Web Letters | The Nation

Healthcare Advocates: Time to Bury the Hatchet

Time to demand what we want and need

The push to promote the national healthcare law, the ACA, mirrors a scenario that has occurred over and over after the passage of previous state healthcare laws. Numerous attempts have been made at the state level to patch the current system together by expanding Medicaid, providing tax credits or subsidies to help people purchase health insurance and regulating insurance companies. The reforms are praised and people are urged to support these patches on the basis that some more people will be helped. The stories of this or that person who gained coverage are placed in the spotlight, while those without coverage are ignored.

No state reform has achieved its stated goals of coverage, as you will see in “State Health Reform Flatlines” [PDF]. Indeed, every attempt has failed when the rising cost of healthcare became unbearable, but not before states tried to hang on by cutting benefits and/or jettisoning people from the system. None of these reforms moved the states forward.

Regulating health insurance to make companies pay for needed services and not discard those who need care has also been tried and failed. States have ordered insurers to spend a certain amount of their premiums on care, but the insurers have simply refused to provide information or have redefined what is “are” without providing more healthcare. Insurers are impossible to regulate, as they have many tricks, such as restricting where policyholders can get healthcare or writing complex policies that discourage people from seeking care or charging high out-of-pocket costs.

The ACA uses the same tools that past state healthcare reforms have used. The ACA regulatory provision, written by Liz Fowler a former executive with WellPoint, is full of loopholes—as Wendell Potter warns us, and as we already see companies exploiting through their influence on the Department of Health and Human Services, where Liz Fowler now works to implement and weaken the law she wrote.

The same hype that we’ve seen when states passed “comprehensive” healthcare reform is echoing through the national media over the ACA. Democrats and the “progressive” groups funded by allies of the Democrats are pouring time, money and energy into defending the ACA. They want people to believe that the ACA is a step in the right direction towards universal and affordable care. In fact, the ACA is a step in the wrong direction, as it further entrenches the private insurance industry.

When the ACA is fully implemented in 2019 there will still be tens of millions of people without coverage, a greater proportion of those with insurance will have under-insurance, and healthcare costs will continue to soar out of control. The insurance companies will use the $450 billion of taxpayer dollars that they will receive from 2014 to 2019 to undermine the law further.

A real solution to the healthcare crisis already exists: improved Medicare for all. Despite industry efforts to convince the public otherwise, the majority of people in the United States already support national improved Medicare for all. And the evidence shows that we are already spending enough on healthcare in this country (the most per person per year in the world) to provide lifelong comprehensive high-quality healthcare to everyone. Medicare for all would control healthcare costs with proven methods, through budgeting and negotiation.

When it appeared that the Supreme Court was going to strike down part of the ACA, the individual mandate, many of the same groups that are praising the ACA started to call for Medicare for all. We saw those who support real health reform starting to come together to support the real solution. Sadly, though, as soon as the ACA was upheld by the Supreme Court, that solidarity disappeared and the “progressive” groups returned to defending the ACA.

Now single-payer advocates are being warned that they should not “make the perfect (i.e,. single-payer) the enemy of the good (i.e., the ACA)” when in reality it is a false “good” that is preventing the “perfect.” It is the willingness to accept reform that has been proven to fail that prevents the nation from adopting a real solution, dropping two words, “over 65,” and applying Medicare for all.

The enemies of real reform are the deception and inconsistent arguments used by partisan groups that defend the ACA. On one hand, they say that private insurance is the problem and that insurers will do whatever they can to prevent real reform; while on the other hand, they say that we must protect the ACA, which further entrenches the private insurance industry in our healthcare system. They say that single-payer is their goal too, but then they try to marginalize single-payer advocates just like insurance companies and other opponents of single-payer have been doing for decades.

Single-payer advocates are told that they must compromise. However, Gandhi said it best, when he said, “You cannot compromise on fundamentals, for it is all give and no take.” We are fortunate to have industry insiders such as Wendell Potter who can point out the ways that insurance companies game the current system to their advantage. The fundamental step for effective healthcare reform in the United States is to remove the private insurance industry and create a system that is about health. Once we establish Medicare for all, there will be much more to do to continue to improve the healthcare system.

We will achieve real healthcare reform, improved Medicare for all, when we are clear and uncompromising in our demand for it. We must be independent of political party and, as Dr. Martin Luther King Jr. said, “be the conscience of both parties.” Like every other significant social change in this country, it is the people who must make it happen. It is time for all who support healthcare reform to join together and loudly call for what we want and need, Medicare for all. The longer we allow the ACA to go forth, knowing that it will fail to solve the crisis, the longer it will take to achieve access to healthcare for all people.

Yes, under the ACA some more people will have access to healthcare. But too many will not and too many others will go bankrupt and lose their homes trying to pay for needed care. Why do we accept less than access to healthcare for everyone, especially when we are already paying for it?

Margaret Flowers

Baltimore, MD

Jul 17 2012 - 8:19pm

Healthcare Advocates: Time to Bury the Hatchet

Beware of partisan deception

Wendell Potter essentially tells the single-payer movement to stay silent when it comes to criticizing President Obama’s Affordable Care Act for fear of “helping the industry’s Republican friends to take back Washington.”

As a single-payer advocate who joined with fifty doctors in filing an amicus brief against the mandate and one of those who stood outside the court protesting that aspect of the law (or as Potter falsely says, “alongside the Tea Partiers on the steps of the Supreme Court”), I continue to oppose the insurance mandate as it further entrenches health insurance dominance of healthcare in the United States.

Potter correctly begins in his area of expertise, criticizing the profit-driven insurance industry, its corruption of government and its lack of care for improving healthcare in the United States. He is right: this already weak law will be corrupted further by the industry. Indeed, the law‘s primary drafter, Liz Fowler, a former executive for WellPoint who worked on the Senate Finance Committee, now works for President Obama’s Department of Health and Human Services (HHS), where she is implementing the law. The law has become weaker as HHS granted over 1,000 waivers to insurers and others to allow them to avoid the law’s requirements and HHS told states that they can narrow the coverage provided to poor people under Medicaid.

What Potter and others who support the ACA want to avoid is an evidence-based discussion of what actually works. Our amicus brief primarily focused on evidence that single-payer works in the United States, comparing the insurance-dominated market system with Medicare and the Veterans Health Administration as well as evidence from around the world. The bottom-line: unlike the ACA single-payer would provide healthcare to everyone in the United States, control costs and improve healthcare outcomes. That is what the evidence shows.

Potter really goes off track when he gets out of his area of expertise and talks about how to achieve single-payer. The single-payer movement has a strategy: education, organization and mobilization. We have already built overwhelming public support for single-payer: two-thirds of Americans support single-payer, despite minimal or negative media coverage. Even polls that inaccurately describe it as socialized medicine find more than 60 percent support. Majorities of doctors and nurses support single-payer. In the Democratic Party, 80 percent support single-payer. To continue to build a movement to enact single-payer, we need to stand clearly with the super majorities of Americans and demand single-payer—not compromise in order to re-elect President Obama.

With that clear goal in mind the single-payer movement can make compromises, but only with laws that go in the direction of a national health insurance that covers everyone. The ACA sends the country in the opposite direction—rather than removing the unnecessary middleman of health insurance it entrenches the industry further. Not only does the mandate force tens of millions to pay a penalty or buy insurance, it also provides $500 billion in subsidies for the insurance industry between 2014 and 2019. With that kind of money they will have lots of money left over to buy politicians after paying their executive salaries and overhead.

Wendell Potter should stick to his analysis of the insurance industry, in which he worked in for twenty years until he finally found he “didn’t have the stomach to be a part of yet another deception-based effort to undermine reform.” Sadly, I expect in a few years he will look back on his current work and find he has substituted insurance industry deception for partisan deception. Healthcare is not about advancing a political career or political party. It is about providing good quality healthcare to everyone in the United States.

Kevin Zeese

Baltimore, MD

Jul 17 2012 - 8:17pm