As I have belly-ached about before, there is a serious and dangerous disconnect in the progressive community between the single-payer advocates and the "incrementalists". What is the source of this disconnect? I think a lot of it has to to with a vague notion of "what's possible" vs a more easily defined "what's best". More importantly, what is a possible way to help bridge this divide, or at least a doable step towards getting a better grasp on the best way forward for a more unified movement?
How about finding out what the public really wants?
While in the throes of winning a presidential election (along with a boatload of house and senate seats) I have been chided (perhaps deservingly) for not going along with the coalition building movement regarding health care finance reform.
However, the health care reform coalition building seems to be concentrating on building a movement around private insurance reform, not finance reform - a crucial difference.
I think we can all agree that private insurance sucks as a way to finance and actually provide access to health care - no need to poll public opinion on that one! There are even Republicans who would agree with that sentiment (even single-payer advocates, oh my!*). So it's pretty easy to build a coalition around beating up on private insurers. It's politically expedient as long as you don't make the mistake of demanding their removal from the system.
It's also lazy, because you needn't inform yourself very deeply about the real issues behind the imminent collapse of our health care financing system. Spending a lot of money beating up on them may not be the best move.
The question is, why are we even talking about reforming/regulating the private insurers? I, along with all single-payer advocates, contend we don't need them. They are the source of, and can never be the cure for, the current situation.
This leads to a better question: are we being politically stupid in devoting so much time and effort to bashing the insurance companies, like the campaign that Health Care for America Now! is currently fielding? Is trying to educate people about single-payer a lost cause? From a personal perspective, having been in many living and meeting rooms and talked to many people from a broad spectrum of political perspectives and knowledge, I would have to emphatically say "No, it isn't!" In fact, I think the support for single-payer is actually overwhelming, not just on a state level (I advocate for California's single-payer movement), but nationally. Yet there is no doubt that it is also latent, that is, people don't necessarily realize that they support it until it is explained to them.
Private insurance reform coupled with expansion of the public safety nets to increase insurance coverage has been tried many different times and in many different ways in many different states (presentation software req'd). All have failed. All have a single common denominator - the inclusion of private insurers. Most have actually been supported by the private insurers because they saw the potential for an increase in revenue. Physicians for a National Health Program have great resources (pdf) about these plans. BTW I fully support expansion of the public safety nets because at the very least this provides some damage control. But that's not really health care finance reform, is it?
So let's put this to bed. Let's see who supports what. Some polls have people agreeing that single-payer is the winner, others would have us believing it's last on the list (n.b. Kaiser is the third largest private insurance company in the country, slide courtesy this diary by DemFromCT).
Let's take a poll (or two). The DKos Research 2000 polls have been a fabulous and accurate tool for tracking the electorate. It seems that Kos has developed a good understanding and working relationship with this outfit. Is it possible to poll regarding solutions to issues in the same way as for candidate preference?
If it is, will the DailyKos community bankroll a poll to see who supports what type of health care finance reform? Shall we all contribute to a kitty to finance the poll? I'm in! And I'm positive I can get a lot of my fellow advocates to chip in. How about you?
I have no idea how to conduct this poll, especially how to phrase questions that are fair and not misleading in some fashion (unlike MoveOn's tragically flawed and after the fact polling of its constituents, as reviewed on the Huffington Post). It's perhaps a foregone conclusion that it will be imperfect, and if it doesn't conform to my personal expectations I'll no doubt whine about that, but I am more than willing to take that risk. Are MoveOn, TrueMajority, Planned Parenthood, and the rest of the gang signed on to HCAN! ready to take the plunge? Will they contribute to the financing of this/these polls? (If not, why not?)
Please comment on how you would phrase the questions. I think it is nearly impossible to speak about this without mentioning its fiscal impact, which was clearly one of the weaknesses of the MoveOn poll, clearly missing in the HCAN! "statement of common purpose", and the CBO "analysis" (pdf) of the Wyden plan is absolutely laughable with its prodigious hedging and qualifiers. Of course, I am clearly biased towards the single-payer solution!
Perhaps something along the lines of (I need your input):
Regarding the financing of health care insurance, which of these do you favor?
- publicly financed comprehensive universal health care insurance, similar to Medicare but with life-long coverage, that is funded and fully pre-paid through a combination of employer and income taxes (short term new money possibly needed, probable substantial long term overall savings)
- an expansion of the current private health insurance system and public health insurance safety net programs (Medicaid, CHIP) with the goal of providing universal coverage (new money needed, long term amount of new money probably substantial)
Those are the two basic choices**. The second one comes in a multitude of flavors, most of which have already been tried in one state or another while having a nearly negligible impact on reducing the number of uninsured (in fact the number has increased in most cases, or privately insured or first-time subscribers have moved into the publicly funded system). The first one describes a single-payer system without using the words "single-payer" which might confuse those who are not familiar with the term (or tip off those who are). It also uses the phrase "like Medicare" which is not really true as Medicare has incorporated elements of private insurance (Medicare Advantage, Medicare Part D), much to its detriment, and includes modest copays and premiums (user fees). But it is the closest thing we have in this country. I'm a bit ambivalent about describing this option in this manner...
In fairness, I haven't used the qualifier "doomed to fail" for the second choice, either, nor have I made any attempt to indicate how it is funded - funding obviously comes from a combination of premiums and taxes but the different ways to do it are mind-numbingly complex and serve mostly to obfuscate the fact that health care dollars are essentially being siphoned away from health care to cover the extra costs of private insurance (administrative, executive salaries & bonuses, profits, advertising, and so on) with no value added.
I honestly believe that you can create a grassroots movement that is smart enough to move beyond the simple-minded act of insurer-bashing, and that can see the most viable solution to health care finance reform. In fact, I think it already exists. The insurance-bashing movement may be doing something to motivate people, and that is very helpful, but it is doing damn little to educate us about actual health care financing, which is tragic.
While we are creating this movement, we can all support the damage control that is necessary: expansion of CHIP and Medicaid and Veterans benefits (more money needed), correction of Medicare to improve and return its leveraging power (less money needed). But let's forget about battling the insurers and focus on education and advocacy for single-payer. It will be money better spent.
______________________________________________
* the originator of this particular effort works to set up single-payer systems in middle-eastern countries (those with lots of petro-dollars), and says that the US private insurers are over there lobbying against his efforts (hmmm...)
** some might quibble with the use of the word "goal" in the second choice, but I think it is important to note that there is no guarantee that everyone will be covered in such a system, an outcome that is common to every attempt to implement this type of solution, partially because people who are currently healthy will most likely be able to continue to game the system, and the systems are so complex many simply fall off the radar