Obamacare not enough, so some in labor want single-payer system; forum Sept. 13

By Olivera Perkins
The Plain Dealer (Cleveland), Sept. 12, 2014

CLEVELAND, Ohio - When many in the labor movement speak about health care reform they are not talking about Obamacare, but a single-payer system.

"It has been a historic goal of the labor movement to establish a Medicare for all, single-payer system in the U.S., just like almost every industrialized country in the world," said Mark Dudzic, national coordinator for the Labor Campaign for Single Payer. "The labor movement, we believe, has to be in the forefront of the fight, if we are going to win that."

Dudzic is one of the speakers in a forum tomorrow (Sept. 13) being sponsored by his Washington, D.C.-based group and the Single Payer Action Network of Ohio, or SPAN, which is lobbying for instituting such a health care system in Ohio. The event is scheduled for 2 to 4 p.m. at the North Shore AFL-CIO Federation of Labor, 3250 Euclid Ave., in Cleveland.

Those supporting single payer emphasize that they are not seeking a publicly funded system run by the government, in which health care workers would be public employees. Instead, they want one more like Medicare, in which users would go to private doctors, using public money to pay the bills. Supporters say one of the reasons such a system would cost less to operate is that administrative costs associated with a private insurance system would be gone.

Dudzic said single-payer advocates lobbied for the system's adoption as Congress was considering the Affordable Care Act, also known as Obamacare. He believes the passage of ACA, has left more people open to single payer.

"It is a mass of contradictions," he said of ACA." On one hand, the Affordable Care Act expands health insurance coverage to millions more Americans, but it doesn't control costs.

"In some ways, it models the dysfunctionality of the for-profit health care system," Dudzic said. "It makes health care more of an individual responsibility than a social right that is inherent. It makes the individual responsible for paying for health insurance. It provides access to health insurance, but not access to affordable health care. That is a big difference between it and single payer."

It is not that he doesn't like the ACA, Dudzic believes it just doesn't go far enough.

"Let me make it very clear," he said. "No one we work with is calling for the repeal of the Affordable Care Act. We ought to finish the job by getting single payer."

Many disagree single payer will be cheaper and allow better access to health care than a private insurance system. Ryan Thorn, president of the National Association of Health Underwriters, said health care costs need to be brought under control, but there are better options for doing this than a single-payer system.

He said if health care providers were required to tell consumers the cost of services and procedures before they were rendered, competition would lower medical costs. Thorn said, things being equal, most consumers would opt for providers with the most affordable prices.

"One important way to control costs is through transparency," he said. "Health care is one of the only commodities in America in which nobody has a clue as to what it is gong to cost until you get the bill.

"We believe competition is a good thing," he said. "Competition, in most cases, will help keep control of costs. Competition keeps technology sharp."

Thorn said when single-payer advocates say they want the U.S. to have a health care system similar to that of other industrial nations, they are seeking to replace what has historically existed here with a lesser system.

"In most countries that have single payer, you will find a rationing of care," Thorn said. "It works great as long as you're healthy, but when you become sick, then you are going to be thinking twice about single payer."

Debbie Silverstein, state director of SPAN, which is trying to get single payer in Ohio, said such efforts so far haven't gained traction. A bill in the Ohio House and another in the state Senate, remain in committee -- not evening having received hearings, she said.

"They are not taking these bills seriously," Silverstein said of state legislators. "They are pretty much ignoring us."

She said SPAN wants a universal health care system in Ohio, which could be publicly funded through such taxes as a payroll tax, a financial tax on investments and/or a sales tax. Beginning in 2017 - waivers -- such as those associated with the ACA health insurance exchanges - could also help fund state single-payer systems, Silverstein said.

Thorn doubts if single payer would lower costs, but he is sure the system would raise taxes.

"As soon as the taxes are depleted, your health care is done until new taxes come in the door," he said.

Like Silverstein, Dudzic believes interest in single payer will increase once waivers become available. So far, they say Vermont is the only state that has approved a single-payer system. While both advocates support single payer, they differ on whether ACA has become a vehicle for moving the country closer to single payer. Silverstein doesn't see the connection. Dudzic does.

"There is buyers' remorse," he said of ACA.

For example, Dudzic said silver tier plans on the ACA exchanges have become the gold standard for coverage. He said unions who have negotiated coverage equivalent to gold or platinum tier plans, could risk facing a hefty tax because they offer more expensive coverage. Dudzic said this has made contract negotiations for many unions contentious.

Despite what he sees as an increasing desire for single payer, Dudzic said he doesn't believe the fight to win it will be easy.

"We're dealing with a gigantic, for-profit health care system that is a huge massive corporate power," he said. "Anytime there is any attempt to change the health care system, so that it impacts their profits, that corporate power just mobilizes all of its resources.

"For every congressperson and senator, there are at least four people whose job it is -- from the moment they get up everyday to the moment they go to bed -- to ensure that no substantial change happens to the health care system," Dudzic said.

Olivera Perkins is a staff writer at The Plain Dealer.