The Single Payer Healthcare Movement in the United States Has Failed...or, Has It?
Against all odds, the movement led by Americans who are outraged by the Commercial Health Insurance industry is louder, united and more forceful than ever | By Kimberly J. Soenen February 4, 2024
Never before have so many organizations and individuals been fighting to enact National (Improved) Medicare for All and statewide Single Payer Programs across the United States.
Vertical integration by the Commercial Health Insurance industry has bulldozed its way through the halls of Capitol Hill since the early 1980’s when Managed Care first overtly telegraphed what it would do to the American people.
Members of the United States Congress and State Legislatures first greenlit the siphoning of taxpayer dollars earmarked for Public Health infrastructure out of Public Health programs and into the coffers of Commercial Health Insurance companies 40 years ago in exchange for campaign finance support.
Since March of 2020, consolidation of wealth has accelerated further with an historic number of hospital mergers and acquisitions, Private Equity buy outs of Long-Term Care facilities, and sweeping medical staff cuts to hospital chains in the name of “efficiencies” and “value-based” care.
Medical care has become so unaffordable it is common for adults to skip or delay care because they cannot afford to pay for it. Every year, the Federal Reserve Board takes a survey on how frequently Americans forego medical care because of cost. The data in 2022 revealed the highest number of U.S. adults foregoing medical care because of cost since 2014. The report showed that Dental Care was the most frequently missed form of healthcare, but Americans also forego seeing specialists, prescription medication, follow-up care and mental health therapy because it is unaffordable.
Despite all odds, the Single Payer movement in the United States—now more than 150 years old—continues to grow larger, louder, more organized, and more forceful.
Medical residents are unionizing from coast-to-coast, nurses across the country are striking and suing hospital management over Patient Safety issues, and—much to the dismay of hospital Public Relations departments—ethical physicians have taken to TikTok to testify about dangerous hospital conditions.
Code Blue and Code Pink alarms are figuratively and literally sounding. Time has run out on the need to change the approach to, and model of, healthcare in the U.S.
Tick Tock, is right.
While he was on day two of a 12-day stretch of clinical service, I asked Dr. Philip Verhoef, the president of Physicians for a National Health Program (PNHP) to articulate the metrics and measurements of success for the movement.
“The ultimate goal is Single Payer, and solely by those metrics, sure, we haven't been successful. However, that neglects both the rise of powers that hope to quash it (through privatization) and the fact that Physicians for a National Health Program and many other left-leaning organizations have done a tremendous amount of work illustrating the dangers of privatization as an existential threat to... well, everything, including Single Payer,” Verhoef explained.
But aren’t the shareholders of Commercial Health Insurance companies laughing all the way to the bank?
“When the forces fighting against Single Payer have increased their power across the board at so many levels, it's surprising that we've kept Single Payer alive as well as we have and that it continues to be a pillar of the progressive caucus. PNHP believes the ultimate solution in this country is a system that covers everyone at a national level...because if health insurance is about pooling risk, what better risk pool than the all 330 million residents of the United States?”
Regarding capacity-building and plans for 2024-2025 Verhoef reported that PNHP has tripled the number of organizers they now have, and doubled the number of communications specialists in the last couple of years.
“We recognize the importance of building membership and increasing our presence at every level—legislative advocacy, allying with other groups like Be a Hero and Public Citizen or labor, continuing to generate important scholarship like our report from last year on the overpayments to Medicare Advantage. We have set ambitious goals of having Students for a National Health Program (SNaHP) chapters in every medical school, and increasing our presence in professional and state medical societies,” Verhoef said.
As class action Denial of Care lawsuits by patients and survivors mount in federal courts, and the Bill-of-the-Month series produced by Kaiser Health News, CBS News and NPR News about White Collar Healthcare Crime enters its seventh year of reporting on Harm-for-Profit, Verhoef is determined, dedicated, confident and steadfast.
“Rest assured, we're busy,” he said.
WILL MINNESOTA BE THE FIRST TO ENACT STATEWIDE SINGLE PAYER?
The state of Minnesota is well positioned to become the first state to enact a statewide Single Payer Healthcare Program called The Minnesota Health Plan (MHP) which was authored collaboratively by Minnesota Senator John J. Marty (40th District.)
Minnesota business owners, medical professionals, ethical hospital administrators and citizens are now buzzing about it around their kitchen tables, at restaurants and at work. But, who best to answer all the questions for clarity and the facts?
Rose Roach.
Now formally “retired,” Roach is currently working as the National Coordinator for the Labor Campaign for Single Payer in Minnesota and the Chair of Healthcare for All Minnesota, an organization that is growing by the day. To the surprise of many, she is not a nurse. Roach grew up in Saint Paul, the daughter of a union brewer at the Schmidt Brewery. She started her career at the Minnesota School Employees Association, where she became executive director. She was a field director at the California School Employees Association before returning to Minnesota in 2014 to become the executive director of the Minnesota Nurses Association (MNA).
Roach and I had a long conversation by phone and email about what’s next for the Single Payer movement. She is one of the leading Single Payer activists in the state and approaches policy change by highlighting the fiscal benefits of Universal Healthcare for everybody.
Soenen: Why is it so challenging to depoliticize and de-privatize healthcare access in the United States?
Roach: The struggle for Universal, Single Payer healthcare has been going on for almost a century. Frances Perkins, the first female member of a United States President’s cabinet, joined Franklin Delano Roosevelt’s cabinet only after he agreed to let her pursue a bold agenda – which included Single Payer healthcare – that became the New Deal. It was the only one of 12 agenda items she put forth that did not succeed.
Ninety years ago, not as much energy was devoted to it because medical knowledge was much more limited, and healthcare was only a minor part of the economy. As medical knowledge and healthcare grew, corporate powers learned how to turn people’s health needs into profit. As healthcare has become more expensive, and more essential to living a full life, the fight for Single Payer has become more important, but the opposition has become more powerful and more defensive of its profits.
Soenen: You are entering the last chapter of your career in this work. Why do you keep fighting?
Roach: We fight for Single Payer not because it is easy, but because the current system is bankrupting families and, literally, killing people. As the system becomes increasingly broken, people are recognizing that we need change and willing to support these efforts. Fifty years ago, the medical profession fought against Single Payer. By twenty years ago, a Minnesota survey showed that a majority of physicians believes Single Payer is the best way to deliver care. We need to win, and we will win.
Soenen: In your opinion, has the Single Payer movement been effective in protecting patients from preventable harm and death and medical professionals from moral injury?
Roach: We are not pretending that this is an easy struggle. Healthcare is now more than 1/6th of the nation’s economy. Trying to replace the dysfunctional corporate system with one based on health and well-being may be the biggest political struggle of this generation.
Soenen: A Minnesota Public Option that competes with Minnesota’s private health insurers was just announced on February 1, 2024. How is The Minnesota Health Plan different from the Public Option?
Roach: De-privatization of our current Public Health programs is job one right now. It’s a solid infrastructure building step towards The Minnesota Health Plan on a state level and the National Medicare for All Act on a national level.
Soenen: So, implementing the Single Payer Minnesota Health Plan is extremely viable, but not overnight.
Roach: We don’t have the conditions to make The Minnesota Health Plan or (Improved) Medicare for All happen right now, but that doesn’t mean we can’t be implementing pieces of those systems.
For example, on a national level, just look at the Medicare for All bills, the transition sections, and let’s start moving those improvements now. Let’s recapture the billions of dollars being stolen from our Medicare fund through fraud and overbilling and use that money to improve traditional Medicare. We don’t have to wait to pass the entire bill.
At the state level, we are focusing on the de-privatization of current Public Health programs, carving out pharmaceutical drugs from the clutches of the PBMs, looking at the potential of implementing global budgets for hospitals, enforcing and strengthening Commercial Health Insurance industry regulations and much more…
Soenen: Are citizens aware of these efforts?
Roach: We need some wins for patients and for medical care providers. As for the movement – we keep pushing for the gold standard that is Single Payer while building the stepping stones that make it the obvious final step to a patient/provider centered healthcare system.
Soenen: The United States prides itself on being a “Free Market” economy. Do patients have “choice” and are patients free to chose where, when and who they go to for medical care?
Roach: Privatization has failed to do everything it claimed it would do —lower and contain costs, improve quality and decrease disparities. We need full transparency on how the HMOs are using American tax dollars within our Public Health programs. They receive a specific “capitated” amount from the state, but from there we have little to no information on how much they pay providers vs. how much goes into their bank account.
Soenen: What does it mean to make the state the Health Maintenance Organization?
Roach: In May 2023, a Star Tribune article noted that the Health Maintenance Organizations (HMOs) in Minnesota’s Public Health programs made a “profit” of $675.8 million. That’s outrageous. We need transparency on their practices around prior authorizations and claims denials. All the money they’re receiving that is not being spent on direct medical care can then be used by the state to expand and improve Public Health programs, thereby making the state the HMO, if you will.
The same can be said of pharmaceutical drugs – let’s have the state be the Pharmacy Benefit Manager (PBM) as they’re superfluous and completely unnecessary. It’s time for them to go.
Soenen: Small-to-midsized business owners are especially curious to know how a shift to the Single Payer Minnesota Health Plan will improve their bottom line, the health of their employees, the health of their families and economies of their communities. How does it help the freelance photojournalist, the electrician, the plumber, the painter, the welder or disabled persons, for example?
Roach: By ensuring that all people get the care they need, when they need it, Single Payer helps keep workers healthy. That is one of the biggest assets for most employers. Because many workers cannot afford premiums and out-of-pocket expenses, they don’t get the care they need. This results in workers coming to work sick, and often leads to more serious medical problems later, and more time away from work. A growing number of small business owners are recognizing that they need Single Payer for financial reasons, as well. Employers spend countless hours shopping around for Commercial Health Insurance coverage that isn’t “too bad” and isn’t “way-too-expensive.” After finding a plan, they need to spend significant resources helping workers understand what is covered and which providers are in vs. out of network.
Soenen: When Americans become sick, injured, disabled or terminally ill, they often lose their ability to work. Then, they lose their employer-sponsored Commercial Health Insurance just at the time when they need it most. Will Single Payer untether access to healthcare from employment to ensure people can access lifelong healthcare maintenance throughout the trials and travails of their lives?
Roach: It is worth pointing out that unlike workers who lose their jobs under the current healthcare system, under a Single Payer system dislocated workers don’t have to worry about losing their healthcare or paying unaffordable COBRA rates for care – they are automatically covered, regardless of the employment status.
Soenen: How will Single Payer leverage business owners and workers?
Roach: Having spent 34 years in the labor movement, always fighting with the employer over the cost of Commercial Health Insurance, watching that “benefit” be depleted through cost shifting onto the backs of the workers at the same time as the workers were sacrificing wages to maintain that benefit, I feel safe in saying this has become one of the greatest transfers of our wealth as workers to the corporate overlords. And many employers, at least those with an organized workforce, use it as a weapon in the class warfare we’re all engaged in.
Soenen: How so?
Roach: Think about it, when organized labor exercises its right to withhold their labor, to go on strike, what’s one of the first things the employer does? They drop those workers off the Commercial Health Insuranc rolls so now those striking workers, and many times their families, are without access to healthcare. It’s nuts. Tying access to healthcare to employment stifles entrepreneurship, shackles workers to unfulfilling jobs because of the fear of being without health insurance and has caused wage stagnation which isn’t only bad for individual workers, it’s bad for the economy overall. It’s time to take healthcare off of the bargaining table and guarantee healthcare for all.
Soenen: Now over to the Kitchen Table. American entrepreneurs shoulder considerable responsibility and risk. How will Single Payer impact households, freelancers, contractors, consultants, sole proprietors and DBAs? That is, how will it help the guy who plows my driveway in the winter, or the disabled person in Lake County? What about the senior citizen who can’t afford to drive four hours roundtrip for medical care after her clinic reduced its services or shuttered? How will Single Payer impact the administrators and medical workers working at our clinics and the hospitals?
Roach: Because Single Payer reduces the overall cost of the Healthcare system, most people would be paying less for care. For many, it is the only way that they can afford care, especially for things like mental health or dental care. Some high-income households might be paying more, but like everyone else, they would have comprehensive coverage and would not face any out-of-pocket costs for care.
Soenen: Will citizens be “covered” by the Single Payer Minnesota Health Plan if they travel out of state?
Roach: Yes, people are covered when they travel just as they are under existing insurance-based coverage. In fact, they would have significantly better coverage when they travel because Single Payer offers comprehensive coverage without deductibles and co-pays.
Soenen: What will happen to the jobs of persons working for Commercial Health Insurance companies?
Roach: Any economic change can result in displacement of workers, and Single Payer legislation recognizes this and sees it as a moral responsibility to assist those facing job transitions as a result of the change. The Minnesota Health Plan would provide retraining and other dislocated worker benefits to quickly move them into new positions. A significant number of people who work in the Commercial Health Insurance bureaucracy have medical training, and some are nurses or physicians who wouldn’t need retraining. There is a serious shortage of medical providers and they could transition back to providing care.
Soenen: Networks, drug formularies, HMOs and PPOs all restrict choice in medical care and doctors. Will patients have choice under The Minnesota Health Plan?
Roach: People would no longer need to deal with Commercial Health Insurance companies to get healthcare and insurers would no longer have any ability to deny access to care or access to the providers of a patient’s choice. Contracts for care and reimbursement for care would be paid to the individual medical professional, or individual clinic or individual hospital – not paid to a large corporate entity, whether that entity is a Commercial Health Insurance company or a hospital system.
Soenen: What is Minnesota’s chance of becoming the first state to enact a Single Payer Program?
Roach: Extremely good. We have strong legislative leadership around the important issue of Public Health programs and thinking beyond the usual, market-based, incremental changes. We’re also finding more and more Minnesotans who are open to a system that removes financial and access barriers and just allows them to get healthcare when they need it, without the fear of going bankrupt in the process.
Soenen: Advocacy work is extremely demanding. What have you learned over the last 30 years and what keeps you going?
Roach: A belief that a system that focuses on health and patient care is possible. That workers are beginning to see the insanity of allowing our employers to control our access to healthcare. The idea that health insurance is a “benefit” is no longer within the sphere of reality.
Soenen: ProPublica in April of 2023 revealed that Cigna and other companies are using Artificial Intelligence software to deny medical claims at a rate of 100 per 1.2 seconds. The PBS NewsHour broadcast that Cigna alone denies about 900 million medical claims each year and relies on only one per cent of patients to appeal. In addition, Optum now employs (or is affiliated with) nearly 90,000 physicians and another 40,000 advanced practice clinicians. Optum also owns naviHealth, the post-acute management organization. The naviHealth “predict tool” is what allows UnitedHealthcare to deny medical claims at record speeds. Physicians and staff who are employed by UnitedHealthcare and Optum endorse this automated, methodical, systemic Denial of Care. Why is it still legal?
Are you hopeful?
Roach: This younger generation gives me hope. Medical students give me hope. We’re still in the fight. The movement is growing. Universal Healthcare is the ultimate act of solidarity with each other and a foundation for our common humanity.