Frustrated by the exclusion of government-financed medical care from the debate to revamp the nation's troubled health system, advocates of a "single-payer" plan are increasingly turning to demonstrations and civil disobedience as a way to get their message across.
During Senate Finance Committee hearings May 5 and 12 on health reform, 13 doctors, nurses, lawyers and activists stood up to complain that no single-payer proponent had been invited to take part and were arrested for disrupting the proceedings.
On Friday in San Francisco, about 200 single-payer proponents held a rally in front of the Federal Building and headed in small groups to Rep. Nancy Pelosi's office to urge the speaker of the House, who was in China, to back single-payer legislation and give its supporters a seat at the table of the health reform debate. The public appeals were part of a series of demonstrations being held in more than 50 U.S. cities over the next few days to encourage lawmakers to enact a single-payer plan.
Some advocates of a nationalized health plan are calling for activists to become even more militant.
"It's the only way - direct confrontation with the people who are blocking what the majority of the American people want," said Russell Mokhiber, the founder of the newly formed Single Payer Action.
"It's about getting in people's faces and being serious about the fact that 60 Americans are dying every day because of lack of health insurance," said Mokhiber, who was arrested at the May 5 hearing and arraigned earlier this week in Washington.
Single payer unlikely
Reforming health care has become a focus of the Obama administration, with the president urging Congress to get legislation to his desk by the end of the year that would cover most of the nation's 47 million uninsured. Whether that will happen remains to be seen, but whatever Congress passes is not likely to come in the form of a single-payer plan.
In a single-payer system, as envisioned by most advocates, the federal government would pay for basic medical care delivered by public and private health professionals. The money would come from taxes, and medical bills would go directly to a government insurance plan, similar to Medicare.
President Obama and lawmakers have proposed a form of "single-payer lite" - a government-administered plan people could buy into as an alternative to purchasing an individual policy offered by insurers. But single-payer supporters say this option doesn't go far enough. They want private insurers completely out of the business of covering basic care, which they say could save nearly 30 percent in administrative costs.
That's clearly not something the health insurance industry supports. Many of the nation's largest insurers prefer a form of "universal" health care that would cover all Americans, while keeping them in business. They tend to avoid discussing the single-payer option largely because it hasn't been included in the national debate.
Some statistics show the single-payer concept has grown in popularity as problems in the nation's health care system have worsened. A CBS News/New York Times poll conducted in January found 59 percent of the 1,112 people surveyed said they supported government-provided national health insurance.
Several groups, including the California Nurses Association and Physicians for a National Health Program, call for a single-payer option. While not supported by the American Medical Association, a nationalized health system got the backing of 59 percent of physicians in a poll published last year in the Annals of Internal Medicine.
The California Legislature has twice passed a state-level single-payer bill - in 2006 and 2008 - making it the first state to do so, but both times the effort was vetoed by Gov. Arnold Schwarzenegger. The legislation, authored by former state Sen. Sheila Kuehl, D-Santa Monica, has been reintroduced as by Sen. Mark Leno, D-San Francisco. Leno's version is expected to meet the same fate as its predecessors.
Still, single payer has been largely dismissed from serious discussion on the national level as politically infeasible.
"It's off the table in Washington because of the politics," said Laurence Baker, associate professor of health research and policy at Stanford University.
Health insurers and drugmakers have contributed millions of dollars to members of Congress. One of the top recipients of that money, said Consumer Watchdog, an advocacy group based in Santa Monica, was Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, who was running the hearings when the arrests took place this month. He accepted $413,000 in drug and health insurance campaign contributions during that time.
Many single-payer supporters interpret the resistance to the single-payer idea to be simply the result of a formidable lobbying effort by the health insurance and pharmaceutical industries, but Stanford's Baker said the hurdles are more nuanced.
Distrust for government
Americans are clearly frustrated by the health care system. While some polls indicate that a majority of Americans favor single payer, some polls show a distrust of government's ability to take over health care, he said. In a Kaiser Family Foundation poll released in April, just 35 percent of those surveyed expressed support for a government-run health system like Medicare.
As the debate continues, single-payer supporters have clearly ramped up their activity and tactics. The 50 demonstrations have been organized by a variety of groups including Healthcare-NOW!, Progressive Democrats of America and the Green Party.
But not all single-payer groups promote civil disobedience as a way to draw attention to the cause. Don Bechler, chairman and founder of Single Payer Now, a statewide advocacy group in San Francisco that helped organize the demonstrations, said he is more interested in drawing in more supporters than seeing people get arrested.
California nurse DeAnn McEwen didn't set out to become one of the "Baucus 13," the 13 arrested at the Senate Finance Committee hearings. She happened to be in Washington for a nurses' union organizing committee meeting when she learned about the hearings.
McEwen, of Long Beach, a nurse for 35 years, said she felt compelled to speak out about the lack of a single-payer voice at the table.
"At that point, I felt I couldn't be silent anymore because it was like I was seeing a gag, a hand covering the mouth of a victim," McEwen said. "There's therapy for the broken health care system, and any other reform that includes the insurance companies is not going to get us where we need to go in terms of providing equitable and fair coverage."
Health care proposals
A number of health policy proposals are under consideration as lawmakers work to overhaul the nation's health care system, but a proposal to have the government pay exclusively for basic health care has largely been left out of the discussions. Here are some of the ideas on the table:
Public plan: Create a government-financed purchasing pool or "exchange" - one that people could buy as an alternative to individual health policies offered by private insurers.
Individual mandate: Require individuals to get health insurance through an employer, the government or on their own. In exchange, insurers would have to stop discriminating against people with medical problems.
New taxes: Tax job-based health insurance benefits, a controversial option that proponents say could help pay for the overhaul estimated to cost some $1.2 trillion to $1.5 trillion over 10 years. Other taxes would come from hikes on alcohol, tobacco and soda.
Reduce health costs: Improve efficiency in the delivery system by upgrading technologies, increasing the availability of generic medications, realigning provider payments to reward quality of care rather than just quantity, and funding efforts to figure out which medical treatments work best.