As published in Common Dreams:  https://www.commondreams.org/views/2021/06/03/lets-go-all-out-universal-health-care-us

We should continue to vigorously advocate for a universal publicly funded privately delivered health care system at every level throughout America—state as well as national.

An article last week by Ana Manilow and Kay Tillow published by Common Dreams sounds a cautionary note about attempts to create state-based universal health care systems, because they will certainly increase the amount of fragmentation in the Medicare program. They are almost certainly right: more fragmentation is the last thing we need in our already too fragmented “system.” I know both Malinow and Tillow, and have utmost respect for their experience and judgment.

There is no doubt that a uniform national program of Improved Medicare for All would be the best way to go, on the grounds of simplicity, efficiency, effectiveness and political sustainability. But so far I see no evidence that the Congress, as it  is now constituted, has any appetite to enact anything close to Improved Medicare for All on a national scale anytime soon.

The Vermont experience

There are ongoing efforts in over twenty states to enact universal health care. Only one state, Vermont, has made a serious attempt to implement a universal health care system.

That attempt failed. Its failure was not due to economic,  technical or statutory barriers, but almost entirely due to politics. Peter Shumlin, the Governor of Vermont at the time of the attempts to enact universal healthcare system there, failed to adequately inoculate Vermont voters against the shock of transferring millions of dollars of private sector spending into taxes, as would have been required by full implementation of Green Mountain Care.

Shumlin, who barely won re-election for a second term, consequently throwing his re-election into the legislature, lost his nerve in the face of the prospects of the need to ask the legislature, that was poised to vote on his own election—for a substantial tax increase to fund Green Mountain Care despite the likely savings in overall health care spending that would have resulted if the program had been implemented.

Enacting a huge tax increase to fund health care is a good idea

The aversion to taxes and the resultant large government that is baked into American culture, (dating back to colonial times (Thomas Paine labeled government “a necessary evil”) is a major impediment to enactment of a universal health care program in the United States. It is one that proponents of universal health care, whether in the form of a state-wide or a national program, to overcome.

We have to persuade not only the public, but also legislators, that enacting a huge tax increase to fund health care is a good idea. I believe that as our healthcare system becomes increasingly dysfunctional—and increasingly expensive, voters will become increasingly willing to accept that reality. We UHC advocates must become much more effective at making the case that taxes, not private premiums and out-of-pocket payments, are the only just, merciful, and fair way to fund health care. They are likely the only way to achieve universal coverage. The U.S.is the last of the wealthy Democracies to accept this reality.

“One size DOES fit all”

We must also be more effective about explaining the virtues of everybody being in the same program (one size does fit all), and of a simpler, more transparent health care system with public accountability and the ability to control overall system-wide costs in a less intrusive way than the current system.  As the current pandemic has demonstrated, we must also have a system that encourages policy-based investments in public health, whether in a national or state-based system—that only public funding can achieve. If there is any silver-lining in the Covid-19 pandemic, it is that has exposed the need for more investment in public health, which is undeniably a public good.

We must continue our intense focus on defending against the lies we know are coming from the opponents of major systemic changes even as we continue our campaign to win over the public for the idea of a publicly funded, universal health care system.

But at the same time, we must go on offense by focusing more on the benefits of such a systemic change for the vast majority of Americans. We all agree that a Universal federally funded and managed health care system is the best way to making health care as a right a reality in the US.

The perfect is the enemy of the good

The paramount question is not whether we can achieve that perfect result, but how to get there from here, given the clash of interests in our current dysfunctional health care system

Unfortunately, the current power of the medical-industrial complex in Congress is such that federal legislators must pay “tribute” to the the large health care corporations (just like the Mafia) that increasingly control the American healthcare system. The ACA is the prime example of one of the outcomes of this reality.

Mainers take action

As an advocate for the past ten years of a state-wide program of publicly funded privately delivered universal health care in Maine, I can attest to the power of that idea to the public, if they believe it is achievable.

In reaction to the suggestion of a national solution to the problem’s of our healthcare system, people often roll their eyes. They don’t believe it’s achievable, because they don’t believe they have the power to overcome the political barriers that prevent that outcome. But when they hear about the possibility of a state-level solution, they pay attention and become activists in trying to make it happen—because they believe they may make a difference at a state-level.

Just last month, over 70 Maine voters turned out to testify at a legislative hearing in support of universal healthcare bills that have been submitted to the legislature this session.  The committee of jurisdiction of one of the bills (Maine LD 1045), not quite ready to vote to pass the bill due to concern that the state would lose some of its federal healthcare funds, carried the bill forward (didn’t kill it), and agreed to support it in the future on the condition that Ro Khanna’s State Based Universal Health Care bill (H.R. 5010), or something like it, was passed by Congress. They plan to introduce a joint-resolution to the full legislature later this year, asking Maine’s Congressional Delegation to support Representative Khanna’s bill.

That would likely would not have happened if Maine AllCare, the state-level universal health care advocacy group I helped establish in 2010, had not been conducting educational programs for the public explaining the benefits of universal health care and organizing for support of a state-based plan. In addition, we developed the language of and are advocating for the passage of a Resolve that we hope to put on the 2022 ballot expressing public support for a publicly funded, privately delivered universal health care plan in Maine.

We believe such a state-based program would not only be a step towards towards Medicare for All, but may be the only way to achieve such a program in the foreseeable future.

Our current reality

I share the concerns of Manilow and Tillow. I wish it was not so difficult to do the right thing in the U.S. I wish our country did not suffer from the systemic racism that has contributed so much to the difficulties they point out in their essay, and wish the American public had not been so susceptible to the anti-government propaganda from the right wing we have endured for the past 45 years.  I wish we had not experienced the massive takeover of our health care system by profit-driven multi-national corporations. I wish the political class and some members of The Supreme Court didn’t think corporations are equivalent to people and money is equivalent to speech. But that is the reality we are living in, and we have to find a way around it.

Mobilizing the power of the people

The idea of state-level universal health care, despite its shortcomings, is a powerful and compelling tool for education and for organizing the power of the people that will be absolutely necessary to overcome the power of the medical-industrial complex.

People, at least here in Maine, respond differently to initiatives that are seen as local as opposed to national and near as opposed to distant, because they feel there’s a better chance they, as individual voters, can have a positive impact on the outcome.

Mobilizing the power of the people is the best shot we have to halt the destruction of our patient-focused healthcare system, and to preserve Medicine as a self-regulating profession governed by the Hippocratic Oath, rather than the pursuit of maximum profitability,

We should continue to vigorously advocate for a universal publicly funded privately delivered health care system at every level throughout America—state as well as national. That may be the only way to effectively reach and motivate enough of the American public to finally achieve our common goals as a nation—health care as a right for every resident of the U.S.—a goal that is already a reality in most wealthy, industrialized democratic societies, but remains only an aspirational vision in our own. Let’s use every tool at our disposal to turn that aspiration into a reality.

Philip Caper, MD

Dr Phil Caper is one of the founders of Maine AllCare, serving on its board of directors from 2011-2020