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Single-payer or bust?

The refrain of “health care reform now” may be being replaced by “single payer in four or five years.” In the wake of the failure of the compromise AB1X health care reform plan in the Senate Health Committee this week, some reformers have reiterated their plans to push private insurers out of the equation and move toward a European-style system with the state as the sole payer for health care services.

“Politicians will try to say they want single-payer, but the public isn’t ready,” said Rose Ann DeMoro, executive director of the California Nurse’s Association. “The truth is that the public wants single payer, and what’s in the way is the insurance industry and their political allies.”

DeMoro said public opinion polls already show that a majority of voters support single-payer. She outlined a multiyear strategy to keep pressure on elected officials and eventually kill off private insurers in California. DeMoro said her group is targeting the 2010 governor’s race. Between now and then, she said, the idea is to turn single payer into such a core issue for California Democrats that any candidate who is against it won’t get the nomination.

It’s clear that such a plan won’t become a reality as long as Arnold Schwarzenegger remains governor. Speaking in front of the Sacramento Press Club on Tuesday, the governor reiterated his opposition to single-payer. “Schwarzenegger’s lame duck season has officially begun,” De Moro said.

While the nurses have been the most adamant, there are many other players in the single-payer movement. Senate Health Committee chair Sheila Kuehl, D-Los Angeles, said 700 organizations supported her single payer bill, SB840.

“It isn’t just the nurses who have held that position,” said Andrew McGuire, executive director of Healthcare for All—California.

McGuire noted that his group and several other major players have stated that a single-payer system is the ultimate goal. This group includes the League of Women Voters, the California Physicians’ Alliance, California School Employees Association and the California Alliance for Retired Americans.

Where these groups differ from the CNA is their greater willingness to support incremental reform, McGuire said — which is exactly what AB1X wasn’t, he added. He characterized it as “a massive expansion” that would further entrench the private system, he added, forcing people to buy overpriced plans from insurers.

“The last thing we want for health care reform is for the government to get involved and it turns into a disaster,” McGuire said. “Then people can say, ‘See, look what happened.’”

Kuehl agreed, saying that what happened to the bill in her committee is “separate” from her support of single-payer in SB840. She, too, could support incremental improvements. But AB1X included many of the same problems as public/private plans that have been tried not only in Massachusetts but also in Hawaii, Maine and Oregon. She also pointed toward “escape clauses” built into the bill if costs got out of control, and the “individual mandate” that is considered anathema by many reformers.

“This bill would have required you to buy insurance,” Kuehl said. “That’s very different from ‘provided.’”

Many are still skeptical of the political viability of single payer. Jeanine Meyer Rodriguez, campaign director with Service Employees International Union, said her experience as one of 120 members of the It’s Our Healthcare campaign woke her up to the reality that “health care reform is not going to happen in one big fell swoop.” While people are talking about the next governor or running an initiative campaign, she said, people are living without health insurance now.

“Who are the people who are going to fund that campaign, and what are they going to do when the opposition comes back with millions of dollars?” Rodriguez asked, pointing to the spectacular failure of a single payer initiative, Proposition 186, in 1994.
Times have changed, DeMoro, argued, especially since the Michael Moore film “Sicko” demystified single payer for many people.

She pointed to a December AP poll of 1,523 registered California voters that found that 54 percent support the idea. A New York Times poll last March found that not only did a majority of respondents support government-guaranteed health care, but a growing number were willing to pay higher taxes to make it happen.

AB1X failed because it was “the worst of both worlds,” said Dr. Bryan Liang, executive director of the Institute for Health Law Studies at the University of California at San Diego. But its failure doesn’t mean a win for single-payer. While he supports single-payer himself, he said some supporters of the idea are glossing over the political realities, as well as financial problems with the Canadian and British systems.

“You have the single-payer people saying they have a mandate,” Liang said. “That’s not true.”

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