2011 at 4:30 am

    Keep it up Margaret. I appreciate your great efforts. Never say die! Medicare for All…the only viable solution to our health care challenges.

  4. Cindy Walsh on March 30, 2012 at 11:45 am

    Dr. Flowers motives are great, but the reality is that the purpose of healthcare reform makes the public option mute. See my response to a ‘mandate’ discussion:

    I think that the real question with the individual mandate comes with the intentions of the mandate. It is given that the mandate is needed to bring a pool of ‘well’ individuals into the market to subsidize the costs to insurance companies of insuring pre-existing and other ‘less-well’ individuals. There have been references to this reform as expanding insurance to tens of millions currently unemployed. This is where the argument for this mandate and reform weaken. The healthcare systems being developed across the nation in response to this ‘heathcare reform’, whether public or private, have set into play the real intention of this piece of legislation…..consolidation of the healthcare industry into a mega-institution mirroring the mega-banks…global entities. That is what healthcare reform is about.

    If you look at Massachusetts universal healthcare after a decade, you’ll see that the state has gotten near complete adherence to the mandate….everyone insured…..but you’ll see that those low and middle class families that would have opted out because they couldn’t afford it, are now paying the insurance premium, but losing vital spending for food, gas, childcare while never accessing healthcare because they cannot pay the co-pays. The subsidies offered are not enough to change this dynamic. Insurance company profits are growing as enrollment expands and access falls. This is about what healthcare reform was based….market/profit maximizing. Medical bankruptcy laws and medical malpractice laws are being modified to account for the cursory care that comes with inability to afford access to quality healthcare. The mandate is a Republican proposal deacdes in the making that is meant to take the burden of non-paying patients off private health institutions and taxpayers by eliminating access to healthcare by those not able to afford it.