US: Single-Payer vs. ObamaCare: Real Health Care Reform or the Status Quo?

On Wednesday, July 15th the United States Senate's Health, Education, Labor and Pensions (HELP) Committee voted 13-10 to approve the Affordable Health Choices Act (AHCA). Sadly this is yet another occasion which demands we take a very close look at the fine print.

On Wednesday, July 15^th the United States Senate's Health, Education, Labor and Pensions (HELP) Committee voted 13-10 to approve the Affordable Health Choices Act (AHCA), legislation which, according to the HELP Committee's own press release "will reduce health costs, protect individuals’ choice in doctors and plans, and assure quality and affordable heath care for Americans... no American can be denied health coverage because of a preexisting medical condition, or have that coverage fail to help them when they need it most. No American will ever again be subject to annual or lifetime limits on their coverage, or see it terminated arbitrarily to avoid paying claims." Sounds like great news, right? Sadly this is yet another occasion which demands we take a very close look at the fine print.

Most Americans today are aware of the 47 million uninsured US citizens and many have heard about the estimated 50 million Americans who are under-insured, lacking comprehensive coverage and paying far too much in out-of-pocket expenses. While many honestly do feel that their insurance coverage is sufficient and will protect them or their family members in case of illness, our present economic crisis has been teaching more and more people a hard lesson about the inefficiencies, injustices and waste of our present, multi-payer, for profit system. It goes without saying that our current health care system is broken, and it has become difficult to watch the evening news, listen to your favorite radio station, or read the morning paper without stumbling upon the ongoing debate over health care reform.

During the long campaign for President in 2007-08 candidates from both sides of the aisle had a lot to say about health care reform. Republican candidates delivered the usual spiel about deregulation to “keep costs down” (as if...), and incentives for insurers who cover more Americans, as well as the expected lecture about personal responsibility; etc. Democrats, with the exception of then-candidate Dennis Kucinich, made vague allusions to “cutting costs,” “universal coverage” and “making health care affordable for all.” Nearly all of the top Democrats running this year supported proposals for health care reform that keep the private insurance companies in the mix, legal mandates for citizens to purchase insurance, continued rationing of care based on ability to pay, and mandates for small businesses to offer enrollment in group plans. Is this “change you can believe in” or is it all just more of the same?

Meanwhile, support has continued to grow among doctors, nurses, organized labor and the general public for a single-payer national health program, which would eliminate private health insurance companies and establish a system that provides all US citizens free at-source coverage for all medically necessary care, paid for through a common fund. Over the years some key Democrats have appeared to support such a system. Even Barack Obama once paid lip service to single-payer. In his 2006 book The Audacity of Hope, Obama describes single-payer as the hope of the left, noting that those on the right continue to support reforms that maintain the role of private insurers and the market. Of course, that was then and today the legislation being pushed by the Obama Administration and Congressional Democrats couldn't be further from single-payer. In the past few weeks the nation has witnessed a media blitz for Obama's brand of health care reform, and the single-payer option has been pushed aside, declared "off the table". So who was it that decided single-payer was not an option, and what exactly is "ObamaCare"?

What is ObamaCare?

The ObamaCare crowd, from congressional supporters to liberal activists and, perhaps surprisingly, the pharmaceutical, biotech and for-profit health insurance industries all are touting the Affordable Health Choices Act as the way forward toward universal coverage, much like the Clinton Administration's failed health reform (dubbed "HillaryCare" by its opponents) was pushed by the political establishment of the 1990's as the only alternative to the status quo. The biggest difference between ObamaCare and HillaryCare has nothing to do with coverage or funding, rather, this time big insurance and pharma are supporting health reform; and they're doing it with their checkbooks. Even "Harry and Louise" appear to have switched sides... sort of (more on that later).

Also, like the HillaryCare proposal back in 1993, ObamaCare is loaded with language meant to sound progressive but chock-full of nasty sprites hidden between the lines. The Reform proposal is full of provisions that might as well have been written directly by the for-profit insurance companies, like the personal or individual mandate. Referred to several times in the draft released by the HELP committee as "shared responsibility", this blame-the-victim law, a concept previously championed by such "progressive" reformers as Richard Nixon, Newt Gingrich and Mitt Romney will require all US citizens not already covered by Medicare, CHIP, the VA or other government programs to either purchase benefits from a private or group insurance provider, or face stiff tax penalties at the end of the year. A third possibility would be to enroll in Obama's much-talked about "public option".

The so-called "public" plan, now referred to as The Community Health Insurance Plan, is perhaps the most disappointing part of the ObamaCare reform. A traditionally conservative and historic opponent of health care reform, the American Medical Association recently agreed "to consider" some version of the public plan, so long as physician participation was not mandated. The plan currently being proposed would only provide benefits to cover the minimum essential procedures, premiums would be high (required to cover the full cost of the plan), and enrollees would still be at the mercy of chaotic forces of the market and skyrocketing costs for services. Actually, the point of the public option - according to its own supporters - is to "compete directly with the private insurers to keep costs down" and "keep the private insurance industry honest". With a market set up to provide the least amount of the lowest quality service possible for the most money, how will the public option accomplish this fantastic and, dare I say, counterintuitive feat? Your guess is as good as mine.

At least the Obama reform will protect us from being denied coverage due to previous medical history, right? After all, Obama says so! Well, not so fast... while the early draft passed in the HELP committee protects Americans from being turned down or having their benefits cancelled due to illness, preexisting conditions or disabilities, it does allow insurers to charge varying rates based on age, geographic location, tobacco use, and family composition and does not protect anyone from having their coverage cancelled due to non-payment. Countless Americans have lost jobs, homes and entire life savings since the beginning of the current economic crisis, and many have lost their health benefits as well. How much insurance could you afford to pay for if you suddenly joined the ranks of the unemployed? The AHCA promises sliding-scale subsidies to purchase benefits for families making up to 400% of the poverty line, approximately $88,000 for a family of four, potentially equaling up to 19% of family income! This may be affordable to President Obama or to the average Congressman's family, but how realistic is this for the rest of us? At least there's always Medicaid, Medicare or CHIP, right? WRONG! The Obama White House is planning upwards of $600 billion in cuts for Medicaid financing, and this on top of decades of under funding and unpaid IOU's. It seems working and poor Americans will be "sharing" a bit more of the responsibility than some others.

Tying this mess together is a new program called the Affordable Health Benefit Gateway. Supporters claim it will help Americans find a plan that serves them best and get the coverage they need. In reality this program, combined with the regressive tax penalty for anyone who goes without basic coverage for over 90 days, will make it extremely difficult for many to cancel or change policies. The bad news doesn't stop there. Congressional aides and key Washington insiders report that, despite his repeated public assurances to the contrary, President Obama is considering a tax on health benefits to help fund start up costs and the massive subsidies for citizens to purchase private insurance. This is the same tax proposed by Senator John McCain during his failed bid for president last year. A tax on benefits will hit organized labor especially hard as union workers are far more likely than non-union employees to have employer-provided benefits through negotiated contracts, and generally enjoy higher quality benefits than workers who have to purchase coverage on their own.

President Obama has consistently delivered this same message in the media for months now, concerning health reform: "inaction on health care reform only supports the status-quo" and "[u]nless we act, and act now, none of this will change." Of course, by "inaction on health care reform" the President specifically means inaction on his reform. The only thing that we can be certain of is that any reform that keeps the for-profit insurance companies in the equation or hands them billions of dollars in taxpayer funds each year for subsidies that fail to guarantee universal coverage or equal access to quality care, a tax on benefits, a weak and restrictive public option that is doomed to failure, and an individual mandate - straight out of Newt Gingrich's Contract on America, in short, The ObamaCare reform, will strengthen the status quo. The doctors, nurses and health care providers, the uninsured, under-insured, and all those at risk don't need another dose of the medicine that made us ill to begin with. But that pill is exactly what Obama and the Democratic Party are pushing.

The Definition of Insanity

The proposals laid out in Obama's AHCA are nothing new. In a comment destined to be mocked relentlessly by John Stewart on The Daily Show, Republican Party Chairman Michael Steel called the Democrats' reform "socialism." Perhaps before slinging the dreaded S-word so carelessly, Mr. Steel should have learned a little more about the history of health care reform, and particularly, the history of his own party. Had he done so, the Republican Party Chairman might have chosen his words a bit more carefully.

The cornerstone of ObamaCare is the individual mandate. Back in 1971 President Richard Nixon, fearing the advance of a single-payer movement, proposed reform that mandated employers offer benefits to their employees and created subsidies for the poor to purchase insurance or sign up for Medicare-like public insurance with a sliding scale of premiums. The legislation failed, but the idea was picked up numerous times over the years by politicians on both sides of the aisle who sought to avoid single-payer reform.

Massachusetts became the first state to pass a version of "mandated care" in 1988. Expanding on Nixon's idea, MA lawmakers added a personal mandate for students and the self-employed. In 1989 Oregon launched a reform that combined employer mandates with expanded Medicaid and rationing expensive treatments. Oregon's effort failed to reduce its uninsured. Between 1992-93, four more states, Vermont, Minnesota, Tennessee and Washington, all tried various mandated care schemes. Howard Dean, then-Vermont Governor, called for universal coverage by 1995, but the state's uninsured rates have only gone up. Minnesota's uninsured were supposed to magically vanish too, but by 1997 had increased by 88,000 and continue to rise. Tennessee's reform increased rates from 14% to over 16% uninsured before its second year in effect, and the program has been a catastrophe for the state's poor and disabled. Washington state, whose health care reform most closely resembles the ObamaCare plan, experienced a horrific increase, 35% in only six years, with nearly a million state residents living without health coverage.

The Clinton Administration included personal mandates in its failed health care proposal in 1993. Only a year later Newt Gingrich's Personal Responsibility Movement adopted the idea of the personal mandate as part of Gingrich's vicious attack on so-called "free riders", participants in public programs and recipients of federal aid. Gingrich supported the personal mandate as part of a punitive strategy to shift financial burdens onto the very disadvantaged communities and needy populations that public programs are meant to serve.

In 2003 Maine passed the Dirigio Health Care Reform Act, which established a system similar to Massachusetts' Mass-Care. The Maine reform introduced new programs meant to extend Medicare eligibility, as well as a state-subsidized insurance policy called Dirigio. The program, like so many before, was meant to achieve universal coverage, but failed miserably. Since its introduction, Maine's reform has only covered 11% of the 136,000 uninsured in Maine. Of those who are now covered, twice as many enrolled in the Medicaid programs than purchased Dirigio's state subsidized insurance, proving that low income families in Maine prefer a fully-paid public plan over sliding-scale premiums and incomplete coverage. All projections for financing through savings offsets, an approach to funding universal coverage favored by the supporters and architects of the ObamaCare plan, have fallen short in Maine. Savings-offset payment, in theory, uses savings to health care providers from decreased frequency of uncompensated care (emergency room visits by the uninsured) and cost-saving initiatives (rationed care, electronic records), to finance further subsidies intended to help citizens purchase private insurance plans. As Maine clearly shows, it doesn't work.

Massachusetts Gov. Mitt Romney initiated further reform of Mass-Care in 2006 , passing legislation that increased the punitive fines on individuals who cannot afford to purchase private insurance or do not qualify for subsidized care to nearly $2,000 in 2008. Despite increased fines and Romneys proclamation that uninsured rates in Massachusetts would be "wiped out", fewer than 2,000 of the state's 651,000 uninsured purchased new policies. According to Jane Slaughter of LaborNotes the state is preparing to place limits on coverage and cuts services like dental in 2008-09. Surveys conducted in Massachusetts show that support for a statewide single-payer reform is growing, as premium rates under Mass-Care have soared, increasing over 10% each year. In polls conducted statewide, most state residents said that the revised Mass-Care did more harm than good. Today in Massachusetts 1 in 7 residents cannot afford the health care they need. For-profit hospitals and insurers lobbied hard to get the new reform passed in 2006, and enjoyed a hefty rate increase and record profits for their effort. Meanwhile, public hospitals and community clinics which serve Massachusetts hundreds of thousands of uninsured are being forced to close down and consolidate due to massive cuts in state funding.

The state programs described above clearly show that the only thing that personal mandates ensure is windfall profits for the health care industry. Any reform that strengthens the for-profit insurers will only make the problem worse, and any reform that keeps a place for the private insurers is doomed to failure. The Obama Administration has crafted a reform proposal modeled after similar state reforms that have time and again failed to achieve universal coverage, failed to control or reduce costs, and failed to guarantee equal access for all Americans to the quality health care they need. Albert Einstein once said "the definition of insanity is doing the same thing over and over again and expecting different results." Do the Congressional Democrats and the Obama White House really expect anything new from a reform proven for two decades-in multiple states to do more harm than good? Or, perhaps, is there another agenda at work here?

Reform for Who?

In a July 20th report NPR Senior News Analyst Cokie Roberts said that President Obama may need to make many "small deals with the many stakeholders involved" in the Obama health reform, including the AMA, big pharma, for-profit insurers and hospitals, as well as Congressional Republicans and Democrats in order to get any reform passed this year. The truth is that Obama and his supporters in Congress already have, many times over. First, committees debating health care reform declared from the beginning that single-payer, the only reform that would truly guarantee free and equal access to quality health care services as a human right, was "off the table". Second, provisions promised by the Obama presidential campaign, which would have allowed cheaper generic drugs to be imported from Canada and empowered the federal government to negotiate Medicare drug prices directly with pharmaceutical companies, were quietly dropped before the Affordable Health Choices Act was announced to the media. Also, a Senate Committee voted to give brand-name drugs a minimum 12 year market exclusivity deal, essentially locking out cheaper generics. Third, the AHCA is a bi-partisan bill and "includes more than 160 Republican amendments" according to its own press release.

These early concessions to big PhRMA and the AMA and all the broken campaign promises should have been expected from the candidate who once spoke in support of a National Health Service, but has since turned his back on single-payer supporters. In a 2003 speech at the AFL-CIO Civil, Human and Women's Rights Conference, then state senator Obama said:

"I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. A single-payer health care plan, a universal health care plan. That's what I’d like to see. But as all of you know, we may not get there immediately. Because first we've got to take back the White House, we've got to take back the Senate, and we've got to take back the House."

However, since then Mr. Obama has gone to great lengths to distance himself from his early statements supporting single-payer. Back in May of '09 The New Yorker reported that Obama said:

"If you're starting from scratch, then a single-payer system'-a government-managed system like Canada's, which disconnects health insurance from employment-'would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside."

On July 1, 2009, in Annandale, VA, the President had this to say about health care reform:

"For us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive, and my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free-market system,"

President Obama keeps saying that "it's important for our efforts to build on our traditions here in the United States", that the American people want choices and want to keep their existing coverage. It seems that the President is confusing "wanting to keep existing coverage" with not wanting to lose existing benefits; the two are not always the same. Is the president mistaken? Does he perhaps believe that Americans don't want "too much" change, or is all this backpedaling to be taken as a quiet admission that ObamaCare won't change much at all? What cruel irony, and this from the man who, as candidate for president, ran on slogans like "yes we can," "hope," and "change you can believe in".

Another Obama campaign promise was that, if elected, his administration would guarantee unprecedented "transparency" and public access. While the Administration thus far has hardly been “transparent,” the facts concerning Obama and his fellow Democrat's financing in the 2008 elections are a matter of public record. Official statistics on election campaign contributions, available through the nonpartisan Center for Responsive Politics on opensecrets.org, show that Barack Obama received more money from health care professionals, the for-profit health insurance and big pharma industries combined than any other candidate for the presidency in 2008 or any candidate in all prior presidential races, for that matter. A report by the Montana Standard presents even more damning evidence of the extent to which the Obama administration and its supporters in Congress, including Montana's own Senator Max Baucus, have been bought off by the for-profit insurance industry. The Standard reports:

In the past six years, nearly one-fourth of every dime raised by Baucus and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

Senator Baucus is the chair of the Senate Finance Committee, the go-to guy tasked by the Obama administration with facilitating a health care reform proposal that is palatable to the industry that financed the Democratic Party in 2008 with nearly $90 million in total contributions, while also lining the coffers of the Republican Party's campaign war chest that same year to the tune of $76 million. Nearly half of Senator Baucus' campaign contributions in 2008 came from special interest PACs from outside Montana, only 13% of funds raised came from donors inside the Senator's home state.

Over two-dozen of Baucus' former campaign staffers now work as lobbyists on K-Street, and many of his closest former employees today represent some of the biggest for-profit insurers and drug makers, including America's Health Insurance Plans, Inc, Merck & Co., and The Pharmaceutical Research and Manufacturers of America (PhRMA). PhRMA's current CEO is former congressman Billy Tauzin, whose recent endeavors include using PhRMA's massive budget to lobby Canadian lawmakers for legislation that would undermine Canada's single-payer system and eliminate the heavily subsidized prescription drug prices enjoyed by that nation's citizens. Recently, PhRMA teamed up with the liberal group Families USA to do its part to make sure we all know that "the only way,” the "American way," is the Obama way. A new round of television advertisements featuring "Harry and Louise" began airing the week of the Affordable Health Choices Act's press release. As you may recall, "Harry and Louise" are the fictitious TV couple who helped defeat HillaryCare in 1993; the couple apparently have seen the light and now support health care reform, specifically, they support ObamaCare.

It comes as no surprise that Baucus received more money from these interests than any other candidate for congress in 2008 (in fact, only presidential candidates Obama, Clinton and McCain received more $$$ from the industry), nor should supporters of a single-payer, national health program be surprised by the lengths to which Senator Baucus, the Obama administration and Congressional Democrats have been willing to go to exclude and marginalize single-payer proposals and craft legislation favoring the medical-industrial complex.

Single-Payer "Off the Table"

Dr Margaret Flowers is one of the 13 activists that got arrested at the Baucus committee. Photo by NESRI on Flickr. To get a clear picture of just how one-sided the official "debate" has been, one need only ask a doctor. Specifically, ask Dr. David Scheiner of Chicago. Why ask Dr. Scheiner? Because he was President Obama's doctor for over 22 years, and Dr. Scheiner supports single-payer. Ask Dr. Scheiner about the President's proposal for health care reform, and he'll tell you exactly what he thinks of it: "It won't work". When producers at ABC news invited the President's former physician to a June 24th White House forum on health care, where President Obama was set to answer questions on the topic from a live audience, Dr. Scheiner was thrilled! "I was going to ask a question directly of the President." Scheiner explained, "I was his doctor for 23 years, and I was going to surprise him." After canceling dozens of appointments with patients and only two days before the forum in D.C., Doc Scheiner received a call from a producer at ABC informing him that his invitation was cancelled. Of the program, in which there was not one single mention of single-payer, Scheiner says “I was pissed! The program was terrible. It was an infomercial for the medical-industrial complex. The questions were softballs..."

Earlier this year Senator Baucus initiated a series of preliminary meetings between interested parties to discuss health care reform proposals before the Senate Finance Committee. Representatives of insurance companies, HMOs, for-profit hospitals and pharmaceutical companies were present, but advocates of single-payer were not invited, and not welcome. In the month of May, 13 arrests were made when single-payer supporters, including doctors, nurses, activists and concerned citizens stood up during two of the Finance Committee's meetings and demanded to be heard. The activists called the hearing a "pay to play" event protested their exclusion from the debates, as well as Senator Baucus' statement that single-payer was "not an option on the table." Dr. Margaret Flowers of Physicians for a National Health Program was one of the 13 activists arrested at the Senate Finance Committee. In an interview with Amy Goodman on DemocracyNOW! Dr. Flowers described the dilemma for single-payer supporters in the health reform debate:

"for so many years, doctors and nurses have been trying to deliver quality health care in this country, and it’s become increasingly difficult. We have tried to have our voice heard. We really requested to Senator Baucus that he include a single-payer advocate at these roundtable discussions, and we were told very clearly that there would be no invitation coming. And so, we felt that... we couldn’t be silent any longer. We needed to stand up on behalf of our patients, on behalf of our colleagues, and speak out."

Russell Mokhiber, founder of SinglePayerAction.org and another of the "Baucus 13" was also interviewed by Amy Goodman. He explained further:

"...the majority of Americans, majority of doctors support single-payer. Get rid of the private health insurance industry. Save $400 billion in administrative costs and profits, use that money to insure everyone. You have a card, an Americare card, when you’re born, and you can go to any doctor, any hospital in the country. So this is what the American people want. Insiders say this is what we’re going to get, sooner or later. Why not just have it now? ...the problem was that you have this lockdown on Capitol Hill, where the corporations, the health insurance industry, is in control. Senator Baucus has had twenty-eight witnesses over the span of these two hearings, not one of which was a single-payer advocate... the faxing, the phone calling, all of that’s not working anymore. We have to use a battering ram to break what’s going on, break down what’s going on in Congress."

In tv interviews and on pro-single-payer websites, single-payer activists criticized Baucus' and the lobbying group, America's Health Insurance Plans's, use of the term "a uniquely American solution" to describe ObamaCare reform, pointing out that America already has a "uniquely American solution" that works like single-payer, it’s called Medicare. The Democrats currently enjoy a 60-vote super-majority in the Senate. Last year, voters were told again and again by Democratic candidates and liberal commentators that a 60-vote majority was all that was needed to pass legislation that has been blocked or ignored for decades. Why dabble now in what Dr. Marcia Angell, former editor of the New England Journal of Medicine, calls "the futility of piecemeal tinkering" when the possibility exists for a fundamental overhaul of the system which 2/3rds of the American public and a majority of doctors, nurses and health care professionals all want? ObamaCare is doomed to fail the American people, though the possibility exists now that it may not even get the chance to fail.

Is ObamaCare Already Dead?

Though the Obama Administration has sought to fast-track its proposed legislation through the Senate before congress' August recess, those plans are already being derailed by infighting between Obama's supporters and conservative "blue dog" Congressional Democrats, stiff opposition from Republicans and wavering support from the public, and the for-profit interests pulling at every thread - hoping to come out on top, no matter what. ABC News opinion polls show that public support for Obama's health care reform proposals has fallen to only 49%, and Associated Press-GfK polls indicate that public disapproval is now up to 43%. Considering that independent polls conducted by Yahoo!, CBS and The New York Times consistently show that 60% or more of Americans support a single-payer national health program and polls of doctors and nurses show similar numbers, it is hard to believe that all of the 43% who disapprove of Obama's handling of health care reform are Republican opposition. Even the traditionally-conservative American Medical Association, which is currently giving tentative support to the Obama reform and has fought single-payer in the past, is beginning to slide. An AMA poll from 2007 showed that 59% of physicians favor a national health program - and this, from the AMA! And the bad news does not stop there for ObamaCare.

On July 16th, 2009 Congressional Budget Office Director Douglas Elmendorf reported to the Senate Budget Committee on CBO projections for funding and cost controls in the current proposed health care reforms. Senator Judd Gregg's summary of the report reads as follows:

"present plans as they’ve been produced have no significant cost spending events in them relative to reimbursement and relative to the way that they structure health care, that most American’s premiums aren’t going to go down and they will continue to go up, and that the debt of this country is unsustainable on our present course, and there isn’t a whole lot in this health care debate to date relative to the bills that have been produced that is going to do anything but continue to aggravate that and actually expand that problem."

The CBO has now reported the projected cost to taxpayers for the Obama health care proposal at over $1 trillion (TRILLION!) over the next ten years, with independent studies placing the cost as high as $1.5 trillion, and that's for a system that is only projected to decrease the number of uninsured nationwide by approximately 16 million by the year 2015. These numbers are based on the proposals of the Senate HELP committee's Affordable Health Choices Act, and contrast sharply against a 2005 study by The National Coalition on Health Care, a group that supports single-payer national health care, which shows that a single-payer system would actually reduce costs by over $1.1 trillion over the next decade, as reported by Kenneth E. Thorpe, Ph.D. Another study, conducted by the Institute for Health and Socio-Economic Policy, indicates that:

Establishing a national single-payer style health care reform system would provide a major stimulus for the U.S. economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the U.S. economy

According to the ISHP study, the number of jobs created by a single-payer national system is nearly equal to the total number of jobs lost in 2008 and the price tag each year for single-payer is roughly $63 billion beyond the current $2.1 trillion in direct spending, which could easily be offset by the billions of dollars saved each year by eliminating the redundant bureaucracies, profits, wasteful overheads and executive salaries of the for-profit insurance industry. As Mr. Mokhiber of SinglePayerAction said, "...this is what the American people want ...this is what we're going to get, sooner or later".

With higher-than expected costs and a less-than enthusiastic reaction from the general public - and Congress - the future appears uncertain for Obama's proposed reforms. Liberal commentators on CNN, MSNBC and NPR had speculated that Obama might use his executive authority to call a special session of Congress, which would prevent congressmen from leaving D.C. until a health care bill were voted on and signed into law. On July 23rd, while speaking to an audience in Shaker Heights, Ohio, President Obama backed away from his ambitious August deadline for a reform bill, saying that if a bill weren't ready by August "that’s OK, I just want people to keep working. I want it done by the end of the year".

What Way Forward for Single-Payer?

Deann McEwen, a registered nurse and yet another of the single-payer activists arrested at Senator Baucus' Committee meetings, quoted Florence Nightingale before the committee; "Were there none that ever hoped for better, there would never be any better". Congressman John Conyers, sponsor of single-payer proposal H.R. 676, was asked earlier this year what it would take to get single-payer legislation passed in the current political arena. Mr. Conyers answer: "nuclear weaponry." While some supporters of single-payer may resign themselves to critical support of the ObamaCare proposals as "better than nothing" or "a step toward single-payer" others, who understand the urgency of the matter, are preparing for a fight and beginning to take more direct action. Russel Mokhiber of SinglePayerAction says "the only way that this is going to happen now is people to—people all over the country to directly confront their members of Congress", but Dr. Flowers may have got a little closer to the answer when she said “We must build a civil rights movement like those that have come before”.

Dedicated activists, doctors, nurses, workers - union and non-union alike are showing the way with demonstrations numbering in the thousands, beginning to pop up from coast to coast in Seattle, WA, New York, even in Washington D.C. Without question, the American public supports a single-payer national health service and free, quality health care for all. Voters chose to pass single-payer legislation in California on two occasions to date, though the measures were vetoed by "the governator" Arnold Schwarzeneggar. H.R. 676 had 93 co-sponsors in the House last year, though several co-sponsors, like CA Democrat Henry Waxman, had their names removed from the resolution after the Affordable Health Choices Act cleared the HELP committee. H.R. 676 has been endorsed by over 128 Central Labor Councils, 39 state AFL-CIO's and a total of 552 union organizations in 49 states. Earlier this year, Independent Vermont Senator, Bernie Sanders, introduced SB 703, a single-payer bill in the US Senate. With out of pocket costs for health care skyrocketing in the US and no end in sight for many Americans - at risk of losing their homes, jobs, benefits, or all or the above - there is no time like the present to organize, mobilize, and continue the fight for a health system that truly covers everyone, provides all necessary care free-of charge, and guarantees everyone the right to live a healthy life, no exceptions! Only by uniting workers, students, activists, health care workers and organized labor, refusing to compromise on single-payer, and breaking with the Democratic Party and all its limitations will we build a mass movement that can bring the kind of social, economic and political pressure to bear that will be needed to win health care as a human right!