As Americans suddenly start waking up about health care, I find reasons to both grieve and rejoice. Rejoice because at LEAST Americans are hearing the words "single payer" now - however mis-construed - in the national media. At least the term is out there for the single payer movement to correct and address ...and the public to wrestle with. Before the senate hearings a week or so ago, we (the 59% of all MDs, growing majority of RNs, and 60% of Americans who support a single payer publicly financed healthcare plan), were thought of (when we WERE considered at all) as hippies, radicals, extremists, healthcare "tree huggers", and aging peace, etc. activists. At least we have the tip of a toe in the back door of the whitehouse now.
Obama and the DNC, et al likely is not paying much attention to the single payer movement figuring push coming to shove, the single payer movement may despise the giving of at least part of "Siam" to the private health insurance monopoly but will not do a lot to prevent it. Nevertheless, it might behoove the man to check his attitude towards the single payer movement. Occasionally, as gracious as he usually is, he is not perfect and an occasional slip into ridicule, grandiosity, and "elitism" can pervade his rhetoric - which it did when he referred to the single payer advocates who greeted him at one of the recent townhalls as "little" single payer people. When Max Baucus consistently refused to allow single payer representation at the senate hearings, MDs and lawyers were left only with options we have not seen used since Martin Luther King walked amongst us. Baucus had them jailed for disrupting the proceedings and thanks to the web (and certainly not to the press which all but ignored the unprecedented action), boom - "single payer" was on its way into a tiny corner of the greater American consciousness and, as we saw in subsequent hearings, at congress's table. I can only wonder that the little lunch meeting in the middle of that day between Obama, Biden, and Baucus might have led to not only Dr. Flowers at the table in the HELP hearings last week but also to Baucus' apology and admittance of regret in not including the single payers in the roundtables.
As I write, some of the legislation is already being drawn up. There is still a lot of noise about the public option, the insurance industry of course lobbying against it, HHS's Sibelius babbling on about how of course the public option is not a conspiracy to ultimately put into place a single payer system and there there, don't worry (though I worry when I hear her tell us that Obama may legislate against this EVER happening), and the usual tea party types running around in circles scared to death they might lose the dividends that fund their country estates, skiing trips, and plastic surgery. The working poor who object to a healthcare system which cuts the middle layer of corporate profit out of the game don't have time for "tea parties", et al - all they can figure out is that govt. is bad and does bad things to them and takes away their freedom (the usual cries about socialism though how many of these whiners have even read Das Kapital is probably less than the head count in most high school world history classes).
I find myself continually amused and intrigued that they who were so up in arms about AIG, et al getting a bail-out and all of the obscene executive compensation excess that went along with all of that are so determined to see to it that the private health insurance execs and companies don't lose those same perks and proit margins. And going further, these folks seem to be absolutely determined to continue to pay the costs for those ridiculously high premiums despite whining and complaining about them and their own healthcare costs.
The blame is dumped off onto MDs for supposedly ordering tests that are characterized as "unnecessary". They told MDs that in the 80s about mammagrams for women under 40 at risk until MDs finally - after who knows how many lives were lost - INSISTED the KaiserAetnaBlue, et al monopoly change their "best practices" re this. Or they tell us that if people just ate more vegetables, they wouldn't have health care costs (when your child gets diagnosed with multiple sclerosis, come talk to us about your "more vegetables" Rx). What's next - the 2nd blood test your MD ordered to verify that the lab work that said you had cancer was indeed correct will be seen as "unnecessary" thus resulting in - uh... not more savings but actually less... not to mention needless suffering and lives lost from such slipshod medicine?
Perhaps we won't get single payer this year at the federal level, but the conversation will not end once Obama has signed into law whatever it is that we are in for. What we in the single payer movement may have to focus on now is assuring the right of every state to do its own thing when it comes to healthcare - so that if California wants to pass its SB810 Universal Healthcare Act (because in California, the ENTIRE legislature DID pass that law TWICE only to see it vetoed twice by a governor who has helped to bring California to the brink of bankruptcy today... thanks Arnold, you wrote your own death warrant and we are only TOO happy to see you terminated as soon as possible...), it can. Focussing on upcoming governor races, retaining at least a Democratic stronghold in state legislatures, and continuing to pester congress about single payer publicly financed universal health care, slowly but surely - as our sisters and brothers did in the civil rights movement and the suffrage movement - will see us prevail. I may be dead by then but we WILL prevail.
The public/private option schema is unsustainable. We see that in Massachusetts and even the legislation proposed so far by the senate re first drafts of this health care bill states quite clearly nothing about how this system will be financially sustainable but that it must be SELF-sustaining. Well, uh - yeah... that's what we've been saying, folks. Throw in the people who will be able to opt out because they are poor (and let's see, at this point - I'd say that's a HUGE proportion of America now given the downturn) thus ending up in the ER again paid for by you and me (and without the preventative care, of course, that would have precluded the need to go to the ER), we soon will be right back where we started and then some. You can count as well on the small businesses who, seeing that only businesses with over 50 employees will be required to provide health insurance, will simply make do with 49.95 worker bees. Here in California, which probably has more contract workers than possibly any other state, employers are already well familiar with these kinds of rules thus making the 51st "employee" always contractor #1 or hell, just making one's workforce employee-less by hiring only contractors (no worker's comp needs, no health ins needs - no problem).
McCain testifed at one of the hearings and though I certainly am not one of his supporters, I was absolutely with him when he asked the right question which was 'how are you going to pay for this'. The question of sustainability has not been addressed and as someone with a hefty background in IT, usability engineering, and health IT in particular, I can assure any reader here that no amount of electronic technology is going to fix the sustainability problem re this multi-payer-w/one-of-them-being-public shticks. Not to mention, with the retention of the 1500+ private insurers (maybe it will drop to 1000), Medicare, and now a "public" option, the amount of payers (all of course with their different rules and requirements) may end up costing MDs even MORE to manage and administer. Or, as we're seeing with this new "advocacy" industry developing (now people can be purchased to fight for you and decipher your EOB for you), maybe this new projected increase of paper/data-pushing to process the claims for all of these payers will spawn new jobs in data/paper-pushing deciphering, et al. Talk about insanity...
Were the public to truly "get" the actual definition and design of a "single payer publicly financed healthcare plan", they would see it as a "no brainer" - a system which is TESTED and has proven MUCH cheaper with better outcomes, where there is only ONE single payer (the govt.) and NOBODY tells MDs what to do or how to do their job, and where ALL parts of the human body are considered... uh... parts of the human body (i.e., teeth and eyes are not considered as ...er... "accessories"...). Hard to even imagine the public would stand for anything else.
When California passes SB810, after it gets rid of Arnold and moves into office the next Democratic governor (and if you're thinking that's you, believe me - we're going to vet you until we are absolutely convinced we are not simply getting another undereducated B movie star), we will see people suddenly interested in moving to the golden state and perhaps, that is the real gift - California will once again drive the US economy as companies flock there attracting workers, etc. Then we here in California can look to Washington and say, "we told you so - we gave you the iPhone and now health care..." THAT is change to believe in.
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