At its Orlando, Florida meeting two days ago, the DNC platform committee voted down a proposed amendment to include single-payer health care in the Party Platform by a vote of 92 to 62, even though public support for single-payer includes 81 percent of Democrats and 58 percent of U.S. residents. As Michael Lighty of National Nurses United said at the time: "If this is controversial in this room, it is the only room of Democrats in which it is controversial." Hillary Clinton's whips in the room were urging on the negative votes. (1)
Hillary has also just come to a compromise with Bernie Sanders's support of single-payer national health insurance (NHI)--bring back the public option (to supposedly compete with private insurers), expand Medicare to include people 55 years of age and older, and increase funding for community health centers. She contends that NHI would undercut the Affordable Care Act (ACA), meanwhile posturing with this rhetoric:
"We have more work to do to finish our long fight to provide universal, quality, affordable health care to everyone in America." (2)
By taking this predictable position, the Clinton campaign ignores these inconvenient facts about the ACA:
- Since the ACA was enacted six years ago, private health insurers have grown stronger through consolidation with most of the market controlled by three giant insurers.
- Insurers still have wide latitude to raise their premiums and pass along more costs to patients and their families.
- There are still no effective price controls in health care.
- There are about 29 million uninsured and tens of millions underinsured.
- One in three Americans cannot afford health care, with many delaying or forgoing care altogether.
- Choice of physician and hospital has been severely restricted by insurers' narrow networks.
- Discontinuity of care is widespread--as one example, a recent study in California found that 70 percent of people could not gain access to primary care physicians of their choice, both within and outside of the insurance marketplaces. (3)
- Most of the co-ops established by the ACA have either already failed or are unsustainable, plagued by high costs and adverse selection.
- The ACA has been a bonanza to corporate stakeholders in health care, with health care stocks the leading sector on the S & P 500.
The main answer, of course, is that Hillary is still captive to corporate and Wall Street money. She has never released her transcripts of talks given to Wall Street groups. Even though she said in 1994 that single-payer would be inevitable by 2010 unless health care was reformed by then (5), she is not taking leadership on health care when there is so much public support for NHI, including Millenials and so many millions of Bernie supporters.
We have an oligarchy, not a democracy, as pointed out by John Acheson in his recent Common Dreams blog:
We the people have no say and almost zero influence in our governance. Forget about the land of the free and the home of the brave--we've become the land of the duped and the home of the indentured. . . . This is reality. It's the logical end-point of the pay-to-play PACster politics that reached its peak with the Citizens United Decision. (6)
The "system" under the ACA is collapsing as many insurers exit markets that are not sufficiently profitable, as the costs of insurance and health care continue to escalate, and as the ranks of the underinsured grow. We have to recognize that multi-payer, profit-oriented health care financing is not sustainable for either patients, their families, or taxpayers.
This is an ideal time to include single-payer NHI in the Democratic platform. The GOP is more fractured than it has been for many years. Trump's "plan", would be even worse than the ACA. It will increase the numbers of the uninsured by 18 million, eliminate the ACA's minimal benefit requirements, and lead to higher prices of insurance with skimpier benefits. (7) And the ACA will never get to universal access, despite Hillary's posturing about Medicare expansion at age 55 and the public option.
Universal access to health care can only be achieved by single-payer NHI. It is time to seize the opportunity, not to be so cautious as to miss it. Though NHI failed at the time, Teddy Roosevelt campaigned for it in 1912, as did Harry Truman in 1948.
2017 could be the moment for real reform if the Democratic platform and Hillary's campaign listen to the public it is supposed to serve, takes on corporate opposition, wins the White House and hopefully gains enough seats in Congress to govern the country. The words of French historian Henry See apply to this moment of opportunity:
History is like the waves lapping at a cliff. For decades nothing happens and then the cliff collapses.
John Geyman, M.D. is the author of The Human Face of ObamaCare: Promises vs. Reality and What Comes Next and How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans
1. DNC Platform Committee votes down single payer. Healthcare-NOW, July 10, 2016.
2. Lucey, C, Thomas, K. In nod to Sanders, Clinton offers new health care proposals. Associated Press, July 9, 2016.
3. Haeder, SF, Weimer, DL, Mukamel, DB. Secret shoppers find access to providers and network accuracy lacking for those in marketplace and commercial plans. Health Affairs, July 2016.
4. Geyman, JP. Hillary's public option proposal: Could it work?, June 3, 2016.
5. Clinton, H. speaking to a group at Lehman Brothers Health Corporation, June 15, 1994, as reported by Health Care for All-WA Newsletter, Winter, 2015, p. 9.
6. Acheson, J. Put away the fireworks . . . you don't live in a democracy anymore. Common Dreams, July 4, 2016.
7. Alonso-Zaldivar, R. Study: Trump health care plan would make 18 M uninsured. Associated Press, July 7, 2016.