MAKING THE CASE FOR UNIVERSAL HEALTH CARE

1. MAKING THE CASE FOR UNIVERSAL HEALTH CARE You are convinced that single payer universal health care is what America needs. Now how do you go about convincing other people? What next?

2. YOUR MISSION— • The health insurance and pharmaceutical industries (aided by the conservative media noise machine) have been pushing the notion that health care belongs in the MARKET GOODS category. • We need to get people to mentally shift health care into the PUBLIC GOODS category.

3. Fire and police protection Schools Transportation infrastructure Courts Libraries Parks and public spaces Garbage collection and recycling Consumer electronics Household appliances and furnishings Books and magazines Movies Restaurants Clothing Toys Music PUBLIC GOODS MARKET GOODS

4. What happens when you put things in the wrong category? • When you put iPods and department stores in the PUBLIC GOODScategory, you get pre-1989 Eastern Europe. • When you put health care in the MARKET GOODScategory, you kill 18,000 or more people per year who can’t pay for the care that might have saved them. BOTH OF THESE SITUATIONS ARE BAD

5. ALWAYS TALK ABOUT THE FIRE DEPARTMENT—ALWAYS! The more often you use the analogy, the more parallels you will think of. What is cheaper—having one fire department in a town, or having more than one competing with each other? What is cheaper—having one hospital in a town, or having more than one competing with each other?

6. Fires and expensive illnesses are statistically rare • The most individualistic “free” market advocate would never, ever advocate that the entire expense of firefighting be divided yearly among only those people who have had fires. • 5% of the population accounts for 50% of health care costs, and 15% of the population for 85% of the costs. Why should society shift those costs onto people who are unlucky enough to get expensively sick?

7. Health care as a right • A “right” can be constitutional, contractual, legislative, moral or ethical. • When we say that health care is a right, we are making a moral and ethical argument. • There is a time and a place for this frame, but discussions of specific policy options are NOT that time and place. • When you are talking policy, talk about health care as a PUBLIC GOOD.

8. Health care as a public good • Always point out that public goods are absolutely necessary in order for market goods to exist at all. • You can have roads without iPods, but iPods can’t exist without roads and other public goods.

9. COST CONTROLS We can control costs with GLOBAL BUDGETING. This means that all health care money is collected in a single pool, and states or regions get fixed capital and operating budgets. It is like controlling the movements of a herd of cattle by building a fence around them and letting them move freely within, unlike our current system which is like hiring a large number of cowboys with individual sets of reins for each cow. Fraud is minimized because cheaters take money directly out of the pockets of their colleagues, who will tend to notice and object.

10. An American System We can learn many different things from other industrialized countries, but we will need to put policy planks together in our own way. Global budgeting is a good idea from Canada, but there are other aspects of the Canadian system that we don’t want to imitate. • Canada funds health care from general revenues. It would be better to have a sequestered fund like Social Security. • Canada makes it difficult to get extra bells and whistles. We don’t need to follow suit. • Canada saves money by sending people to the US instead of investing in more expensive diagnostic equipment.

11. Objection #1 Why should I pay for health care for lazy slobs who never exercise, smoke and eat junk food? Why should I pay for dental care for snot-nosed kids who drink soda pop all day and whose mothers don’t teach them to brush their teeth?

12. Snappy comebacks #1 Why should the fire department answer calls from people who let their kids play with matches, have wiring that isn’t up to code, or store dirty rags in their basements? In early 2007, lack of $80 for extraction of an infected tooth killed a child when the infection spread to his brain. The subsequent unsuccessful attempt to save his life cost$250,000!

13. #1 Underlying issue People raise the question of “undeserving” people getting health care because they resent paying for the health care of the elderly, the poor, and public employees when so many of them have limited access to health care themselves. Why should they tolerate this? The answer is that they shouldn’t. The money that they are paying could and should be used for universal single payer health care that covers everybody—no exceptions. EVERYBODY IN! NOBODY OUT!

14. Objection #2 This is a capitalist country. I don’t want socialized medicine. The government screws up everything it touches.

15. Snappy comebacks #2 • When did you start thinking that Taiwan wasn’t a capitalist country? • Capitalism doesn’t work very well without extensive investment in public goods. Like roads and schools, health care is infrastructure. • The US government gave us the Interstate Highway System, the Apollo moon landing, the Internet, the aviation industry and the computer industry. • Health care will mostly be privately delivered, as it is now. The only thing that will change is the funding mechanism.

16. #2—Why infrastructure needs to be public One word—Enron As Enron and Reliant have demonstrated, maximizing profit in the energy industry amounts to large-scale theft. They found that they could make more money by withholding power than by supplying it, so that's what they did, just as insurance companies make more money by denying care than by providing it. Note that publicly owned utilities in California didn't have any brownouts during the manufactured 'crisis'. Having private health insurance is like hiring someone to tap into your power line between the meter and your house and siphon off as much as they can get by with.

17. Objection #3 Universal health care means rationing. I don’t want to die while I’m waiting in line.

18. Snappy comebacks #3 Under the current system, without money you die because you aren’t allowed into the line in the first place. For those who aren’t old or poor enough, and who aren’t public employees, a very common way to cut into the line is to deliberately commit a crime.

19. Objection #4 What are you going to do with all the surplus people in the insurance industry? (This is a serious potential problem that we can’t just blow off.)

20. Snappy comebacks #4 By sheerest coincidence, we are now looking at a very serious shortage of nurses. Retraining a work force that we now pay to tell people “That isn’t covered” to provide actual care is a non-trivial problem, but it’s where we have to go, and better sooner than later. If the financing of health care is a public good, then public oversight can insure that the claims processing jobs that remain will never be sent out of the country. This is true whether we hire existing insurance companies to do this work or build a separate institutional structure from scratch.

21. Objection #5 But people are currently satisfied with their health insurance, and an overwhelming majority are satisfied with the cost of their health care.

22. Snappy comebacks #5 • Why in heaven’s name should anyone be surprised by the fact that the 50% of the population that has NO HEALTH CARE EXPENSES AT ALL in any given year are absolutely delighted to be paying nothing for health care? • Unless you’ve been expensively sick, you don’t really know if your health insurance is any good, just as you don’t know if your local fire department is really any good until you have a fire. And if you’re really lucky, you’ll never have to find out.

23. Beyond framing—organizing • California is way ahead of us in this respect—hundreds of organizations call their Senate and Assembly members when some action needs to be taken on SB 840. • Last year, SB 840 passed both houses and was vetoed by the governor. Supporters were only two votes away from being able to override the veto. • No supporter of the bill was successfully targeted for electoral defeat in the fall of 2006. HOWEVER IMPORTANT FRAMING OUR HEALTH CARE ARGUMENTS IS, ORGANIZING OUR SUPPORTERS IS STILL MORE IMPORTANT.