Sunday, July 3, 2011

PRIMING THE PUMP--SINGLE PAYER NOW AND THEN… A brief history.

(Presented to the San Francisco Progressive Democrats of America June 23, 2011)

I’m a member of Physicians for a National Health Program. I am not a physician. I am a Jungian psychotherapist. Martin Luther King, Jr. said that “of all forms of inequality, injustice in healthcare is the most shocking and inhumane.” I’m in this because it is the right thing to do and I want a voice on how it impacts my portion of the health field.

There’s a phrase that I’m sure we all are familiar with—but perhaps not so much aware of its origin. “Priming the Pump.” The old hand pumps for water wells required that you put a little water down the pump in order to create the pressure to start pumping water up. This is priming the pump.

Now, my dad, a good Nixon Republican…. Funny after all these years those two words—“good” and “Nixon” still don’t go together… My dad, used to present me with story questions—
his way of teaching life lessons. In one he would tell me to imagine myself crawling across a desert, dying of thirst and coming upon an old rusty hand pump. Next to the pump was an old bottle of brackish water with a label on it instructing you to use the water to prime the pump and there would be plenty of fresh, clear, cold water. And—to be sure to fill the bottle back up for the next person.

He would ask me would I trust that old pump and the note, or would I just drink the bottle of water. I thought about it and it was pretty clear to me that the bottle certainly wouldn’t keep me alive very long and then there would be none left for the pump or the next person. So, though I didn’t have the words for it at the time, that’s when I realized I was a Progressive Democrat. I would need to trust the pump and leave enough for whoever came after.

Now a Republican would look at that brackish water and that old pump and decide he’d need to drink it for himself. But, don’t worry, he’d give the pump a tax cut and the invisible hand of the market would pump the handle – though it would only spew out dust. Then he’d crawl off and die from the insufficient and tainted water. But, at least , he’d keep it all for himself to the very end.

The health reform, Single Payer movement has been priming the pump for a long time. And we certainly have more to do. There are more successful flows in various places throughout the world-- France, Germany, Taiwan the United Kingdom – but those are subjects of other talks.

Right now, I’ll just present a brief comparative history of Canada and the U.S. In both there is a long history and though Canada is clearly much further along, there are still efforts afoot to reduce the pumps primer.

Many of you might know that Tommy Douglas was the Saskatchewan leader who created Single Payer for that province in 1962. For that and other accomplishments Canadians have voted him the Greatest Canadian of all-time.

But what you might not know is that Universal Healthcare for Canada was proposed as far back as the 1919 Liberal Party national platform. Douglas himself, got universal Hospital coverage in Saskatchewan in 1947. In 1957 the Canadian government began to provide 50% of hospital costs to the Provinces. Priming the Pump.

In 1962 Saskatchewan introduced a province wide universal , publically funded health coverage. This was greeted by a three week doctors’ strike in an effort to overturn it. The government held strong, established the system. Six years later the Canadian government instituted province based Universal Single Payer Healthcare known as MediCare . Priming the Pump.

Today there surely are things to improve in Canada. Many of the problems have resulted as successive governments have reduced funding . These could largely be addressed by adding another percentage point of GDP into health care, and still leave it at 2/3rds of U.S. costs.

IN THE U.S.

Teddy Roosevelt, promoted universal health care in his unsuccessful effort to return to the Presidency in 1912. Priming the Pump.
FDR initially had universal healthcare as part of the Social Security legislation, but had to drop it in 1935 due to political resistance. Priming the Pump.
Truman’s 1949 Fair Deal included universal coverage, but was defeated. Priming the Pump.
In 1965 LBJ headed a coalition that successfully created universal single payer for people 65 and over—Our MediCare. Many had the intent, thus far unrealized, to reduce the age qualification incrementally over time. Priming the Pump.
Nixon (Nixon!?) proposed a healthcare system in 1974 that while employer based allowed for a sliding scale buy-in to MediCaid for those of low income. Teddy Kennedy thought it was insufficient—he was right. He also thought he could get better—he was wrong. Priming the Pump.

(At about this point a woman in the back of the audience yelled out “Time for a New Pump!”)

Today health refors efforts are active in Congress and something like 19 states are at various stages of development.

Congressionally, as you probably know, Michigan’s John Conyers has introduced a national single payer health bill every year since 2003. HR 676 would create an improved MediCare for all. It would, additionally require for-profit hospitals return to or become non-profit institutions. Vermont’s Senator Bernie Sanders and Washington’s Representative James McDermott have introduced S915 and HR1200. They would create state based single payer programs. Inexplicably, they would exclude “undocumented” residents.

In the states, most significantly we hear about Vermont and California. California has SB 810 in the legislative process into the 2012 session. ( My co-presenter followed me and reviewed 810 )

We’ll come back to Vermont momentarily.

There are formal legislative processes up in running in Oregon, New York, Wisconsin, Pennsylvania, Minnesota, and Maryland. Additionally at least Ohio, Montana and New Mexico have inititiated strong grass roots movements. A lot of pump priming going on.

Labor, of course, would like to stop having to negotiate against itself—healthcare vs. wages/working conditions. They would much prefer to have a national healthcare program take care of one side of that equation.

And, perhaps that is true for big business, too. It would most likely be better for their bottom line and make them more competitive in the international markets. However, never underestimate the class loyalty of big money, nor would they want to give up such a divisive weapon against labor.

In Vermont, where single payer activists were called “bomb-throwers” two years ago the movement has made major strides. The governor and much of the legislature was elected on a single payer platform. Vermont has passed and signed into law what is billed as single payer. However, it is important to realize that at this point the law’s framework would be more accurately described as “fewer payer.”

The regulatory skeleton that has been established may in two to three years time actually produce a single payer system. Unlike California's proposed (and twice passed and vetoed)legislation, Vermont does not incorporate MediCare into their structure. Also stlll “in-play” are our old favorite private for-profit insurance companies, co-pays, deductibles, etc.

And, finally, there is one county in the U.S. that has single payer for everyone. Every resident, even every “former” resident of Lincoln County, Montana is now covered by MediCare for All. Is this some sort of pilot study?, something that will set the stage for universal single payer ? Well maybe the latter. But how did this come about?

You may remember Montana Senator Max Baucus chair of the Finance committee. Single payer activists showed up at his committee chanting, “We need single payer!” He had them thrown out, famously commenting, “We need more police.” Well, Max decided for the good of politics, er, the people of Lincoln County.

The small town of Libby in Lincoln County was the home of a W R Grace vermiculite mining operation that spread asbestos and other pollutants throughout the air, water and ground. Grace has avoided all responsibility and the county has been declared a Public Health Disaster. To cover for his old friends Baucus inserted a MediCare for all -–of Lincoln County-- into the Health Care bill. No age limit, no income limit, no waiting, no exclusion, no buy in just—MEDICARE FOR ALL.

1 comment:

  1. Good essay. And brilliant response to the Brooks column today over at nytimes.com.

    ReplyDelete