Blues for single-payer.

In June, Hillary Rodham Clinton conceded to the Economic Club in Washington, D.C., that the so-called single-payer health-care reform option isn't "politically infeasible" after all, as it has been characterized by politicians and the media ever since the Clintons elevated health care to the top of the national agenda. "I can stand here and make this prediction," said Ms. Clinton. "There will be a grass-roots movement which will sweep this country that will achieve a single-payer system. It will start ... and build and be like nothing you have ever seen."

Make no mistake: this was not a rallying cry in support of single-payer. This was a scare tactic employed to get legislators to pass something--anything--that could be construed as "health-care reform" (a strategy that was rendered moot when Senate Majority Leader George Mitchen officially declared health-care reform dead--for this year, anyway--on September 26, 1994). Yet Ms. Clinton was correct in her assessment, whether or not she meant to speak the truth.

This "grass-roots movement" is well under way, although you wouldn't know it from the sketchy media coverage of the single-payer option (see "Media Coverage Uncovered," p. 5). But the organizations which are pushing single-payer up the tremendous political incline of Capitol Hill don't need empirical data to convince them of media bias. They have experienced it first-hand for several years.

One of these groups is the Northeast Ohio Coalition for Health Care Reform, which has been fighting for a single-payer system since 1988. This regional group later spawned the national organization Universal Health Care Action Network (UHCAN, pronounced "You Can"), founded in November 1992 when the organizers realized the importance health care would assume upon the election of Bill Clinton to the presidency. Since its inception, UHCAN has been successful in educating and organizing people in support of a single-payer system in all regards except one: through the media.

UHCAN held its first town meeting on December 12, 1992, in Little Rock, Arkansas. Its strategy was to maximize media coverage by renting a hotel ballroom right next door to the conference hall in which President-elect Clinton was holding his economic summit. UHCAN was promised media coverage by all three major networks as well as CNN, all of which had descended upon Little Rock in droves to cover the economic summit. "Come Saturday afternoon," says UHCAN coordinator Diane Lardie, "and what do you know, but there is nothing in the way of a camera or a reporter to be found."

Outraged by the conspicuous absence of the media, all 1,000 activists spontaneously began a protest march down Main Street, chanting, "We want Bill!" on their way to the Arkansas State Capitol, where Bill Clinton was attending the swearing-in of the new governor. They continued their town meeting outside the State Capitol until Bill Clinton finally came out to chat with the organizers for about 20 minutes. And yet, "President-elect Bill Clinton talking with the folks on the steps of the State Capitol received no national coverage at all," Lardie says with amazement nearly two years later.

"That was our clue as to how serious the power structure is about blocking any single-payer reform," says Lardie, "and it has been consistent ever since. It is very disturbing to me as a citizen, quite apart from the health reform issue, that to a dimension I never thought existed the media makes the news; it does not report it. That is very frightening when you think about what a democracy is supposed to be. The extent to which the power players are playing the power game with something that is going to affect the entire population tells us what our values are and who we are as a people. And I don't like what I see."

The media blackout has been largely successful. Most people have either never heard of single-payer at all or associate it with "socialized medicine," which conjures up un-American images of rationing and incompetence from our highly propagandized collective unconscious. As a result, there is confusion and ignorance about what exactly the single-payer plan is and how well it works. The single-payer system streamlines health care by eliminating insurance companies from the health-care delivery system. The government acts as the sole insurer by financing health care through progressive income and payroll taxes. This has been shown to spread the cost of health care evenly over the entire population as well as to reduce the waste that results from insurance administration. Single-payer is not, however, a government-run health-care system.

"We use the highway analogy," says Lardie. "The interstate highways are built with government money (your taxes), but private contractors do the actual work. Social Security is a single-payer program. Medicare is a single-payer health-care system. No one wants to throw those programs out."

A United States General Accounting Office report, "Canadian Health Insurance: Lessons for the United States," further describes the Canadian-style single-payer system as such:

First, [Canada] does not have a socialized system of delivering

medical care. Rather, most health resources in Canada

are in the private sector. It is a system whereby a third

party pays private providers. Second, most physicians are

independent and earn their incomes by fee-for-service.

Ninety-five percent of Canadian doctors work for them,

selves, not for the government. Finally, 90 percent of hospitals

are private, nonprofit corporations.

[emphasis added]

In addition to scaring people with the erroneous "socialized medicine" allegation, opponents of a Canadian-style national health program have propagated myths about long waits. While there are waiting lists in Canada for elective surgery and other non-life-threatening conditions, the General Accounting Office reported that "there was no wait for emergency patients" and, furthermore, "hospital capacity in the United States is a safety valve" that would prevent waiting lists here. Considering that one-third of all hospital beds in the United States are empty, this "safety valve" would more than make up for the waiting fists that have developed in Canada.

And more importantly, indicators of a population's health favor Canada's system over ours. According to The National Health Program Book, written by two Harvard Medical School physicians, Canada has a lower infant mortality rate: 6.8 deaths in the first year per 1,000 births as opposed to 9.1 in the United States. Some doctors are under the impression that a higher infant mortality rate in the United States is not due to a lack of care but, rather, to a lack of responsibility on the part of mothers. Yet other industrialized nations which have a single-payer national health-care system, such as Sweden, have achieved the same low level of infant mortality for minorities as they have for the more privileged classes. Because minority groups in the United States are the most likely to be uninsured and the least likely to receive appropriate care, their statistics are shocking: black infant mortality is twice that of whites; deaths during pregnancy and childbirth are rising among African-American women; white women live nearly six years longer than black women; and white men live nearly eight years longer than black men. Yet Canadians have a longer life expectancy than Americans for both men and women of all races.

What little attention the Canadian health-care system has received from the major media has focused on the problems Canada has had recently in funding health care, emphasizing that health-care costs are rising there, too. But these funding problems are not due to rising costs (which have in fact remained steady) but, rather, to the fact that health-care revenue is pooled with other programs. Since the recession, all government programs have suffered from a decrease in tax revenue and an increase in demand (such as rising unemployment), subsequently draining funds from health care.

The single-payer bill introduced into the House of Representatives by Jim McDermott (Democrat-Washington) and into the Senate by Paul Wellstone (Democrat-Minnesota) in March 1993 seeks to address this problem by keeping health-care, like Social Security, "off-budget" In other words, all revenue collected for health care would be in its own separate fund and unavailable to finance other programs that become jeopardized by cutbacks or increased demand.

"The McDermott proposal is the best proposal to meet this country's health-care needs," says Barbara Otto, coordinator of the grass-roots lobbying organization SPAN (Single Payer Across the Nation). "Everything else we're seeing is private health-insurance reform, not health-care reform. If anything less than health-care reform [is passed], we're going to have to come back at it and fight."

SPAN has already been fighting hard since its inception in February 1994. What was originally intended to be a four, month campaign to spearhead a national petition drive has turned into a coalition representing a wide spectrum of national activist groups which favor a single-payer reform bill--including, but not limited to, UHCAN, ACT UP, Public Citizen (Ralph Nader's group), the Gray Panthers (senior activists), and many unions.

One of the most influential activist groups represented by SPAN is Physicians for a National Health Program (PNHP), which boasts over 6,000 physician members. PNHP, which formed in the summer of 1986, published a single-payer proposal in the New England Journal of Medicine in January 1989. Since then, the organization has continued to push for single-payer reform by briefing legislators and educating the public; its members have appeared on such national news programs as the "McNeil/Lehrer Newshour" David U. Himmelstein and Steffie Woolhandler, two founding members of PNHP who are also doctors at Harvard Medical School, wrote The National Health Program Book (Common Courage Press).

Dr. Dena Magoulias is a member of PNHP and has been involved with single-payer health-care reform since the inception of the Northeast Ohio Coalition in 1988. "I think what's happening with the medical profession right now is that doctors are running scared. A lot of people are afraid of this "managed competition" because it might turn--and we're already seeing it--hospitals into big monopolies.... I think they [doctors] are more afraid of that than they are of single-payer. I'm hearing more and more that doctors are starting to say that maybe we do need single-payer. They don't want insurance companies telling you that you can't order that test on that patient because it's going to be too expensive.

And there are a lot of doctors that are in favor of [single-payer] not just because it is the lesser of two evils. Basically, it's a justice issue. You see patients all the time who don't have insurance and they are not able to afford to come in. Sometimes they don't come in for months and years even though they have illnesses like diabetes and high blood pressure which could be taken care of. When we "we this, a lot of us feel like it's very unfair that our system is run like that."

While the single-payer proposal has been guaranteed a House vote, predictions are that Republicans will win enough seats in November to prevent any meaningful insurance reform, much less health-care reform. "We'll keep the pressure on to ensure that whatever bill is finally passed will include a clear single-payer option for the states," says Barbara Otto of SPAN. "If each state has the option to form a single-payer health-care system, we will have won a battle." But for single-payer supporters, the war won't be over. "We will keep pushing hard for single-payer, because through single-payer you get to choose your doctor, you get doctor autonomy, you get it at an afford, able price, you break the connection between employment and health care, and you get universal coverage. Last time I checked, universal coverage meant 100 percent, not 90 or 95 percent, which seems to be what [Congress and the president] are willing to settle for."

Not too long ago, Clinton vowed to take his pen and veto any legislation that did not guarantee universal coverage--but that has changed. "After President Clinton's initial stirring speech calling for universal health care," says Dr. Ken Frisof, who is a family practitioner and the chair of UHCAN, "the debate switched from being about health care to being about money. This was predictable." And this is precisely what happened.

The threat of health-care reform sparked the most intensive lobbying effort in the history of America. The Center for Public Integrity, a non, profit organization based in Washington, D.C., has recently published a report entitled Well-Healed: Inside Lobbying for Health Care Reform. This comprehensive report reveals what many people already knew: a lot of money has been spent to influence the outcome of health-care reform.

CPI reports that, according to Federal Election Commission records, over $25 million was given to members of Congress from 1993 through the first quarter of 1994 by organizations with health-care,related interests. "Add to that the tens of millions of dollars in television, radio, and news, paper advertising, plus untold millions of dollars spent in lobbying contracts, polling, and grass-roots campaigns, and the result is the largest blitz on proposed legislation in the nation's history." The grand total of this "blitz" exceeds $100 million spent by health-care,related industries to lubricate the democratic machine. And even this wasn't enough for some.

Many government officials abandoned the pretense of public service altogether and went right to the source. Of the 80 former congressional and executive-branch officials who have gone through the "revolving door" to work for health-care interests, 23 of them left their government positions in the last two years. Twelve of the 80 are former members of Congress. This distinguished list includes Representative Willis Gradison (Republican-Ohio), who is now president of the Health Insurance Association of America, which sponsored the "Harry and Louise" ads to the tune of over $10 million. CPI reports that Gradison was "a congressman on Sunday and an insurance lobbyist on Monday."

"The lesson that is going to be learned from this, although it's going to be hard since most of the mainstream media doesn't like this lesson," says Dr. Frisof, "is that we are politically paralyzed due to the corrupting influence of money. Money defines the agenda, and that is what happened here."

The pretext for all this lobbying is to bolster America's belief in market forces, despite the obvious fact that market forces have gotten us into this mess. Lobbyists are working overtime to convince the public that the United States has more and better health care due to the wonders of competition, especially when it comes to expensive high technology. But studies have shown that competition actually raises the cost of medical care. For instance, if one hospital gets a magnetic resonance imaging (MRI) machine, then in order to compete for wealthier patients, other hospitals have to get their own, too, resulting in a kind of medical "arms race" Because each hospital then has to pay for the high-tech equipment, the cost to the patient for use of the machine has to be jacked up. A report published by the Wall Street Journal in 1990 found that hospitals in more competitive markets had significantly higher costs than hospitals in less competitive markets.

Not only does competition increase the cost of medical care, but it results in wasteful duplication of expensive high technology while many Americans have to forego even the most basic service because they don't have insurance. "There's a simple truth in our current, health-care situation: it costs too much money, it excludes too many people, and it doesn't meet the people's needs," says Barbara Otto. This is corroborated by the government's own studies. According to a U.S. General Accounting Office report, Canada spent 23 percent less per capita on health care in 1987 than the United States, mostly due to administrative costs; at the same time, every Canadian has coverage. Insurance administration--which includes marketing competitive health-insurance policies, billing and collecting premiums, and evaluating insurance risk--costs Canada $18 per person; in the United States, the cost is $95 per person.

"There are no antitrust law's regulating insurance companies. They are the most unregulated industry in the entire country," says Diane Lardie. "The insurance industry does not provide health care and it certainly doesn't provide security. All the insurance industry does is make money, so let's get it outta there"

Nevertheless, the Clinton strategy of "managed competition" relies on insurance companies to reduce waste and at the same time to provide universal coverage, even though the government's own General Accounting Office has concluded that this objective would be better served by eliminating insurance companies from the health-care delivery system altogether. "If the universal coverage and single-payer features of the Canadian system were applied in the United States," the GAO report states, "the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured. There would be enough left over to permit a reduction, or possibly even the elimination, of copayments and deductibles, if that were deemed appropriate." The Congressional Budget Office also reported that, under a single-payer plan, the United States could provide health care to everyone and still cut costs by $14.2 billion annually.

"In other industrialized nations, health care is considered a social issue not unlike education and other aspects of the infrastructure," says Otto. "In the United States, health care is seen by a sector of the population--namely, the business class--as a commodity to be bought and sold. They have made a substantial profit when those that need health care the most are excluded: the sick, the poor, and the elderly. The rest of us think that the only way to provide adequate health care to everyone is to remove the profit-making motive. Until the business class is either beaten back or gives in, the struggle for health-care reform will continue."

RELATED ARTICLE: Media Coverage Uncovered

If single-payer was just another abstract proposal floating around Washington, the lack of media coverage of the plan might be defensible. But given that single-payer is the only plan being considered that has been tested in real life and for which empirical data exist, the media coverage has been anemic at best, and misleading at worst.

For a fair comparison of media coverage of the different health, care reform plans, the number of articles written about the single-payer McDermott plan is compared to the Cooper plan (often called "Clinton Lite" because it uses the idea of "managed competition" but does not ensure universal coverage). Both sponsors are legislators of similar importance and could be expected to receive about the same amount of coverage--as opposed to the Clinton plan, which will (for obvious reasons) receive a lot more attention from the major media.

A survey of the New York Times, the Washington Post, the Wall Street Journal, the Los Angeles Times, and the Christian Science Monitor revealed that, until June 1994, 33 news articles were written about the Cooper plan compared to six written about the McDermott plan, two of which were written by McDermott himself, (Apparently, the major news media had a staff shortage when it came to covering single-payer.

The media slant did not begin with the introduction of the Clinton plan. The media watch group FAIR (Fairness and Accuracy in Reporting) reports that, in the six months following the 1992 election, the phrase managed competition appeared in 62 New York Times news stories while single-payer appeared in only five stories during the same period--never in more than a single-sentence mention.

As FAIR points out, the major media has the appearance of balance by covering "both sides" of the issue, the two sides being the Clinton plan versus the more conservative plans. By setting the parameters of debate in this way, the media is able to ignore the single-payer option and still maintain the pretense of balance.

Elizabeth Chamberlain is a freelance writer with a degree in inter, national relations from the University of California at Davis. She is a regular contributor to the Cleveland Press, a weekly writer, native paper.