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Dr. Quentin Young Headshot

Single Payer after the Midterm Elections

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While it's clear from post-election surveys that having voted for "health care reform" was not a major cause of the Democrats' defeats, the new health law didn't help. What should have been a feather in the administration's cap - i.e. a genuine reform that guaranteed truly universal, comprehensive care - instead became an albatross.

Many Democrats, sensing the electorate's unease with the new health law's mandates to buy private insurance, its lack of cost controls, and its limited reach - e.g. 23 million will remain uninsured in 2019 - found it difficult to defend. Some even boasted they voted against it.

In a fundamental sense, health care reform was botched by Congress. People wanted serious reform and didn't get it. The big insurance and drug companies got their way, making a few concessions that they are already trying to wriggle out of.

As a result, what was adopted last March was so defective that ultra-conservatives were actually able use it against the president's party.

Yet those who might interpret the election results as a repudiation of any health care reform should pause for a moment and consider these developments:

In Vermont, Peter Shumlin, an outspoken supporter of single-payer health reform who defeated four opponents (some of whom also supported single payer) in the primary, went on to win the governor's race.

Shumlin reports that he has already spoken with President Obama and Health and Human Services Secretary Kathleen Sebelius about getting the necessary federal waivers to implement a single-payer system in the state of Vermont.

Besides Shumlin, four other political heavyweights in the state also support single payer: former governor Howard Dean, Senators Bernie Sanders and Patrick Leahy, and Rep. Peter Welch.

Dr. Deb Richter, a family physician in the Green Mountain State, says, "Peter Shumlin's election shows Vermonters want a single-payer health care system. We're going to get this done."

In California, Jerry Brown won the governorship, defeating Meg Whitman, who spent $141 million of her own money in her failed campaign. In his 1992 presidential primary bid, Brown declared his support for single-payer health reform, and California activists hope he will sign a single-payer bill in 2011 when it comes to his desk. (The Legislature there has twice passed a single-payer bill, only to have it vetoed both times by Gov. Arnold Schwarzenegger.)

In Hawaii, former congressman Neil Abercrombie, a co-sponsor of Rep. John Conyers' single-payer bill, H.R. 676, was also elected governor. He, too, takes office in a state where many lawmakers have signaled their openness to the single-payer alternative.

Significantly, in the House races, only one of 88 co-sponsors of H.R. 676, Rep. Phil Hare, D-Ill., was defeated in the general election by a Republican. Seven other co-sponsors were lost due to death, resignation, defeat in the primary or retirement. Just one of those went to a Republican, Tom Reed, who won Rep. Eric Massa's old seat in New York.

The Congressional Progressive Caucus also did well, losing only three of its 69 members. In contrast, over half of the 54-member conservative Blue Dog Democrats went down to defeat.

In Massachusetts, voters in 14 of 14 legislative districts affirmed their support for single-payer health reform by turning in a majority of "Yes" votes (overall, around 2 to 1) for the following ballot question: "Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?"

Benjamin Day, executive director of MassCare, writes: "The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far [as of Nov. 3] except two. Five of the districts backing single-payer reform voted for Scott Brown in last year's special Senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state."

A similar referendum in 2008 swept 10 of 10 different legislative districts in Massachusetts, refuting the Republican boast that single-payer health care reform is unpopular.

Apparently, whenever people are given serious choices, single payer's popularity is sustained, even in the face of scurrilous attacks from the right claiming it is "socialistic" or "un-American."

There were also setbacks to the single-payer cause, too.

The defeat of Sen. Russ Feingold of Wisconsin was a very heavy loss. Just last February, Feingold had reaffirmed his longtime support for single payer. He should be sought out to help lead the movement for single payer in this new phase.

One of the most egregious results was the election of former hospital company executive Rick Scott to the governor's mansion in Florida. In 1997, Scott was forced to resign his post as CEO of Columbia/HCA, a giant hospital chain, amid a scandal pointing to massive Medicare fraud and other improper billing practices. The company ultimately admitted to 14 felonies and agreed to pay the federal government over $1.7 billion in fines. Scott spent at least $73 million of his own money to get elected to Florida's top office.

In Arizona and Oklahoma, ballot initiatives purporting to uphold "freedom of choice" in health care passed. Couched in anti-mandate language, these initiatives are in fact intended to keep patients prisoner of their insurance company networks and are really directed against enactment of single-payer systems.

So what to do going forward?

Aside from the very promising prospects for fundamental reform in Vermont, one of the immediate tasks of single-payer supporters is to block the proposals from the co-chairs of the Deficit Commission to reduce Social Security and Medicare benefits. The commission is set to make its recommendations to Congress by Dec. 1.

As my colleague Dr. Margaret Flowers has testified, the best way to safeguard Medicare is to improve its benefits and to expand it to cover everyone.

Otherwise the battle for fundamental health reform remains front and center, on both the state and national levels. The Medicare-for-all proposal is simple, clear, legitimate and compelling in its logic. The destructive role of private corporations in our health system is also plainly evident.

Just as women's suffrage and civil rights laws were widely seen as unattainable - sometimes just a few years before they were enacted - single payer is an idea whose time has come. It is unstoppable.