Cleveland, Ohio

David Corn in “Healthcare for All–Now” [Jan. 6] succinctly lays out the paradox confronting universal healthcare advocates–a new opening for comprehensive reform alongside public distrust of big-government solutions. The federal-state partnership is the answer–national legislation that offers federal financial support to states implementing health plans that meet federal standards of affordability, comprehensiveness, cost containment and accountability. The states, choosing from a variety of systems, would decide how to structure healthcare delivery and financing. This plan addresses the puzzle of how to create legislation when strong majorities favor health reform but can’t agree on its precise shape. It recognizes the variation in state health systems and reforms, and it finesses the rhetoric of devolution, states’ rights and choice. National politicians whose opposition to reform has been cloaked in objections to specific plans will have to come clean, because the bill doesn’t impose any one plan.

Universal Health Care Action Network

Los Angeles

What to call a universal healthcare system? Medicare for All. There are many advantages: First, Medicare is a functioning system covering tens of millions. It is tied to Social Security, so people would not even need a new number or card. Second, Medicare is easy to understand, in contrast to the Rube Goldberg contraption designed by Hillary Clinton and Co. to protect the insurance companies. Third, Medicare is popular, and Medicare for All would receive wide support, despite savage attacks from the insurance companies, which are hated by everybody. Many businesses would support the extension of Medicare because the new payroll taxes would be lower than the insurance premiums they pay today.

Fourth, Medicare, by using uniform rules across the country, has lower administrative costs, internally and for the users, the healthcare professionals and the hospitals, i.e., one form, the same everywhere, instead of the bewildering array of forms and provisions of various insurance plans. This would also eliminate expenses that have nothing to do with healthcare–sales, advertising, exorbitant executive salaries, insurance company profits, etc., all paid for by the hapless consumer. Fifth, Medicare for All would provide complete portability and continuity, when people move, change jobs, become unemployed or retire.

Sixth, Medicare for All would help the present system, which, we are told, will eventually run out of money. It would lower the average cost per person, since it would include the healthier young and middle-aged, in addition to the seniors, who have more medical problems.

If the Democrats would come out swinging for Medicare for All, they might just win in 2004. The public is enraged about this issue and waiting for them.


Hastings-on-Hudson, NY

I heartily agree with David Corn about the nondescriptive nature of the term “single payer.” In light of Katherine Eban’s cover story [Dec. 9] on the sorry state of public health services for everyday emergencies, let alone a bioterror attack, I suggest we call for “national medical defense” or, if you will, “Star Wards.” The smallpox vaccinations are dispensed free, courtesy of the taxpayers. There’s a principle buried there that “national medical defense” could unearth: The only real defense against new forms of disease, be it bioterror or E. coli, is a first-rate healthcare system that covers everyone, regardless of ability to pay.



In politics, as in healthcare, a sound policy (treatment) requires a correct diagnosis. The malady of our healthcare system is not Massive Health Insurance Deficiency; that is merely a horrible symptom. No, the diagnosis is Run Amok Commodification of Health Services.

David Corn accurately defines the remedy, “a universal, government-funded national health insurance system.” But he errs in his trashing of the term “single payer,” which no more impedes health reform than “abolition” delayed emancipation, or “woman suffrage” put off women’s right to vote.

Our health system is imploding in skyrocketing costs, plummeting access and declining quality. The engine of this catastrophe is the takeover of the system by giant venture-capital corporations oriented to maximize profits. A single-payer government insurance system is no longer the best solution, it is the only solution.

Many good people have been euchred into falling for the current fool’s gold–politicians and lobbyists calling for “universal healthcare.” The American Association of Health Plans (insurance industry), the American Medical Association, the pharmaceutical oligopoly and our waffling leaders embrace this mush, touting failed incremental programs, vouchers, defined benefits and other tactics that booby-trap single-payer reform to aid continued corporate control.

Single-payer will recover vast administrative waste, exorbitant executive compensation and profit-taking; it will control drug costs and, at long last, address mental health and long-term care and emphasize preventive care. We should not pillory the term “single payer,” but if Medicare for All or simply National Health Insurance with “everybody in, nobody out” works for you, go for it.

Physicians for a National Health Program

Amherst, Mass.

No, stick with “single payer.” Use it. Explain it. Enact it.



Washington, DC

Mark Green’s diagnosis of the money cancer in our democracy, “The Evil of Access” [Dec. 30], is right on the, well, mark. But his call for public financing and other legislated solutions fails to address the core problems. First, most Congressmembers are unwilling to abandon the very rules that have allowed them to achieve and maintain power. Second, voters do not trust that the problem will be solved by having the public pay for the hideously expensive campaigns of people who are so corruptible. The way out of the trap is to go directly to the people with a constitutional amendment limiting campaign spending and declaring that election expenditures are not protected by the First Amendment. Such a mobilization would appeal to most voters, who are convinced that money buys influence; generate populist outrage against corporate power; and perhaps inspire young people to get into politics.

Economic Policy Institute

San Francisco

As a campaign finance reformer who organized, with Common Cause, a successful effort for public financing of San Francisco’s City Council elections, I agree with much in Mark Green’s article, but he misidentifies cause and effect, citing the much-abused figure that “94 percent of the time, the bigger-spending Congressional candidate wins the race.” Our research reveals unequivocally that Congressional candidates win mostly as a result of the lopsided partisan demographics that result from gerrymandered districts, not inequities in campaign finance. Using our predictive model, we have picked winners with stunning accuracy, 1,229 of 1,230 races in 1996-2002, without knowing anything about inequities in campaign finance. We’ve already predicted the winners in more than 350 of 435 House races for November 2004–yes, 2004–and financing will play a minor role in those races.

We must look to proportional representation electoral systems as used in European social democracies and places like Peoria, Illinois, and Amarillo, Texas, to make more voters feel their vote is worth something, to crack the two-party duopoly, and to protect and expand fair representation for minorities. More progressive policy will result when our democracy is more representative, and less the stunted eighteenth-century relic of today.

Center for Voting and Democracy


New York City

As Jeff Faux notes, it’s very difficult to get a body of incumbents to change the rules that got them there. But it can happen if (a) a Watergate/Enron-like scandal makes them fear voters more than their donors, or (b) a sympathetic President during his “honeymoon” insists on it. Indeed, Congress did pass a good public-financing bill in 1992–which President Bush Senior vetoed–and would have again if President Clinton hadn’t allowed Speaker Foley to dissuade him in 1993 from making a major effort.

A national drive for a constitutional amendment is a huge, expensive yet conceivable undertaking, which I agree should be attempted–after the 2004 elections. For there actually is a prospect that a pro-reform Democrat could win the nomination and presidency (e.g., Senator Kerry was the author of the best public-financing bill in the Senate a decade ago) and then insist early on a strong law, just as the current Bush interpreted his “victory” as a mandate for significant tax cuts.

While I don’t doubt the influence of gerrymandering, it’s simultaneously true that today’s give-to-get, pro-incumbency money system prices out much talent from running in the first instance and forces all candidates to the same special-interest money trough, inhibiting the public conversation and tilting public votes on issues of interest to big donors. And, of course, gerrymandering doesn’t apply to mayoral, senatorial or presidential campaigns.

Finally, I respectfully suggest that Steven Hill someday seek high office and be outspent 5-to-1 before he so confidently concludes that money doesn’t matter.

President, New Democracy Project