CHAPTER ONE. WHY DEMOCRACY FOR AMERICA SHOULD NOT SUPPORT OBAMA’S PUBLIC OPTION PLAN

Written by: Rick Staggenborg, MD on May 10, 2009 6:10 AM PDT

Congress is reportedly considering a variety of universal health plan options that involve using multiple payer sources including a Medicare-like plan and traditional insurance offered by for-profit corporations. These plans are all supposed to offer similar benefits, but there is a huge debate as to whether the public option will have to be handicapped by regulations to decrease its efficiency to match the poor performance of private plans. 

We do not know the details of the negotiations because Max Baucus, chairman of the Senate Finance Committee, has closed the hearings after supporters of a single payer, Medicare for All plan tried to speak from the audience in the opening committee hearing.  Instead of being invited to join the negotiations, 13  patriots including doctors, nurses and lawyers were arrested and charged with trespassing for refusing to be silent in the face of this betrayal of the American taxpayer, including most of the millions of workers who were denied access to health care.

The Baucus 13 were forced to speak out  when Baucus refused to invite any single payer supporter to the hearing, which was dominated by representatives of the for-profit health care, insurance and pharmacy industries. 

The ostensible purpose of  the hearings is to come up with a plan that will provide health care to the millions of low and middle income wage earners whose taxes would disproportionately fund the resulting plan. Instead, experts in the economics of  single payer health care were excluded from the process of coming up with a plan. Predictably, this  will ultimately prove to be a bailout of the medical insurance industry that has caused the crisis. Perhaps it is not coincidental that these same industries gave a combined total of over 1.6 million dollars to Baucus during the previous Congress.

The public option will not work because Baucus and these lobbyists are not about to endorse a plan that will let the Medicare option outperform the private plans, as it would if it were operated as efficiently as possible. How could Medicare, with its three percent overhead not outcompete private insurance, which consumes 30 per cent of its revenue in administration, advertising, marketing and profits? 

The only reasons Medicare is so expensive is that 1) It covers the at-risk elderly and the much sicker patients who cannot get private insurance and 2) Since the passage of the Medicare Modernization Act, it has been burdened by partial privatization and the unsustainably expensive Part D medication plan that specifically bars the government from negotiating for favorable drug prices using its huge purchasing power. These problems can be corrected by incorporating what amounts to repeal of this law in the reform legislation. 

As an Oregonian, I cannot fail to note that our own Senator Wyden cast the final and deciding vote for this bill, despite strong Democratic opposition to this blatant gift to the private medical insurance and pharmaceutical industries.

The Medicare Modernization Act is a perfect example of what a Senate brought to us by corporate sponsors will produce when it is not watched closely by citizens. This is the reason we must educate ourselves about the options being considered by Congress and more importantly, the one that is being explicitly not considered, the single payer system. 

Polls show that this is the option favored by over 60% of the American public and 60% of physicians. These numbers are growing rapidly as universal insurance approaches reality and people are educating themselves about the costs and benefits of various proposals. The percentage of doctors favoring a single payer plan has increased by ten percentage points in just five years.

The public option plans are estimated to sacrifice over 80% of the savings achievable through a single payer plan in order to satisfy the corporate medical care industries that dictate policy to many of our Senators. Single payer achieves its efficiencies through a variety of means. 

It streamlines paperwork and would dramatically cut administrative costs to providers that currently consume 10 % of the health care dollar. It eliminates excessive insurance industry profits and all of their advertising and marketing expenses. It would lower administrative costs because government employees do not demand excessive salaries to serve the public. A single payer plan can monitor abuses of fee-for-service providers and administrators will have the mission of ensuring prompt payment to providers, rather than to repeatedly review claims to find loopholes to deny payment.


Most people do not realize that government is only expensive because we keep re-electing pork-loving politicians who reward their corporate masters with lavish contracts paid for by the taxpayer. If we paid more attention to what our Congressional representatives were doing and routinely got rid of those not serving the public interest, corporate money would be less influential. In other words, most of the blame for the exorbitant cost of government is ours.

We are not powerless. President Obama has told us that we must “be the change.” If we let our Congress know that we want single payer now through letters to newspapers, magazines and especially calls, emails and faxes to members of Congress, we can change minds by empowering more responsible members of Congress to resist lobbyist pressure. 

As for those who put corporate interests over those of citizens, we can send them an even stronger message in 2010 and 2012, when 2/3 of the senate will stand for re-election. While there are compelling reasons to oppose single-issue voting, the establishment of a single payer system is the defining civil rights issue that will tell us which members of Congress understand and believe in democracy and which do not.

Please learn more about the advantages of a single payer system of universal health care at the website of Physicians for a National Health Program.

Rick Staggenborg, MD


Physicians for a National Health Care Plan


Coos Bay, OR

CHAPTER THREE. WHY THE PUBLIC OPTION WON’T WORK: HOW SINGLE PAYER WILL SAVE DEMOCRACY IN AMERICA

Written by: Rick Staggenborg, MD on May 21, 2009 7:40 AM PDT

This essay is dedicated to James Madison, chief architect of the American Constitution.

Americans need to know that Congress is refusing to consider the single payer approach to universal health care for a reason: Max Baucus and other key committee members writing the legislation refuse to betray the interests of medical insurance industry lobbyists. Go to opensecrets.com and see for yourself how Baucus received 1.65 million from these corporate interests to come up with an expensive taxpayer bailout of the failing private insurance industry.

Democratic senator Charles Schumer  has announced his intention to refuse to vote for any public option plan that does not force the public option to be handicapped in such a way that it will not compete with private insurance plans using its inherent cost advantages. The result is that tens of millions of Americans will continue to suffer from lack of insurance or underinsurance.

The whole point of health care reform is not just to provide universal access to health care, but to do so in a sustainable way. We cannot afford to continue to sacrifice our children's future for the sake of the profits of these soulless corporate entities. It was a group of particularly fallible men on a previous Supreme Court that erroneously or deliberately decided that corporations have all the rights of citizens. 

Some of us find convincing Jeffrey Toobin's argument that the current court has so little respect for precedent that the rule of law itself is threatened. Fortunately, more recent decisions suggest that they have begun to take their responsibilities more seriously. (Note to reader: This was written prior to the Citizens United decision).

Thank God that erroneously decided opinions can be reversed by a more enlightened Court. The legal argument that corporations are persons as referred to in the Fourteenth amendment and thus possess the rights of natural persons was not based on precedent and is incontrovertibly erroneous. The due process clause of the Fourteenth amendment clearly states that "All persons born or naturalized" in the United States are guaranteed all the rights of the Constitution. If corporations are born, then it seems that the government should be able to execute them for crimes against humanity, but this does not seem to be the case in the Incorporated States of America.


Corporate personhood has resulted in formerly illegal lobbying practices corrupting Congress and the Senate in particular. This Court must recognize the danger of discarding stare decisis, or We the People may have to call for a constitutional convention to restore the meaning of "person" under the Fourteenth amendment to its original, intuitively obvious meaning. The only other alternative is for Congress to pass such an amendment itself, which is clearly beyond the realm of the possible with this Congress.

It is not that all politicians are working against the public interest. Many understand the problem and want to stand up for single payer but are afraid to make themselves the target of smear campaigns by these ruthless advocates of naked greed. President Obama himself has repeatedly stated that the single payer plan is optimal but that he believes it is politically impossible. This may simply represent a failure of imagination. He is said to be a political chess grandmaster and I do not rule out the possibility that he foresees the results of this blatant antidemocratic process and is waiting for the American people to rise up in righteous anger and "Be the change."

It makes little sense to me to hold the President responsible for failing to expect more out of this Congress, when he sees passage of some form of reform as critical to his ability to advance the rest of his domestic agenda. Whether or not he is considered sufficiently progressive by Democrats, the consequences of his being replaced by an even more neoconservative President with a veto pen would be disastrous, as recent history has demonstrated. 

Failure to recognize the culpability of a bought and paid for plurality in Congress would be a grave tactical error if progressives want to ever advance our cause. The only recourse is to follow the lead of Republicans and organize together to elect those Senators and Representatives who would best represent what we consider to be American principles. 

While some believe that the Democratic Party can be reformed just as the Republican Party was transformed into a blatant arm of the corporatocracy, human nature suggests that true change will only come from outside the Party. It is clear that its leadership feels that cooperation with the corporate interests that now control the political process is in their own best interests. I am sure that they believe that this is the only way to represent the People against corporate power, but their actions belie their stated intentions.

I believe that President Obama will withhold his support of single payer until the public stands up as one and demands it. This is our chance to prove that despite a dysfunctional Congress, we still have the power to take back the American government and demand that it serves the interest of the people it is supposed to represent.

Will we have a government of the people, by the people and for the people or will we simply continue to shrug and drop out of the political process in despair of the prospect of taking back our government from corporate rule? Our task is to build a movement that will take to the streets and demand that the interests of the People be given precedence to those of the corporate sponsors of campaigns for our Congressional representatives. Failure to do this would be to surrender the fight to restore democracy in America.

We need to write, call, fax and email our Congressmen and demand single payer now. If a complicated and expensive substitute is created now, we will eventually have to borrow more money from China to finance it, since there is no constituency willing to bear the burden of paying the ever-increasing cost of a multipayer system accessible to all and there is no way to prevent cost inflation in such a system. China has already indicated its hesitancy to continue financing our profligate ways. Wake up, America! We have no real choice. When the average income is projected to equal the average individual insurance premium by 2025 at current rates of growth, we must have single payer and no other form of health care reform.

It is ironic that the birthplace of modern democracy has ceded its leadership role to the former monarchies of Europe who have been able to achieve this obvious means of providing what the UN has declared is a human right. We have to stand up to the fundamentalists of the cult of Ayn Rand and prove to them that they are wrong. The pursuit of individual self interest is ultimately destructive. Just look at what it has done to the world economy if you still need proof.

Get off your knees and join the fight to preserve democracy in America. There is no use  praying that our President expend some of his enormous political capital to give us real health reform or that he would find the Senate receptive if he tried.

To paraphrase the immortal words of Jack Crabb in the classic movie "Little Big Man" as he simply used the truth to set up his revenge against the arrogant and cocksure General Custer: "You go, General. You go into the streets of America with your army of corrupt and cowardly Congressman armed only with corporate blood money. You are going to be facing millions of angry Americans. These ain’t helpless men, women and children. Them are American warriors, brave and true. They are going to fight to the death to protect their children's future. So you go, general. You go out there and see what happens."

Rick Staggenborg, MD


Physicians for a National Health Plan


Coos Bay, OR