On Wednesday I posted a blog on Huffington Post asking readers to sign a Petition requesting that our friends at MoveOn.Org let its members vote on whether they support universal single payer health care or reforming private health insurance (while adding an optional public plan that the uninsured could purchase themselves). In less than 48 hours, nearly 3,000 people have signed the Petition and, as the Petition spreads virally, new signatures keep coming in at the rate of 50-100 per hour.
On Thursday, Eli Pariser of MoveOn responded with a blog asserting that MoveOn had already determined that by 70%-23%, a majority of its members supported reforming private health insurance with an optional public alternative instead of supporting universal single payer health care, based upon what MoveOn claimed was a "random sample" of its members.
At first this seemed strange to me. Most members of MoveOn are presumably progressive. So one would tend to assume that they would be more supportive of single payer health care than the average American voter. But while polls by major news organizations have shown a majority of Americans supporting single payer, MoveOn's "random sample" indicated MoveOn's member's rejected single payer by nearly 3-1 in favor of a private insurance/public hybrid.
Meanwhile, an Associated Press poll in December, 2007 asked voters "Do you consider yourself a supporter of a single-payer health care system that is a national plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?" 54% said "Yes" and 44% said "No".
A CBS News poll last September asked "Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by the taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?" 55% chose "One Program for All" and only 29% chose "The Current system".
Something seemed strange here. Could it really be that average American voter is more progressive on universal health care than the average MoveOn member?
Then I started to look more closely at MoveOn's "random sample" and it started to raise a lot of questions about whether it really gave an accurate reading of the opinions of MoveOn's members.
Was this survey conducted by a professional polling organization or put together by the MoveOn staff? Will MoveOn post the polling methodology and statistical results? How many people were sampled and how were they selected? I'm not an expert on statistics, but here are some questions that one Doctor posed about the survey: "What is the power of the study, the standard deviation, the p number?" I've emailed these questions to my friends on the MoveOn staff, but they haven't responded yet. I look forward to their responses, either in private or here in the Huffington Post.
Most important, "Was there any validation study done beforehand to assess the wording of the questions?" The closer I looked, the more it appeared as though the wording of the MoveOn survey had a build in bias that at least appears to skew it towards eliciting the answers that the MoveOn and Health Care For American Now staff had already decided that they agreed with. Two alternatives were provided:
o "Support single payer: Work to cover all Americans by switching from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system."
o "Support national public health insurance: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don't require people to switch."
This wording is confusing. It makes it appear as though the issue is about free choice: Either you can be forced by the Feds to switch into a government program or be given the free choice to keep your present insurance or switch into a "free or affordable" Medicare-style program. I'm a strong supporter of single payer, but if you phrase the issue as one of individual free choice of whether to switch or not, I'd choose the free choice alternative, too.
There are so many ways in which, in real life, the second "appealing" free choice is a fictional alternative. It is unlikely that voluntary "Medicare-style national health insurance" would be "free or affordable" for most middle class Americans. The plan that MoveOn and HCAN is actually backing is based on the Health Care for America plan developed by Jacob Hacker and the Campaign for America's Future. According to the financial model for this, plan prepared for the plan's backers by the Lewin Group, the real cost for a two-parent family is $8040 a year. In addition, families could have to pay as much as $5,000 per year in out of pocket costs. Moreover, the Lewin Group's cost projections are probably low, because they assume that 128.6 million Americans would be insured by the optional public plan, a wildly inflated number that would give the public plan bargaining power to reduce costs that it is unlikely to have. A 2007 study by the Brookings Institution estimates that the annual cost for a family of four to buy a Medicare-type plan would be $10,000 per year. Whether the number is $8,000 a year or $10,000 a year, plus co-payments, this is hardly 'free or cheap" except for those close enough to the poverty line to receive a substantial government subsidy.
Meanwhile, for this plan to have even a chance to work as advertised, it would require a government mandate requiring everyone not covered by their employer to buy insurance. For middle class people who are not poor enough to receive a substantial government subsidy, this would be a financial backbreaker, making this plan a dead bang political loser.
Finally, MoveOn and HCAN argue that an optional public alternative would somehow provide a transition to single payer. They believe it would be so much more attractive than private insurance that more and more people would buy it until private insurance is marginalized. In fact, the opposite is true. Even given administrative savings, as a cadillac insurance program with good benefits, coverage for all medically necessary conditions, choice of doctors, and low deductibles and co-pays, it would be an expensive program. Private insurers would compete by offering low-cost stripped down programs with limited benefits and high deductibles and co-pays, but which would siphon off most of the young and healthy. The public program would become the private insurers' dumping ground for older and less healthy people whom they don't want to cover anyway, thus making the public program increasingly expensive. (This is known as "adverse selection".) Far from marginalizing private insurance, this plan is likely to make the public program increasingly unaffordable for most Americans and bust the federal budget by increasing the cost of federal subsidies.
So the MoveOn "random sample" question alternative for an optional "free or affordable Medicare-style program" is not based on reality. That would explain why MoveOn's "random sample" makes it appear that MoveOn's members are to the right of the American public on single payer.
I truly wish there could be an easy solution that would provide good inexpensive health care for all Americans and wouldn't involve a major political battle with the health insurance and big pharma lobbies. In his Huffpo blog, Pariser accurately warns against "the huge campaign we'll face from private insurance companies, HMOs, and pharmaceutical companies." He then argues that the MoveOn/HCAN proposes "the best strategy for progressives to take" because presumably it will face less political opposition from the special interests. In another Huffpo blog, HCANs Richard Kirsch even argues that the insurance lobby has "nothing to fear" from HCAN's plan, since under HCAN's principles, "people are free to keep their health insurance if they want. They can choose another private plan if they prefer".
MoveOn/HCAN honestly believes that single payer supporters are politically naive, and that MoveOn/HCAN can pass a plan that provides tough new regulations on the private insurance industry, limits their profits, and offers a public plan that will seriously compete with private insurance, without the insurance lobby fighting against such a plan as hard as they will fight against single payer. Doesn't that sound a bit naive?
So, if to have a chance of passing meaningful universal health care reform, we're going to have to build a mass movement to take on the full force of the insurance and pharma lobbies anyway, why, as George Lakoff puts it, does MoveOn/HCAN want to "surrender in advance" by conceding on single payer and promising the continuation of wasteful private insurance system? Somewhere along the line it may be necessary to make some pragmatic political compromises. But you don't win a political fight by giving up your most important principles before the fight even begins. In particular, the job of a progressive mass movement like MoveOn is not to pre-negotiate in advance with the insurance lobby, but to help organize a mass citizens' movement to take it on.
I hope our friends at MoveOn will allow all of its 3.2 million members to vote, in a fairly worded professional poll, on which direction MoveOn should take in the fight for universal health care, after a full and fair debate on the issue is presented to its members.
If you agree, please sign the Petition.