Advocates of Single-Payer Health System Say White House Left Them Out

By Alex Wayne
Congressional Quarterly
March 4, 2009

Groups that support a government-run, single-payer health care plan similar to those in Canada and Europe say they have been shut out of Thursday’s White House summit on overhauling the nation’s health system.

The groups argue that President Obama is trying to appease the health insurance industry and political conservatives, who are certain to fight any health care overhaul that does not keep insurance companies in business. Obama has said that he does not support establishing a single-payer system.

It’s not clear exactly who has been invited to the summit, but the list includes lawmakers, representatives from the health industry and advocates for all manner of overhaul plans. Advocates for a single-payer system — which effectively would obviate the need for health insurers — say they were left out to limit the scope of the discussion.

“If they actually were to introduce single-payer advocates into the room, there would be genuine debate about what direction to go,” said Michael Lighty, national policy director for the California Nurses Association/National Nurses Organizing Committee, a large labor union that advocates for an expansion of Medicare to cover all Americans.

“That is apparently a political decision they don’t want to face — a policy argument on the merits,” Lighty said. His union is part of a new group advocating for single-payer health care called the Leadership Conference for Guaranteed Health Care.

None of the group’s member organizations were invited to the summit; they have circulated e-mails to their constituents, including doctors and nurses, urging them to call the White House to complain. One of the groups, Physicians for a National Health Program, is organizing a protest on Lafayette Square at noon Thursday.

Earlier this week, House Judiciary Chairman John Conyers Jr., D-Mich. — probably the most outspoken advocate for single-payer health care in Congress — asked for an invitation to the summit and was turned down, Lighty said. The White House, according to Lighty, told Conyers that only the chairmen and senior Republicans on committees with jurisdiction over health care were invited to the event.

A spokesman for Conyers did not respond to phone messages or an e-mail asking about the dispute. Wednesday morning, according to the nurses association, the White House reversed itself and extended Conyers an invitation.

Lighty said that his group’s request for an invitation to the summit was denied on the grounds that its parent union, the AFL-CIO, will have a representative there.

A White House spokesman, Reid Cherlin, said he wasn’t aware of the complaints by single-payer advocacy groups but would look into the situation. The White House’s Web site describes single-payer health systems as one “extreme” in the spectrum of health care overhaul proposals; the other, the White House says, is “letting the insurance companies operate without rules.”

“President Obama and Vice President Biden believe both of these extremes are wrong,” the Web site says.

The term “single payer” generally describes a health care system in which only one entity — the government — pays everyone’s bills. Many senior Democrats besides Conyers have long supported establishing such a system, including Rep. John D. Dingell, D-Mich., and Sen. Edward M. Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee.

But after a coalition of lobbyists for the insurance industry and business sectors managed to defeat President Bill Clinton’s attempt to overhaul the health care system in 1994, most Democrats reconciled themselves to the idea that insurance companies could never be excluded from health care.

Dingell, for example, introduces legislation in every Congress to expand Medicare to cover every American. But the bill has never seen debate — not even by the Energy and Commerce panel, where Dingell was the top Democrat for many years. And Kennedy has spent the last six months meeting with insurers and other health industry representatives to try to reach compromise on a health care overhaul that keeps them in business while expanding insurance coverage to millions of Americans who lack it. Senate Finance Chairman Max Baucus, D-Mont., is doing the same.

“People have lowered their expectations so severely in this country in terms of what’s achievable,” said Rose Ann Moro, executive director of the nurse’s association. She and her colleagues argue that most Americans would prefer a single-payer system, in which they would have a free choice of doctors, hospitals and other health providers, over private insurance, in which those choices are restricted.

The insurance industry argues, in effect, the opposite: That most people with private insurance through their employers are satisfied with their coverage and do not trust the government to take over the health care system.

Some Democratic Party-aligned health activists have taken to pushing for a variant on single-payer health care: an insurance plan run by the government — like Medicare, but open to all Americans, not just seniors — that would compete with private insurance plans. But they call this proposal a “public plan option,” not single-payer health care.

Roger Hickey, chairman of Campaign for America’s Future, a liberal advocacy group, was invited to the summit and said he plans to press for such a public plan, as part of health care reform. He was reluctant to discuss the plight of the single-payer advocates on the record.

“It is definitely part of the debate,” he said of single-payer proposals.