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The Guardian: Universal healthcare supporters see their chance

By Jessica Glenza, April 11

Minerva Solla (far left), an organizer with the New York State Nurses Association, works a crowd of healthcare demonstrators in Albany, New York.

Minerva Solla, far left, an organizer with the New York State Nurses Association, works a crowd of healthcare demonstrators in Albany, New York. Photograph: Jessica Glenza for the Guardian

It was a cold, misty, gray, early spring day in Albany, New York – the kind of bone-chilling, turn-up-the-heat weather that encourages residents to flee to Florida.

But 500 New Yorkers were still out on the sidewalk lobbying for healthcare reform that has long seemed like a pipe dream: government-provided universal health insurance.

“I wanna make sure my children get healthcare,” said Minerva Solla, a 66-year-old organizer with the New York State Nurses Association. “It’s a right, not a privilege.” Moments earlier she riled the crowd with call-backs: “If they don’t pass it? Vote them out!”

Americans might know the liberal dream as “Medicare for all”. If it ever passed, it could be as comprehensive as the UK’s National Health Service.

Universal healthcare is not a new idea, but one with fresh energy since Republicans’ disastrous attempt to reform the American health system. In Albany, a record number of peopleturned out to a rally for universal healthcare in New York, several activists and one lawmaker said.

“It’s an uphill battle, and the Republicans are in control of Congress, and there’s no signal they would be willing to let this pass right now,” said Clare Fauke, spokesperson for Physicians for a National Health Program, which advocates for universal healthcare. “But we’ve been thinking in terms of the long game, and there’s never been more support for it than there is right now.”

In a universal healthcare system, New York would pay for every resident not covered by an existing federal health insurance program, like Medicare for the old or Medicaid for the poor. For-profit health insurance companies would be all but eliminated.

That would mean New Yorkers would be freed from “co-pays”, “deductibles”, and “premiums”, all insurance industry jargon for one thing: medical bills.

“We’re unanimous that this is the most logical system going forward,” said Phil DeSalvo, a 29-year-old medical resident from New York City. He and three fellow health workers traveled three hours north on their only day off to protest. Was universal healthcare gaining momentum?

“Absolutely, particularly with the collapse of the plan advanced by the Republicans,” he said. “This is the best solution going forward.”

Despite campaigning for seven years to “repeal and replace” the Affordable Care Act, better known as Obamacare, Republicans’ first attempt at a reform bill sank like a stone.

Trump and the Republican leadership’s concessions to both hardline conservatives and moderate Republicans made the bill a mishmash. Tax credits would have helped Americans buy private insurance, but the gutting of insurance regulations would have made policies practically meaningless. It would have left 52 million people uninsured by the end of the decade, at last estimate.

It had an abysmal 17% public approval rating, and lasted two weeks before it was pulled. It is Trump’s single largest loss to date. In the vacuum of ideas, liberals have conjured hope.

“I think fear of the Republican bill, and fear that it will come back in even worse form, is sparking support,” said Richard Gottfried, a New York City Democrat who has sponsored a universal healthcare bill since 1992.

Advocates of universal healthcare are not missing an opportunity to make a fuss. Physicians for a National Health Program held their first day of national rallies to coincide with the Congressional recess on Saturday. Protests were planned from Florida to New Hampshire, Oregon to North Carolina.

Bernie Sanders plans to introduce a bill in the US Senate to support single-payer healthcare. In the House, there is already a single-payer bill with 93 co-sponsors.

In an issue of the British medical journal the Lancet devoted to the US healthcare system this week, Sanders wrote the opening letter.

“The goal of a healthcare system should be to keep people well, not to make stockholders rich,” wrote Sanders. “The USA has the most expensive, bureaucratic, wasteful, and ineffective healthcare system in the world.”

Sanders called single-payer healthcare “as American as apple pie” – an attempt to throw off single-payer reform’s negative reputation as “socialized medicine”.

Meanwhile, the American healthcare system may be worsening inequalities, the the Lancet found. A widening income gap, paired with insurance companies’ increasing tendency to push health costs on to consumers, has resulted in a “regressive” system in which the richest 1% of Americans can now expect to live up to 15 years longer than the poorest 1%.

Even for those who have insurance, increasing monthly costs have eroded wage gains, the Lancet reported. Medical debt accounts for more than half (52.1%) of all unpaid personal debt.

“I could tell you this – I’ve been on the job for 25 years. When I first started, I paid nothing” for healthcare, said Chris Tague, who works in road construction. He is also a part-time town supervisor in Schoharie County, New York, which voted overwhelmingly for Donald Trump.

Tague’s health insurance costs grew to $20 per week, then to $50 per week, then $75, then to more than $200 per week, he said. Middle class Americans, he said, “work their asses off for nothing”.

The ACA insures more Americans than ever. Nevertheless, 9% of Americans, or 28 million people, remained uninsured in 2015, according to the Kaiser Family Foundation. Those people are predominantly in Republican-led southern states, which rejected an expansion of Medicaid, a federal program for the poor, even though the national government paid for it.

Even conservatives admit that government-run healthcare could save money.

“I mean look, you can save money with a single-payer system, don’t misunderstand me,” said Robert Moffit, a policy analyst at the conservative Heritage Foundation. “But the quality and supply of medical services is going to be determined by government officials.”

For this and other reasons, many argue single-payer reform simply is not viable.

“The history of healthcare reform in the US has dictated that it is politically untenable,” said Richard Boxer, a Los Angeles urologist who studies insurance reform. He pointed out that a public insurance option was proposed when the ACA was first under consideration in 2010. A Democratic Congress rejected the idea.

Grassroots efforts at the state level have also failed.

In Colorado, advocates tried to establish a state-funded universal health program through a ballot initiative last year. State residents would have paid a 10% payroll tax to fund the program.

Though the program would have insured all Coloradans, only 20% of voters favored the effort.

The insurance industry group Coloradans for Coloradans had a seven-to-one fundraising advantage at one point. The group raised more than $4m, its single-largest $1m donation coming from the insurance company Anthem. Comparatively, the pro-universal healthcare group ColoradoCareYES raised $902,000.

“The insurance companies, of course, were worried this would pass,” said Patricia Rice, a spokesperson for ColoradoCareYES. “Because it would signal a tidal wave. Once it passes in one state, I think it would just spread to other states and it would cut into profits.

“They were throwing everything they had at us, and we only had a few spots on television,” said Rice.

Richard Gottfried of the New York state assembly advocates for the New York Health Act, a piece of legislation he has sponsored since 1992, in Albany.

Richard Gottfried of the New York state assembly advocates for the New York Health Act, legislation he has sponsored since 1992, in Albany. Photograph: Jessica Glenza for the Guardian

The economics of a public option

Most analyses of universal healthcare assume that money taxpayers once spent on private insurance would go to support a government program, and that the elimination of bureaucracy and profit would save money.

A 2015 analysis of single-payer health insurance in New York found the system would save $44.7bn in healthcare costs in the first year, assuming the state could negotiate with drug companies. Studies of single-payer healthcare at the federal level have also found savings. One 1998 study found that a single-payer health system would lead “to sizable savings in the future”.

Not all projections are rosy. The non-partisan Committee for a Responsible Federal Budget analyzed Sanders’ plan for universal health coverage in 2016, and found it would add $19tn to the federal debt.

New York’s latest battle to pass universal healthcare represents a theme in the long fight – so close to passage, but so far from enactment.

Gottfried’s bill is expected to pass the lower New York state assembly, but could run into trouble in the Republican-controlled senate.

The Republican senate majority leader may never let the legislation come to the floor, and it is an open question whether the moderate Democratic governor, Andrew Cuomo, would support the legislation.

If the bill did make it to the senate floor, just one Democrat stands in the way of a majority: Simcha Felder. He represents deeply conservative orthodox Jewish neighborhoods in Brooklyn, and often caucuses with Republicans.

“I do not have a position on the New York health act,” Felder said in an email. “This legislation would be a huge overhaul of the healthcare system in New York, and I would like to hear from experts and other senators on the committee.”

“Everybody’s calling about it,” said a worker in Felder’s office, as she folded a “Healthcare is a human right” sign in half and stuffed it into a wastebin.

Just an hour earlier, Dr Roona Ray was whipping up demonstrators, exclaiming, “We can have healthcare that covers everyone as a right and as a public good,” she said. “There will be no premiums, no co-pays, no co-insurance, no deductibles, no doughnut holes, no bills!”

“The other side has money,” she said, “but we have people.”