08/24/2009 05:12 am ET | Updated May 25, 2011

Senatorial Silence on Single-Payer

"Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize that right." -- Cardinal Joseph Bernadin

While most persons of conscience would agree with this sentiment, there is enormous disagreement on how to achieve this lofty -- but necessary -- goal.

Today there were rallies across the country sponsored by, including in my hometown of St. Louis. Like many progressive groups, is supporting President Obama's version of health care reform -- namely the 'public option.'

A major feature of the event was a meeting with Missouri Senator Claire McCaskill's staff to present the constituents' concerns on this critical issue. I was part of a small contingent group visited the Senator's local office to present the letter of concern. I was also using this opportunity to "grill my senator" -- so, prior to the event, I contacted Senator McCaskill's DC office, hoping I could get her to answer HuffPost readers' questions about the health care bill.

I was unable to speak to the honorable senator, but I did reach her DC Press Secretary, Maria Speiser. Ms. Speiser initially agreed to have the staff speak with the senator and forward answers to questions generated by HuffPost readers across the country. I added a few questions of my own. In all fairness, I informed Ms. Speiser of the tight timeline for this series, so I didn't expect detailed answers, perhaps talking points from some campaign literature.

The questions I sent along to Senator McCaskill:

  1. From Ali Hassan: Who are the 3 percent that will not be covered by the public option plan?

  • From Karen Pordhum of Marina del Rey, California: I run a temporary staffing agency in Marina del Rey, with about 800 temp employees. Insuring them through the current system is a nightmare, so I offer individual plans and reimburse employees for up to250. of their monthly premium. How will the bill going through Congress now affect temporary agencies like mine?
  • (The following questions were mine)

  • MSNBC has aired a dialogue with the Senator where she flatly stated her support for the public option and was a strong proponent of the President's plan. The Senator then went on to state that the single-payer proposal was never going to be an option. What were her reasons for this position? What studies has she seen that support the contention that single-payer is not possible or wise? How does the Senator define the fundamental differences between single-payer and the public option?
  • What is the Senator's opinion of HR 676, also known as the "United States National Health Insurance Act" as introduced by Rep. John Conyers?
  • What is her opinion of the Kucinich Amendment which has survived a full House vote and is attached to the bill? How would she view her state or any individual state which chooses the single-payer option as would be their rights per this amendment? Would she support single-payer in her home state if it came to a public vote? If not, then what would be the basis for her objections?
  • Finally, if single-payer eventually became a viable contender for a new and reformed health care model in the US, what resources would have to be in play for single-payer to become a serious plan of action?
  • Truthfully, when you consider the vast resources of the US Senate, we should demand serious accountability and transparency. How can any US Senator vote on a bill or take a political stance on an issue without having reasonable documentation and talking points handy? Proponents of single-payer, namely the Physicians for a National Health Program were exceptionally able to provide documentation with all sources properly cited.

    Conversely, I received the following email in response from Senator McCaskill's DC office:

    Hi Jeanine,

    Since your questions are so in depth and your timeline is tight, it looks like they would probably be better answered by the Senate Health, Education, Labor, and Pensions Committee.

    Maria Speiser

    Press Secretary

    Office of U.S. Sen. Claire McCaskill

    Somehow, I expected more. Even 'canned' talking points would have been more thoughtful than referring me to the HELP Committee, the same committee which has been in hiding throughout this entire summer ordeal.

    In response to the letter of concern, McCaskill replied via email to's St. Louis Leadership Council, expressing her concern and recognizing the many tough issues -- the families who are driven into bankruptcy because of medical bills, the enormous difficulties that arise when health care is denied. Her email expressed her support for pet programs such as the Children's Health Insurance Program Reauthorization Act or CHIPS (H.R. 2), which provides health care to children from indigent families. She also cited her support for the American Recovery and Reinvestment Act (ARRA) which includes extended unemployment health benefits. She never did explain her position on single-payer vs. the public option, but she did empathize with the public.

    As you recall, Senator McCaskill was an early supporter of Obama's candidacy, along with Representatives William Lacy Clay and Russ Carnahan. It is telling that among these three politicians, only Clay has pushed for the single-payer program. In fact, Congressman Clay is one of some 83 co-sponsors of HR 676, a bill which would provide single-payer coverage for all Americans. It should be noted that Congressman Clay's district is among the poorest in Missouri, encompassing a large part of St. Louis City. Under the public option, his constituents are among those who would be kicked to a separate public option as the private insurers continue to cherry-pick the healthiest and wealthiest among us.

    The group Physicians for a National Health Program has been pushing for a single-payer system which they liken to 'Medicare for All.' The members of this group are M.D.'s who hail from many organizations, including former editors of the New England Journal of Medicine, a former president of the American Academy of Pediatrics, an advisory committee member of the National Hispanic Medical Association, a former president of the American College of Physicians, the national president for the American Medical Student Association and professors at the Harvard Medical School. Together, they have produced position papers which question whether the public option would be effective, and discuss the medical, financial and moral reasons that a single-payer system is necessary. Unlike our recalcitrant Senators, these medical professionals have extensive documentation for their claims and have studied the problem on an international level.

    Among the many well-documented articles produced by the PNHP is a statement of four principles that guide their vision of reform:

    1. Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms' past record disqualifies them from a central role in managing health care.

  • The right to choose and change one's physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.
  • Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing, and useless or even harmful medical interventions must be shifted to needed care.
  • In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.
  • I'll end with that last principle, the one that openly declares the right of "we the people" to set health policies for our nation. As for the closed minds of our senators, I decry the smallness of their actions. Our elected representatives would have us reduced to beggars in front of our own government. I denounce their small-mindedness, their lack of sympathy and the futility of this politics of incrementalism.