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The Fight for Single-Payer Health Insurance, 2014

By Paul Song, M.D.
Labor Campaign for Single Payer Healthcare, Sept. 15, 2014

The Labor Campaign for Single Payer held its largest ever strategy conference August 22-24 in Oakland, CA. Over 300 attendees packed the joint session at the historic ILWU Local 6 Hall, which was co-sponsored by Healthcare-NOW! and One-Payer States. Dr. Paul Song gave the keynote address for the workshop on "One-Payer States." The following are his notes from his talk.

I am so honored to be here and speak to you, both as the head of the Courage Campaign and also as a co-chair of the Campaign for a Healthy California and a board member of Physicians for a National Health Program - California.

I believe that we as a society are judged by how we care for the least amongst us. And I love everyone in this room because you all get this!

When I hear people on the right say that America is under attack and heading in the wrong direction, I absolutely agree. I find our nation's declining care and concern for the least among us and the overall waning progressive influence in our country as well as the declining overall share of America's workforce that is unionized to be no coincidence.

It is labor organizations and progressives working together who stick up for the middle class, our sick, our elderly, and our uninsured. No one else does!

When times are hard, it is always our most vulnerable who bare the biggest brunt, but when times are good, it is always corporations who reap all the benefits.

It is corporations who use huge profits at the expense of laying off workers, cutting healthcare benefits for their employees, or actually denying care for patients to buy and elect their corporatist legislators who then give them more corporate tax breaks and more deregulation. It is corporations who bought off our elected corporate whores like Max Baucus, who in turn wrote the ACA and continue to stand in the way of real progress and Medicare for all.

Because the inconvenient truth is that while the ACA is a good start:

Health care costs as a proportion of GDP will continue to rise while tens of millions remain uninsured. Family premiums are currently $15,000 per year and rising, with employees having to contribute more every year. Premiums, copays, and out-of-pocket costs will continue to increase as insurance companies continue to maximize their profits under the ACA. Provider networks will continue to be very limited and patients enrolled in Medicaid will have an even tougher time finding a provider who will see them, Our undocumented brothers and sisters are left out and over 30 million people will still be uninsured by 2025.

Now, we all know the facts about single payer and why it is the only solution, but unfortunately most of our general public remains ignorant as to its benefits and instead continues to believe that private insurance is the best.

So we need to be careful not to bash the ACA too much. It is very fair game to point out the limitations of the ACA, but if we spend too much time tearing it down, between this and the VA debacle, the American public will begin to believe that the government is incapable of healthcare.

What we need to do is take back the overall narrative. We need to make the moral argument for single payer or rather point out how immoral our current healthcare system is and we need to make the economic argument by sharing Gerald Friedman's great economic research on the benefits of single payer.

At the same time, it is very important that we point out the facts about our current single-payer system (Medicare) and how despite it constantly being trashed and financially undermined by Congress, the fact is that it is run far more efficiently and with greater patient satisfaction than the private sector.

Remember that Medicare was established when 44 percent of adults over 65 years of age were uninsured and one-third of all seniors were living in poverty. Sadly in 2012, close to 50 million people were living in poverty in the U.S., the largest number since the great depression and 50 million were uninsured.

In the run up to the vote on Medicare, the AMA hired an actor by the name of Ronald Reagan to record an album to disparage it. He said "If you don't stop Medicare and I don't do it, one of These Days, you and I are going to spend our sunset years telling our children, and our children's children what it once was like In America when men were free." Despite his pleas and what many conservatives still say, Medicare has been a huge success and clearly demonstrates that a single-payer system is indeed superior and possible.

Seniors and practicing physicians have much more freedom than patients in the private insurance system. Patients have greater choice and do not need pre-authorizations. The government does not tell doctors how to practice, what tests to order, which hospitals to go to, or what medications to prescribe.

A study by the Commonwealth Fund reveals that Medicare patients continue to have much greater satisfaction, better access to care, and fewer billing problems than those with employer sponsored plans.

A Kaiser Family Foundation study showed greater overall satisfaction and much more cost efficiency than private insurance companies.

But in spite of how successful Medicare has been, it does face significant future challenges. Each year it takes up more and more of the federal budget, patients in Medicare tend to be older and have more chronic conditions, and this population is only expected to get larger and larger in the coming years.

While many worried that Medicare would lead to a government takeover of healthcare, it is the private healthcare industry that has been quietly increasing its influence and control over government. In fact, while Congress continues to publicly criticize growth of Medicare costs it privately restrains it from getting a better deal for Medicare patients and U.S. taxpayers, through corporate welfare disguised as privatization.

Kip Sullivan, in an excellent study, showed that the real administrative costs of Medicare are 1.4 percent and could be lower if not for the administrative excesses of the private Medicare Advantage and Medicare Part D drug programs.

In 1995, The GOP pledged that by placing at least 20 percent of Medicare beneficiaries in HMOs would save $270 billion over seven years. In reality, since 1985 Medicare has overpaid private insurers by $282.6 billion, or 24.4 percent of all Medicare payments.

In 2012 alone, we find that Medicare Advantage plans are being overpaid by $34.1 billion, or 6.2 percent of total Medicare spending.

The Affordable Care Act called for cuts to the Medicare Advantage program, but the politics of cutting Medicare have been getting in the way.

Just this past April, the Obama administration turned a proposed 1.9 percent cut to 2015 Medicare Advantage health plans into a .4 percent increase after heavy lobbying from insurers and the Hill. It was the second-straight year that the Medicare agency transformed a proposed rate cut into a raise.

Congress should really question whether the higher administrative costs associated with the growing privatization of Medicare are justified!

As for drugs, per capita spending on drugs in the U.S. is 40 percent higher than in Canada and 75 percent greater than in Japan and 300 percent higher than the amount spent in Denmark. And Medicare Part D is a huge part of this.

When I hear the GOP talk about trying to protect Americans from a huge government run healthcare program, they must not remember Medicare part D for prescription drugs.

Rep. Billy Tauzin (R-La.) and the GOP-controlled House and Senate crafted Medicare Part D, which was then signed into law by President Bush. Soon after, Tauzin left congress to head PhRMA for an annual salary of $2 million.

In 2006, the first year of Medicare Part D, the combined profits of the largest drug companies soared 34 percent to $76.3 billion.

Medicare Part D made it illegal for Medicare, the nation's biggest health plan, to use its market power to negotiate for lower prescription drugs prices. It is also banned importation of cheaper drugs and gave drug companies stronger protections against their generic competitors.

And the administrative costs for administering it are almost 10 percent.

How come when WellPoint negotiates lower prices, it is good business and the free market at work, but when Medicare tries it, it is government interference?!

It is clear that removing these pork spending constraints on Medicare would not only lead to lower prices at the drugstore, hospital, and doctor's office, it could spark a new era of healthcare innovation.

So whenever anyone criticizes Medicare or says it is a failure or that it should be privatized, I hope you will hit them over the head with these facts.

I think we can learn a lot from the marriage equality fight. There was no federal appetite to pass legislation in the dysfunctional highly partisan Congress. Instead it started state by state and within 10 years we now we have 19 states with full marriage equality and another 14 states where judges have issued rulings in favor or freedom to marry. I think one of the biggest reasons for the incredibly fast shift in opinion was due to more and more gay individuals coming out to their friends, family, co-workers in a way that made this an issue that the general public could individually relate to. We need to find a way to come out to our greater communities at large (especially those of color and those who have continually left behind) and not just continue to preach to the choir.

So that in 2017 when the federal waiver sets in, it is finally time for at least one state to pass single payer, and this can begin to spread state by state.

But this can only be done if all Americans wake up and say enough to the stranglehold of the private health insurance industry along with their excessive rate increases and to the continued privatization of Medicare!

Finally, I want to say that we need to stop fighting with one another and eating our own. As a Korean American, I am always being asked how come there are so many Korean churches. I wish it was because our hearts are so on fire for God, which for many it is. But, the fact is that Koreans can also be pig-headed and always want to be in charge, and as a result when the elders of a church cannot put their God before their own agenda, they often split and go form their own church.

Sadly, this also happens in the single-payer movement. We have those who rail against the ACA and anyone who shows any support for it and we have those who believe we must embrace the ACA as a good start. We have those that believe a national federal program is what we should fight for and others who feel it should be state by state. We have those who believe we can achieve single payer legislatively and those who think it will be via ballot initiative. Whatever you believe, we all should be able to respectfully share our thoughts and opinions constructively while remembering that we are all on the same team. It is the corporatists and the private healthcare industry that are our enemy, not one another. We need to save our energy and our bullets for them and not on friendly fire.

It is time for us to come together with one voice to hold our elected officials accountable and fight back against this corporate bull, and to make sure corporations do not continue to get their way.

And while we rid ourselves of this corporatist evil, all of us need to continue to work very hard to educate everyone about the true merits of single payer and continue to build the broadest coalition possible to make this a reality.

Enough is enough!!

Thank you!!

http://singlepayer2014.wikidot.com/ops-keynote-paul-song
http://www.laborforsinglepayer.org/2014-national-strategy-conference-out...
http://www.healthcare-now.org/2014-strategy-conference-wiki