Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter’s appeal to single payer advocates to “bury the hatchet,” recently published in The Nation, is both misdirected and shortsighted.
Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.
But there are some gaping holes in this thinking.
First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don’t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.
Second, let’s not have illusions about the history of the ACA.
Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.
So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It's one reason so many people vote against their own interests.
To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the “professional left” who will only “be satisfied when we have Canadian healthcare and we’ve eliminated the Pentagon.”
It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate – the brainchild of the rightwing Heritage Foundation – as high principle.
Even with its positive elements – yes, it does have some – the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.
We can, as Michael Moore has said, acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation’s health care crisis is over.
For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:
I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn’t pay it.
I had a heart attack. I knew I didn’t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn’t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn’t take the pain any longer and I kept passing out, and he kept saying "Mom, you’re going to die."
“OK," I said, "take me to emergency." So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don’t think I can even start [paying]. I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.
Since the ACA’s cost control mechanisms for insurance companies are so weak – for example permitting insurers to charge far more based on age and where you live – and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?
Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.
Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It’s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.
Nurses respect the president. But they love their patients far too much not to go the distance for their patients’ health and survival.