Health Care for All’s John McDonough is pumping up the major accomplishments of the new health care law: 100,000 people now have health coverage who didn’t have it before the law. I’m thrilled to jump on the bandwagon in celebrating this. HCFA and their friends actually have real people they can point to that have been helped by their work.
That being said, I certainly can’t agree with the contention by HCFA’s Eric Benson that “bad press is a threat to health reform’s success”. Hooey. Chapter 58’s flaws are the threat to health reform’s success: The cost, the potential imposition of the personal mandate on those unable to afford it, the lack of an incentive for non-insuring employers to do the right thing, and so forth. (I would imagine that Eric and I agree on these things.) I think all health care advocates realized that the new health care law was what-we-could-do-now, not the ideal.
As much as I respect the ideals of the single-payer crowd, they don’t have the organization to really bring pressure to bear on the legislature. They can’t get in the faces of lawmakers the way that the ACT coalition (of which Health Care for All is a part) has done. And therefore they can’t yet point to actual people that have been helped directly by their efforts.
I think it’s amazingly unfortunate how the pro-universal health care movement is fractured over policy mechanics and political tactics. And there’s really quite an amazing amount of bad blood between the factions. That definitely doesn’t help anyone get health care.
I don’t expect people to agree on how to insure everyone, but I would hope that people could agree to provisionally support each other’s efforts, even while pursuing their own methods. In other words, it’s OK to say “X is good, but it’s not enough and we’re really pushing Y.” That way you work in coalition with people who share the same goals without sacrificing one’s ideals. Furthermore, it increases the political power of the entire movement and makes ambitious reform more likely.
I hope that the single-payer folks and the “incrementalists” can find points of agreement and bring their combined forces to bear on implementation of the new law. To the extent that they can speak with one voice, they should. And that means a full acknowledgment of both successes and flaws — in public. Citing successes is not tantamount to ignoring failure; citing problems is not the same as “rooting” for the law’s failure.
Charley- Thank you for pointing out an essential problem to meaningful longterm health care reform.
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Treating criticism of reforms that the architects themselves describe as a first step or a blueprint as some sort of advocacy treason has not helped. It is reminiscent of the Bush/Rove reaction to dissent on Iraq.
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People and groups who have doubts about where Chapter 58 will end up or who believe it is critically important to push hard on affordability by changing how we deliver and finance health care have been shut out of the discussion. This, in spite of the fact that many groups who have never supported any type of incremental reform before are supporting important initiatives before this Legislature to cut and control costs.
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Single payer advocates are actively working with legislators on issues like uniform billing, bulk purchasing of prescription drugs and other efforts to cut administrative waste. These are incremental reforms that could save billions of dollars and grease the skids for a sustainable Chapter 58. They also lay the groundwork for more far-reaching reforms if Chapter 58 proves to be an inadequate solution to the “(un)affordability” crisis.
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These groups are working to get past health reform as “religion”. Many were in constant contact with their members to call legislators to push the Chapter 58 reforms through last spring – even though they fundamentally disagreed with the incremental tactic and with the specifics of the reform.
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Many are now working to make a positive contribution to shore up some seriously shakey reforms. It’s often painful. It’s hard enough to take on the major institutional stakeholders to eliminate waste and improve quality of care. But being treated as heretics because they are unwilling to get down on their knees and worship at the alter of incrementalism is outrageous.
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Double digit premium hikes, an epidemic of chronic illness butting up against a health delivery system designed to treat acute illness and an inefficient financing system will undermine the access expansions of Chapter 58 which are paid for primarily by individuals and taxpayers.
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The Legislature killed the only proposal – a proposal supported by single payer adovcates and ACT coalition members alike – that had the legal teeth to keep the access expansions in place until the affordability and quality pieces can be made to catch up. So political unity is essential to taking the next steps.
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And the next steps are the traditional single payer agenda:
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Whether we get to a Canadian-style system or stop along the way at a high performance public-private hybrid like most other nations have is a question of pragmatism not of religious dogma. It’s time for our elected officials and HCFA to listen to folks outside the charmed circle who put Chapter 58 together. They did the best they could but the consensus is it’s not enough.
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Barbara Waters Roop, PhD, JD
You have read my post rather one-sidedly. The call for cooperation was aimed every bit at the single-payer movement as at HCFA/ACT, although I did not quote you. My impression is that the single-payer folks have frozen themselves out of the process by not taking part in efforts like ACT.
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And listen to your own language: “Being treated as heretics”; “outrageous”; “It’s time for our elected officials and HCFA to listen to folks outside the charmed circle who put Chapter 58 together.” Who exactly has treated you as a “heretic?” Isn’t that a little bit inflammatory?
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That’s the kind of stuff that needs to stop, IMO. We don’t have the luxury of getting angry at people who ought to be our allies.
Dr. Roop is too kind. And Charley engages in what might be termed “emotional incrementalism.” Sitting around singing Kum By Ya aint gonna solve this emerging mess. Meanwhile, the media have continued to marginalize, demonize, and stigmatize the single payer options incessantly. The issue is not policy-by-incrementalism, it’s policy-by-cronyism. Who are the big donors to HFCA? Blue Cross, Tufts Health, etc. Who dominated the initial Connector decisions? Big insurers, big providers, and, of course, that designated-hitter bully, Tom Trimarco. (And I won’t even mention the dead hand of the Heritage Foundation.)
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When 16th century astronomers tried to save the earth-centric astronomical system from the falsifying data of observation, they did it by adding “epicycles” to plots of the rotation of the planets. When that didn’t suffice, they added epicycles to the epicycles. It still didn’t work. In this model, the central earth around which everything revolves is replaced by the big insurers and providers. Keep adding epicycles, it doesn’t make the system work, and doesn’t address the issue of exploding costs.
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Who would not agree that advocates of health insurance reform need allies, not adversaries? Your move, folks.
Then get organized, get your friends and allies together and make such a legislative stink that will put the ACT coalition to shame and give us single payer.
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Being right on the merits counts for exactly squat. ACT/HCFA have helped actual people with their work. If you actually care about folks not getting health care, and not about winning some intellectual debate, then get out of the car and start pushing. I might suggest you need some friends to do so.
I hardly know where to begin to write a reasoned, constructive comment to a post that contains snipes, smears and false truths that are quite disparaging.
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The final Chapter 58 reform law developed out of a excrutiatingly long process that involved months of outsider advocacy work and lots of insider deal-making (politics is politics, in the end) that many MANY groups AND individual activists across the state had an active role in. In 2005 and 2006 countless organizations and individuals (those in ACT and many who were not official members) urged their members and friends to call legislators and the Guv time after time over many months to advocate for incremental reforms that are NOW LAW in Chap 58. These reforms are what has made the state-subsidized insurance coverage expansions for 100,000 possible.
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Many of these groups and individuals have differing visions for fundamental system reforms but kept their shoulders to the wheel for months and months and followed the legislative/political process closely in order to alert members, fellow activists and fellow health care providers to take action to shape the reform law and particularly to expand subsidized quality coverage for the poor.
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The federal medicaid waiver money ($378Mil) and a few other major dynamics were driving the process forward, and the HC Amendment played its part in contriubuting to that pressure for “real reform” too, so over these many months it was the time to step up as advocates. These advocates included large numbers of people who did not trust the process of the ACT coalition due to past direct experiences getting burned in coalition work with some of the leaders of ACT (including HCFA leadership) but who continue to care deeply about needed health system reforms and people’s unmet health needs.
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So it is with this lived history clearly in mind that I read this post and hoped by its title that it might be useful and instead found numerous slights, smears and false truths that make me feel pretty crappy.
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Yes, for decades dozens of us in a variety of different non-profits, professional associations and unions (that together count tens of thousands as members) from all walks of life have been slogging through the trenches as underfunded grassroots activists attempting to provide leadership and vision, speaking truth to power in seeking fundamental health system reforms. We have voiced the need to work together as a statewide community whenever possible and acted on that belief. Baseline agreements have been made to, at a minimum, not knowingly harm other health reform advocates’ efforts.
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Too bad not all “reform advocates” play by those simple and decent rules or value ethics such as honesty when it’s time for the back room deal making that characterizes much of the political process.
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Yes, HCFA and its huge annual budget of more than $1Million a year can bring more “pressure on the legislature”, especially if that lege knows that HCFA will back off and cut a deal, as history as shown time and again. Some might call that smart politics. Some call it something else. I call it tragic when there is so much needless bureaucracy and waste in the HC system that is bankrupting not only countless families but our entire state budget.
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So what is this “split” really about? In all honesty?
Say exactly who did what and when.
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Ann, the “back room politics” and “deal-making” are what get people covered. Period. If you’re not willing to play ball, then don’t complain that you’re not in the lineup.
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I’m discouraged by the reactions to my post, because really, it’s all more of the same recriminations and bad blood. You’re all making my point for me.
Your suggestion that the two sides meet in the middle is well taken – but I’m not sure that it’s do-able given the place that we’re in right now.
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When we have “back room politics” and “deal making”, we can achieve nothing other than the possible incremental changes that we’re getting. Only sunlight will get The People what’s best for The People here, because there is nobody in a back room that gets more cash in their pocket if single-payer goes forward.
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Back room politics, when one side (the insurers) have [u]all[/u] of the cash to spread around, is a guaranteed loser for people who want the dramatically lower cost and high quality of single-payer.
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Single payer folks simply want good healthcare at a reasonable price. The insurers backing the incrementalists simply want a blizzard of cash to fall on them – they show no evidence at all of wanting the best health care at the best prices.
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The inequality in cash to spread around has had the effect of crushing the single-payer folks. I’ve only been a casual observer in the process, but it seems to me that the insurance industry’s cash has purchased:
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– A law that forces virtually everyone in the Commonwealth to give money to private insurance companies, i.e., Chapter 58. The single-payer people were totally shut out of this.
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– An agency charged with insuring everyone, which is primarily staffed by folks in the private insurance industry. Why not staff it with people from Medicare – those are the folks with the best experience in getting great medical care for less. Again, the single-payer people were totally shut out of this.
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– The Legislature illegally crushed The People’s petition for a ballot question on good ground rules for universal healthcare. Again, the single-payer people were totally shut out of this – and The People were abused by their Legislature. (And Travaglini is – SURPRISE! – being considerd for the top spot at the Mass. Hospitals Association – whose constituents profit nicely from the Legislature’s illegal action).
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I have almost no knowledge of how things got to this point. But we are here and it is now: unless I’m missing something, this all seems way too lopsided for the single-payer folks to have any impact. It’s like telling the Congressional Democrats in 2002 that they should play ball with the Republicans – the results were pathetic and ineffective.
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The insurance-industry-backed incrementalists have chosen their course, and have chosen to totally shut out the single-payer folks, probably as a condition of receiving funding from the insurance industry. Unless the incrementalists choose to extend a branch, there is nothing for the single-payer folks to hang on to.
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I have posted and commented extensively when asked about these distressing past events, both here on BMG and on the HCFA blog. You can search thru my past comments if you are so inclined. To put forth such a directive like it’s a simple thing or even a realistic thing to do, for that matter, seems quite naive and disrespectful.
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Speaking truth to power is not done nearly as much as it could and should be. There are others who know much of what I know yet it stays unspoken.
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I do not care to dwell on such things if there is not a sound reason for it, but it does seem that if a person and a movement does not seek to learn from the past then failed efforts will likely continue to be repeated.
Shorter Ann Em:
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But we worked SO HARD! and we’re such NICE PEOPLE!
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Boo Hoo
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I don’t care how hard you worked to cobble this together.
I don’t care that your heart is in the right place.
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You and your allies have produced a mess that has been floundering from before Day One. It codifies right-wing health ideas. It rewards big providers and insurers. It does NOTHING to control costs. It is coercive almost exclusively on poor people.
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The only bright spot I can see in all this is that we have a somewhat rare thing in public policy implementation: almost a controlled experiment. This is mainly because of the July 1, 2007 deadline that is built into the law. If, on July 1, there is in place a reasonable number of coverage choices; if premiums are within the realm of affordability for the working poor; and if there is enough funding in the system to make the whole thing work, I’ll eat crow and shut up. It is now February.
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More likely scenarios:
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1. shorter run changes: the July 1 date is moved back
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2. middle-range changes: the General Fund is raided to make up the huge deficits the program will run.
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3. longer range changes: none.
So before you think/say any more snide things about me personally (that likely are a result of unintended ignorance) or about my postions on fundamental health care reform, I’d ask that you look over the advocacy group’s website that I manage: Alliance to Defend Health Care at http://www.DefendHealth.org
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And also take a look at MassCare’s website. It’s of one of a few coalitions that I as an individual and that the Alliance is very active with (I was a founding member back in 1995): MassCare.org
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The train was out of the station and barreling down the tracks when the Romney/DiMasi/Trav/BCBS/Partners health reform was underway in 2005-06. As a front-line health professional and health justice activist it made sense to try and have a positive impact of what the end result of that process would be (I’m a nurse and clinical instructor educator). At the same time I and the Alliance, and many others worked to educate and engage as many people and organizations as possible to build the momentum for more far-reaching fundamental system reforms since it was clear that the Romney/DiMasi/Trav/BCBS/Partners plan would be severely flawed and worsen the crisis we are all experiencing with rising health costs. We continue to be actively working toward those goals and invite all who are intersted to join in.
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Thank you.
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p.s. I am a colleague and activist ally of Rose Ann DeMoro, RN who wrote an excellent piece that I agree with on all points. You may find it of interest, too.
click link for Focus on patients, not profits
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p.p.s. Charley, it seems that I am getting beat up from all sides. How nice.
Ms. EM’s work is pointed in the exact opposite direction of where I think you’re pegging her. She’s trying to ACTUALLY enable health care for all, via a single-payer universal plan – the same plan that saves money and produces better outcomes in most of the rest of the industrialized world.
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The folks responsible for the current Chapter 58 situation are an entirely different group – who are (confusingly) named Health Care For All. Ms. EM has no affiliation with the Chapter 58 folks. She’s not a cobbler.