Saturday, May 09, 2009

Health Advocate McGuire Speaks Out for Single-Payer

Even Some Progressives Skeptical It’ll Be “Just Another HMO”


Copyright © 2009 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved

Judging from the questions he got from audience members listening to his presentation at the First Unitarian-Universalist Church in Hillcrest May 7, Andrew McGuire is going to have his work cut out for him in persuading Californians to support single-payer financing for health care. He was already aware of some of the pitfalls, including a well-funded health insurance industry with excellent political connections willing to spend billions to make sure that single-payer — which would essentially replace them with a government agency — never sees the light of day anywhere in the U.S. What he probably wasn’t expecting, though, was that even in a progressive audience there would still be people highly skeptical that single-payer would work and fearful that the plan would simply turn the state’s health care system into a gigantic government-run health maintenance organization (HMO).

Not that McGuire hasn’t faced challenges before. He’s currently a professor of sociology at Sonoma State University north of Marin County in the San Francisco Bay Area, and also serves as executive director of the Trauma Foundation at San Francisco General Hospital. His 36-year career in health activism started in Boston in 1973, when he organized Action Against Burns and successfully lobbied for government standards requiring that sleepware for children be flame-resistant. In 1978, he began a national campaign to require that cigarettes be made to burn out if they’re dropped on bedding or furniture, leading to mandatory fire-safety standards for cigarettes in seven U.S. states and Canada.

McGuire’s most famous project was Mothers Against Drunk Driving (MADD). He helped Candy Lightner found this group after her daughter was killed by a drunk driver, served on its board of directors from 1981 to 1983, was acting executive director and helped secure MADD’s first major funding. In 1990 he chaired an unsuccessful campaign to pass a “nickel a drink” alcohol tax in California. McGuire led the statewide campaign to ban cheap, unreliable “Saturday Night Special” guns in California and organized the first nationwide grass-roots campaign for gun control in 1998. Originally called the Bell Campaign, it was later renamed the Million Mom March — and McGuire directed it until 2001 and organized a protest in Washington attended by 700,000 people.

As if that weren’t enough, McGuire is a documentary filmmaker with 10 movies under his belt, mostly about ethical issues involving health care. He won an Emmy Award for his first film, Here’s Looking at You, Kid — about the rehabilitation of a seven-year-old boy who had suffered burns over 75 percent of his body — and has won the John D. and Catherine T. MacArthur Foundation’s prize fellowship (the so-called “genius-grant” award) and the Kellogg National Fellowship. In the early 1980’s he ran the Mill Valley Film Festival. “That was embarrassing,” McGuire said after Tanja Winter, head of the church’s Peace and Democracy Action Group (which was sponsoring the program) finished reading his résumé. “That was all an apprenticeship for bringing single-payer health care to California.”

McGuire spoke on behalf of the California OneCare Campaign, established by an organization called Health Care for All — California, which he said was one of only two groups in the state, along with the California Physicians’ Alliance, whose only mission is to bring the single-payer system to this state. (There are other organizations that have single-payer as part of their mission, but do other things as well, McGuire explained.) Before he opened the meeting to audience questions, McGuire focused on the political arguments for single-payer and outlined his group’s strategy for achieving it in the face of the ferocious and well-funded opposition of the health insurance industry.

According to McGuire, none of the other health care reform plans — including the one President Obama’s administration is developing and the one former Democratic Party chair Howard Dean is putting together privately — will achieve the benefits of single-payer because they keep the current health insurance industry in place. “Though it is admirable that the President is taking steps to insure everyone,” McGuire said, “his plan has been tried before at the state level — and has failed every time. As long as insurance companies are involved, they will take profits out of the system, there won’t be cost controls, and they will defile the reform year after year through their crushing amendments on appropriations bills, and by trying to have funding cuts enacted by the legislators that are in their pockets.”

McGuire said that even the much-discussed “public option” in Obama’s plan — setting up a government-run insurance system that people can pick as an alternative to private insurance — won’t work because legislators, dependent on insurance companies’ campaign contributions, will gut the public plan’s budget and wreck it. Indeed, he admitted that even a single-payer system isn’t invulnerable to ideologically driven political tampering. He pointed out that in Canada, when a Conservative government is elected, it cuts the budget for the health-care system — “and that’s when you get those long waits for elective surgeries,” he added, referring to one of the most frequent arguments made against single-payer in the U.S. “When the Liberals return to power, they restore the cuts.”

According to McGuire, America’s current health care system is “immoral, demeaning and lethal. It’s immoral that an infant, child or adult cannot afford, and therefore cannot receive, health care. It is demeaning to all of us that we stand alone among industrialized, and many non-industrialized, nations that we allow at least 50 million people to go uninsured while private insurance companies reap robust profits as they make insurance unaffordable to millions, or deny insurance to those with ‘pre-existing conditions.’ Also, there are millions of Americans who are under-insured. Seventy-five percent of those who file for personal bankruptcy because of medical expenses are insured, but, to their horror, are inadequately insured to cover their medical expenses. And, according to the National Academy of Sciences’ Institute of Medicine, each year over 20,000 U.S. residents die because they bear the diagnosis, ‘Uninsured.’”

The single-payer plan McGuire was pushing is SB 810, a bill introduced in the California legislature by openly Gay State Senator Mark Leno (D-San Francisco). It’s the same proposal as the former SB 840, which former State Senator Sheila Kuehl (also openly Queer) pushed through the state legislature twice, only to see it vetoed by Governor Arnold Schwarzenegger. Unwittingly proving the old adage that the devil is in the details — the full bill is 80 pages long — McGuire found himself having to field audience questions about just what the plan would or wouldn’t cover, and in particular whether it would set up a government agency that in practice would act like a private HMO.

“The specifics,” McGuire explained, “are that you have a primary health care provider — a doctor or a nurse-practitioner — and that’s your access to the system. Whatever that provider thinks you need is prescribed and paid for 100 percent. Corporations like Kaiser can bid to provide care on a capitation basis [i.e., a certain specified amount per patient], and they will bill the system rather than individual patients.” Fielding a question about whether the system would allow someone to have a “medical home,” McGuire joked that that was a euphemism for “a primary provider that you really like,” and said that the plan’s exact coverage will be decided by a medical board “based on input from health care providers and consumers.”

One audience member took exception to the use of a primary care provider as a gatekeeper, and said he couldn’t support the plan if it didn’t allow people to make their own appointments with specialists without having to have it approved by their primary care provider first. “Then it’s just like an HMO,” he said. Another man, family-practice doctor John Gordon, said that health care systems in which patients are allowed to see specialists on their own generally have worse patient outcomes than ones in which they have to go to a primary provider first. McGuire said that one difference between a single-payer plan and an HMO is that if you don’t like the decisions your primary provider makes about your care, you can fire them and hire any qualified person you want.

Another audience member asked if alternative treatments — acupuncture, chiropractic, homeopathy and herbal therapies — would be covered. McGuire said the bill definitely covered acupuncture and chiropractic, and the others would be available based on approval from your primary care provider. The person who raised this issue said that would be a problem because many Western-style allopathic doctors know nothing about alternative treatments, regard them all as quackery, and therefore wouldn’t allow patients to use them if the choice was theirs.

McGuire also took questions about the politics of single-payer and why his organization is aiming at California rather than the federal government. Part of the reason, he said, is they’re following the Canadian model; single-payer was first introduced in the province of Saskatchewan and gradually spread to other provinces before being adopted nationwide. But his main concern, he said, was the sheer power of entrenched financial interests over the Washington system and their ability to use politicians’ dependence on large campaign contributors to kill all meaningful reform, not only on health care but everything else as well.

“When Hillary Clinton formed her health care task force in 1993,” McGuire recalled, “there was no one in the room, aside from some union people, who wasn’t part of the health insurance or health care industries. It’s the same today with Obama’s group. Whenever people are polled directly, single-payer is their number one choice for how to reform health care. But Washington isn’t a place where change happens; it’s a place where change doesn’t happen, and that’s why I long ago lost interest in tracking what’s going on in Washington.” Indeed, McGuire said that he advised every grass-roots health group he helped start not to set up an office in Washington or in any state capitals, precisely because he feels lobbying politicians through such an office is just a distraction from the need to build grass-roots community support throughout the state and nation.

Responding to an audience member who expressed his frustration that the current collapse of America’s financial system isn’t inspiring more Americans to question the workability of capitalism and the wisdom of its bankers, McGuire said, “The insurance industry is just as powerful as the banks. Senator Max Baucus (D-Montana) [chair of the Senate Finance Committee and considered the number one Senator in shaping health care policy] got $600,000 from the insurance industry in the last two years. It’s a putrid system. We’re gong to construct a grass-roots movement and we have a chance to get something through.” McGuire said he had “no hope for the national level,” especially after the staff which put together the panel of experts to speak to Baucus’s committee deliberately excluded anyone who supported single-payer.

“When it comes to banks or health issues,” McGuire said, “there’s little or no difference between Republicans and Democrats. The only solution is real campaign finance reform.” He didn’t elaborate what he meant by “real campaign finance reform,” though in most progressive circles that’s become code for plans like those operating in Maine and Arizona. These allow candidates who get a certain number of petition signatures and nominal contributions from ordinary individuals to have their campaigns fully financed with public money — as long as they agree to take no further private contributions at all.

McGuire explained his political strategy for organizing grass-roots support for single-payer in California and getting it past the two-thirds vote requirement in the legislature needed to adopt a plan to finance it. (A bill to establish a single-payer system in principle only needs a majority vote of the legislature and the governor’s signature, so SB 810 is written without any specifics on how to pay for it. Instead, the bill calls for setting up a blue-ribbon panel to come up with the financing plan.) The plan also includes a way to respond when the health insurance industry puts the issue up for a vote and tries to scare Californians into voting against single-payer with “Harry and Louise”-style fear propaganda.

“If I have to leave all of you with one point, it is this: we’re going to do it in California, and then in another 10 to 15 years we’ll have it nationally,” McGuire said. “There’s light at the end of the tunnel in California. We have to create a database of supporters so that, when the commercials against single-payer come on the air, we’ll have an educated public that will be inoculated against them.”