My take on health care reform

For months I have been assiduously avoiding commenting on the current national health care reform debate. My reasons for this were many: I was too busy; I was cynical about the chances and didn't want to dampen anyone's spirits and most of all, I was out-of-loop and ignorant and didn't want to face the barrage of correctional comments I would invariably receive since, given my background, if I waded into the water of health reform I would be unable to restrain myself from acting like I knew something.

What do I know? Oh, everything and nothing. See my little profile to the right on the blog page if you're not familiar with my background. Suffice it to say that I was a Washington lobbyist for national health insurance in Washington in the early 90's when Clinton tried to pass it and I've worked for arguably the four strongest single payer health care organizations in the country: Public Citizen, Neighbor to Neighbor, California Nurses Association and Physicians for National Health Plan.

Since 2002 when I left the California Nurses Association though, I have floated more and more to the fringes of health politics. Like so many before me, I have believed that we simply can't pass meaningful health care reform in this country without finding a way to counteract the effects of big health care industry campaign dollars on the parameters of the possible. Hence, I have largely confined my efforts to pass national health reform to a) working to pass public financing of elections and b) prayer.

Nonetheless, I couldn't resist a lump in the throat and a feeling of excitement this week as the health care headlines sailed by. From what little I know, I think it's a huge stretch to compare this legislation to Social Security, but it is historic. It's historic largely because it actually passed and for generations little else has (Children's Health Insurance Program and Health Insurance Portability Act notwithstanding).

My standard rant on this subject is that Democrats will never get anywhere on health care reform as long as they run away from government. Obama's effort proves that no matter what the specifics of the bill, Republicans will campaign against it as if its single payer national health insurance. It may be (and to me it looks like this largely is) basic no-brainer insurance reform mostly to increase access, without any major diminution (and perhaps a slight increase) in private sector power/profit and influence and the GOP will still call it socialism, government takeover, government taking away your doctor.

The thing is that if it really is single payer you can counter back with things like: yes, but every man, woman and child cradle to grave will have full health care coverage for the same amount that we're paying now to cover a fraction of the population. No matter where you work or live or who you're married to or what money you make we'll all have an insurance card and we'll take it to any doctor and we will all get coverage of everything we need. I don't think you can say that here. I don't think you can say it by a long shot.

This time around despite (or maybe because of) the win, I am enjoying being peripheral to this process and out of the loop. My strong guess is that if I were working for Public Citizen now I'd trade in the lump in my throat for a pit in my stomach. I can viscerally recall the contempt that familiarity with the Clinton administration bred in me and so many others. It can really be comforting to know nothing.

C.N.A. vs. Nunez

If it wasn't clear before, the gloves are officially off in the relationship between California Assembly Speaker Fabian Nunez (D-Los Angeles) and the California Nurses Association. Today's Sacramento Bee has CNA openly calling for Nunez (sorry, I don't know how to get my blog to bring the requisite tilde to Nunez's name) to recuse himself from the health care debate due to his wife's lucrative position with the hospital industry.

The same article has Nunez spokesman Steve Maviglio firing back calling the nurses "radical and out of touch."

In my experience this kind of open declaration of war between a progressive union and a Democratic leader of the legislature is unprecedented in recent California politics. It simply isn't done.

And, yes, I am known as the Miss Manners of the California Legislature. Everyone knows how much I respect the etiquette of the place.

But whether it is or isn't done, it has been. The CNA leadership clearly has decided that they are not going to let Fabian Nunez get in the way of their goal of achieving single payer health care in California.

I find this open push for what Californians really need refreshing, if risky politically. The goals of the deal that Nunez and Schwarzenegger are negotiating towards reveal that it is they, rather than the C.N.A., who are out of touch with the people of California who want universal health care, real systemic change, not whatever the meager parameters of the politically possible may bring.

Flagging Nunez' supposed conflict of interest is just a convenient way to attempt to blow up this deal. I remember when Paul Koretz was first sitting on the Assembly health committee he had a policy of "recusing" himself from voting on every health care bill that involved Kaiser Permanente because his wife worked for Kaiser. Since virtually every bill was opposed by Kaiser, the net result of Koretz' conflict resolution was to provide a convenient permanent abstention for Kaiser so that the proponents of these measures had to work to replace his vote. It was lunacy.

I don't think the Speaker of the Assembly can reasonably be asked to recuse himself from attempting to solve one of the most important crises of the state. I do, however, think he can be asked to get serious, stop playing the hospitals' game, and put the people of California first.

California Democrats Need to Stand up for Government-Financed Health Care Coverage

Inevitably, every credible health care expansion put forward by Democrats will be attacked by insurance-backed Republicans as "socialized medicine." "Socialized medicine" the lore goes, lets government instead of your doctor decide whether you live or die or receive the procedure or device you so desperately need for a quality of life.

Fifty years after the death of McCarthyism and red-baiting, many Democratic elected officials still shy away from the dreaded label of "socialism" for anything they support. Scrambling to sell their "new idea" to a public they are sure is sceptical of government, they back away from the government part of their health care plan. They market whatever their health care expansion is in private sector terms, "putting doctors in the driver's seat," "leveling the playing field for business," or simply appealing to issues of basic fairness.

In doing so, Democrats flout the advice of Madison Avenue which has a long held tenet of marketing a product by its weakest feature, rather than its strongest. Karl Rove and the Republicans have perfected this tactic. Thus, George Bush was re-elected by re-characterizing his stubborn record of stupid bad decisions, as "a strong leader who stays the course." (Correspondingly, Kerry's greatest strength as a war hero was turned into a liability by swift-boating him)

Replacing the crazy quilt "system" of private health care financing with a simple government plan is the greatest single strength of the most obvious solution to our health care crisis. But it's also becomes our greatest weakness if we appear to be hiding the government part of it.

Similar to the debate on global warming, the debate over what to do about health care in this country is long since over. All experts who are not funded by people who stand to gain financially from the status quo in the highly-lucrative health care industry agree that removing the health insurance industry/HMOs from the equation is the way to go. Government-financed (so-called "single payer") health care similar to what they have some form of in every other developed nation in the world is the only way to save enough money to provide every man, woman and child with cradle to grave full portable high quality health care coverage, for the same amount we are paying now to cover only a fraction of the population.

SB 840 by Senator Sheila Kuehl is the only serious credible universal health care reform proposal before the California legislature. The Governor vetoed similar legislation last year while on the campaign trail.

The only arguments anyone can muster against SB 840 other than "it's socialized medicine therefore it's evil," are political. "It's too soon," "it costs too much," and "it requires a 2/3rds vote for a tax increase," all serve to distract from the basic fact: the entrenched interests, insurance, HMO and pharmaceutical and medical device companies, for-profit hospitals, medical groups as well as integrated health care systems like Kaiser Permanente and SEIU who carries its water in the legislature, all have a lot to gain from preserving the private financing structure of the current system--or at least the part of it that benefits them.

Given the entrenched nature of the current big health care players, AB 8, the compromise health care proposal put forward by the Democratic leadership, appears to be a worthy incremental step--expand coverage for children in the state who currently fall through the cracks in the system. How can we be against that? But there's no question that this type of expansion is fiscally irresponsible, a short-term non-solution to the problem and risks either over-stressing the public budget or under-funding the coverage in a time when inadequate health care coverage is perhaps an even bigger a problem than lack of coverage altogether.

I don't know what I'd do if I were a politician facing this conundrum in the California legislature. But I know what outside groups that care about health care reform should do. They should stop mistaking themselves for the politicians. They should push for what they know really works and not what doesn't work.

It's not up to us to make the tough choices. It's up to us to make the choices tough.

And to do that, Democrats and pro health care reform groups need to stop backing away from government. Government-financing is the solution and the reason it's the solution is the efficiency and accountability of government. Until we embrace that and lead with it, we'll keep losing.

A health care advocate's take on Sicko

(:)(:)(:)(:) for Sicko directed by Michael Moore now playing in theaters everywhere (I hope). Even though Ralph and Mike are at odds, I consider this another great Nader date movie--Bill and I and the two or three other couples who both worked for Ralph Nader are so blessed to have this genre.

We loved this film. I laughed, mostly I cried, and I walked out with a renewed sense of how much of a crucial difference in real people's lives it would make to have national health insurance.

As someone who spent a decade working for almost every major organization in the country that fights for universal health care, I expected to agree with this film; I didn't expect to learn much.

I was wrong on both counts. I didn't agree with all the film-maker's choices and I learned a few things. If Michael Moore's goal was to make a film which could convince mainstream audiences that they'd be better off under national health insurance, he could have shown a little more restraint. In France he should have stopped short of showing us the amazing state-funded childcare and laundry services and in Cuba, he should have simply pointed out that a poor nation like that can afford good health care. By setting up a totalitarian society as an example, he risks undermining his whole point: we can do this here in America, national health insurance is compatible with a capitalist democratic system.

Maybe I'm wrong, but I'm not the target audience here. My resume reads like that of a socialist girl scout. From 1992 to 2002 I worked as an advocate for single payer health care for Public Citizen, Physicians for a National Health Program, Neighbor to Neighbor and the California Nurses Association.

My father was an activist college professor who marched for Democratic Socialists of America. He used to say a socialist "is a communist with 3 children." At age 12, I stood in Balboa Park for hours collecting data for a study I was doing about people's views on publicly-funded programs.

What I learned that day was later confirmed as a health care advocate, most Americans still think they hate Socialism and government-run anything, even while they depend upon the fire department, library, post office and schools. I have even heard people in focus groups say, I kid you not, "let the government keep its hands off of my Medicare."

In other words, Americans want national health insurance...without the government.

What I learned in this movie was that I carry a buried pain in me from living in a society that has been duped by doctors and HMOs into not taking care of its own.

With health care reform likely to fall apart on the California legislature's watch yet again, and a compromised Hilary Clinton a leading contender for U.S. President, what Moore most accomplished for me is to revive a latent dream of mine to move to Paris and become a deliriously happy ex-pat.

See the film, and join me on the Left Bank.

A bientot, enjoy the Fourth of July!

Health care quagmire screams for public financing of elections

Here's that Cliff's Notes version of an old joke: a U.S. Senator spends his whole life fighting for single-payer (Medicare for all) health care. He loses a lot of battles. Towards the end of his life, people ask the Senator, "will the U.S. ever have single payer health care?" The Senator says, "yes, but not in my lifetime."

The Senator dies, goes to heaven and gets a special audience with God. He only has one question, "God, will the U.S. ever have a single payer health care system?" God yes, "yes. But not in my lifetime."

I've been working for universal health care reform since 1993-94 when I fought for it at Public Citizen in Washington DC at the height of the Clinton reform effort. The past few years I do it by working to pass public financing of elections.

Don't get me wrong, I'm glad that the folks in Sacramento like Senator Sheila Kuehl (D-Santa Monica), Senator Don Perata (D-Oakland) and consumer groups are giving it another try. But despite Schwarznegger's stated intentions and leadership on the issue, and the crying public need, it still seems that there's very little that can be done as long as health care controls a huge percentage of the Gross Domestic Product and the interests that are benefiting from the current system disproportionately fund campaigns.

That's why I like AB 583 by Loni Hancock, a bill which creates a pilot project for public financing of elections for the Governor's race as well as one assembly and one senate seat. The bill has passed the Assembly and is in the Senate Elections Committee where it died last legislative term despite Senate Pro Tem leader Don Perata's promise that it wouldn't.

This year Senator Perata is a co-author of the reform legislation. If he wants to eventually get universal health care, I think it's essential that California start moving seriously in the direction of public financing of elections. AB 583 is a good way to start.