We are not Europe. We are not Canada. We are America. This is not a single pay country. (1)

This has been the uncompromising view of Senator Max Baucus (D-MT), who as chairman of the key Senate Finance Committee in 2008 and 2009 played a leading role in shaping the Affordable Care Act (ACA). As described in my 2010 book, Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform, he and his committee kept a single-payer option off the table, and even called the police to arrest eight activists who showed up for a hearing before his committee on health care options. (2) Elizabeth Fowler, a former health insurance industry insider as vice president for public policy for WellPoint, was the lead author of the Senate Finance Committee bill that made sure that the industry would be well served by the legislation. (3)

Conservative politicians, including both Republicans and many Democrats, have long been wary of a single-payer public financing system for national health insurance (NHI). They go out of their way to denigrate the Canadian system, even though it is extremely popular in Canada since its enactment in the 1970s, is tied to a private delivery system, and is more efficient and less bureaucratic with better outcomes than our far more expensive system. They tell us that a public financing system would be un-American and antithetical to American values, while overlooking the strengths of traditional Medicare and the Veterans Administration. Their opposition to NHI, of course, is enabled and perpetuated by extensive lobbying and campaign donations by the insurance industry.

These erroneous assertions by conservatives about public opinion concerning health care financing are entirely discredited by national polls over many years, virtually ignored by the mainstream media. Three of four Americans supported NHI during the 1940s (4) Since then, a majority of respondents to many national surveys have supported NHI. A 2009 CBS/New York Times poll found that 59 percent of respondents supported NHI. (5) A 2015 Gallup poll found that satisfaction of enrollees is highest in publicly financed health insurance programs (78 percent for the VA, 77 percent for traditional Medicare, and 75 percent for Medicaid), compared to 69 percent for employer-sponsored private coverage and 65 percent for individually purchased private plans. (6) After seven years with the Romney health care reform plan in Massachusetts, upon which the ACA was based, 72 percent of respondents to a survey prefer NHI to that plan. (7) A 2015 survey by the Kaiser Family Foundation found that 84 percent of respondents support Medicare negotiating discounted prices for prescription drugs. (8)

The U. S. society is in the midst of major political, demographic and cultural change. Noam Chomsky, professor emeritus of linguistics at the Massachusetts Institute of Technology, historian, philosopher and political activist, brings us this perspective of these changes:

There can be no denying that the United States is undergoing a serious ideological and political realignment due to its rapid transformation into a society characterized by an immense gap between rich and poor, unprecedented economic insecurity and growing poverty, the abandonment of public investments in public infrastructure and an overall decline in the standard of living.. . . The [November 2016] elections are quite significant, whatever the outcome, in revealing the growing discontent and anger about the impact of neoliberal programs of the past generation, which, as elsewhere quite generally, have had a harsh impact on the mass of the population while undermining functioning democracy and enriching and empowering a tiny minority, largely in financial industries that have a dubious, if not harmful, role in the economy. . . . The tendencies have been clear for some time, but, in this election, the party establishments have lost control for the first time. . . . It is rather striking, for example, to see how easily the Democratic Party almost openly abandons the white working class, which drifts into the hands of their most bitter enemy, the leadership and power base of the Republican Party. (9)

Health care is primarily not a left-right issue, as a December 2015 national Kaiser public opinion poll found--58 percent of adults in the U. S. supported NHI (Medicare for All), including 81 percent of Democrats, 60 percent of Independents, and 30 percent of Republicans. (10) Since we all depend on access to affordable health care on many occasions, it should not be a partisan issue. Having a large risk pool--all 320 million of us--will benefit the common good most effectively and at lowest cost to us as patients and taxpayers. All of us will need affordable access to care at various points along our journeys in life.

Instead of a left-right issue, health care reform has become a top-down issue--corporate profits and oligarchy vs. democracy and the public interest. So far, democracy is losing, and the pendulum will have to swing back to best meet the needs of all Americans. Robert Reich, professor of public policy at the University of California Berkeley who was secretary of labor in the Bill Clinton administration and served in two previous administrations, sums up our current choice for the future of health care this way:

The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people. Or else a government-run single-payer system--such as in place in almost every other advanced economy--dedicated to lower premiums and better care for everyone. We're going to have to choose eventually. (11)

References:

1. Baucus, M. As quoted in an interview with Karen Tumulty from Time Magazine in a Health Care Reform Newsmaker Series, March 3, 2009. Kaiser Family Foundation.

2. Robbins, K. Baucus 8 update: Single payer in the news. Healthcare-NOW! May 7, 2009.

3. Conner, K. Chief health aide to Baucus is former WellPoint executive. Eyes on the Ties Blog, September 1, 2009.

4. Steinmo, S, Watts, J. It's the institutions, stupid! Why comprehensive national health insurance always fails in America. J Health Politics, Policy and Law 20: 329, 1995.

5. Public opinion polling on single payer: Americans (still) support it! Everybody In! Healthcare NOW!'s Quarterly Newsletter on the Single-Payer Healthcare Justice Movement, 10, Spring 2016.

6. Saluja, J, Zallman, L, Nardin, R et al. Support for National Health Insurance seven years into Massachusetts healthcare reform: Views on populations targeted by the reform. Intl J Health Services. OnlineFirst--November 3, 2015.

9. Ibid # 6.

10. Reich, R. Why a single-payer healthcare system is inevitable. Common Dreams, August 22, 2016.