[Peace-discuss] Lessons On The Struggle For Health Care As A Human Right

Mon Jan 5 10:24:27 EST 2015

Lessons On The Struggle For Health Care As A Human Right

Description: 1hchr

By Margaret Flowers, www.popularresistance.org
January 4th, 2015

What happened in Vermont where a so-called single payer proposal died?

For decades healthcare advocates in the state of Maryland worked with state
senator Paul Pinsky who introduced a state health bill each year calling for
a universal healthcare system that is publicly financed, a single payer
system. Even when advocates educated lawmakers, gathered co-sponsors and
testified in committees about the dire need for a health system that would
solve the current healthcare crisis, one based on solid evidence, the bill
fell flat. The closest we came was one vote short of getting it passed in
one committee. We had all of the facts on our side, but no political muscle
to move the bill.

 <https://www.popularresistance.org/wp-content/uploads/2015/01/1hchrvt.jpg>
Description: 1hchrvtThe people in Vermont took a different approach starting
in 2009, and we in Maryland have since followed their lead
<http://healthcareisahumanrightmaryland.org/> . The Vermont Worker
<http://www.workerscenter.org/> 's Center and allies started by first
building the grassroots movement necessary to provide that muscle. They
focused on educating people throughout the state and used a human rights
framework to do that.

After years of work to elect a favorable governor, pass legislation and
implement it, the people of Vermont were recently spurned by Governor Peter
Shumlin when he announced
<https://www.popularresistance.org/vermont-governor-unilaterally-denies-sing
le-payer-health-care/>  that the state would not go ahead with the health
law as planned. This turn of events provides an important lens for examining
what happened in the advocacy for health reform and what must be done now.
The fight for universal healthcare has been going on for a century in the US
and it is certainly not over
<http://www.workerscenter.org/news/release-vermont-workers-center-responds-r
elease-gmc-financing-report>  because of Shumlin's failure.

I want to say from the beginning that I applaud the people of Vermont.
Hindsight is always clearer. The groups on the forefront of this struggle
face many critical issues that need attention and lack adequate resources as
it is for most groups that are working to change the system. So this article
is not a criticism of them, but rather an analysis of the situation and what
we can learn from it for current organizing efforts throughout the US as
well as next steps in Vermont.

Human Rights Framework is Necessary

There has been hesitancy by some health reform advocates to embrace the
human rights framework for single payer organizing. However, the human
rights framework is necessary for organizing on all of the social, economic
and environmental justice issues that are in crisis today. It helps us see
that all of our issues are connected, know when our human rights are being
violated and advocate for changes that respect all of our rights.

<https://www.popularresistance.org/wp-content/uploads/2014/12/1hchr-e1418913
627830.jpg> Description: 1hchrMany in the US don't understand that they have
human rights, let alone that their rights are being violated. The human
rights framework is based on five core principles. Put simply, they are
universality, that all people are included; equity, that all are able to
participate; transparency, that all have access to information;
accountability, that those who make decisions answer to the people; and
participation, that all are able to participate in the process. It is the
government's responsibility to guarantee our human rights.

Once we have this understanding of our rights, we see the violation of our
human rights across a broad sector of issues whether it is the right to
housing, education, a job with a living wage, healthcare, clean water and
air or other rights. Then we can look more deeply to understand why these
rights are being denied and that there are systemic root causes that are the
same for all of these issues. All of our struggles face the same obstacles
of monstrous industries that are driven by profit through exploitation of
people and the planet and that control not only the lawmakers but in most
areas, the method by which they are elected.

Several studies were released last year documenting that public policy
reflects the desires of the wealthy rather than the needs of the majority of
people. We are facing a crisis of democracy
<https://www.popularresistance.org/fighting-for-a-legitimate-democracy-by-an
d-for-the-people/> . It will take all of us working together strategically
to overcome these obstacles and shift the balance of political power to
respect our rights.

The human rights framework teaches us that we cannot accept that rights are
respected for some and not for others. A core principle is universality. For
example, a health law that gains access to care for some but leaves others
out does not fulfill the criteria. The human rights framework prevents the
tried-and-true tactic of 'divide and conquer'. It requires that our work is
not done until we all have the same rights.
This human rights framework is especially relevant when it comes to health.
The US spends the most per capita on health care in the world but our health
outcomes are relatively poor. If our goal is a healthier population, then we
must recognize that our fight is not only for access to health care, but is
also for quality education, housing, a healthy environment, an end to
systemic racism and all of the factors that constitute the social
determinants of health.

And not only do we need to include all of these factors in our ultimate goal
of health, but to succeed in changing the system we need to build a movement
of movements that has the political muscle to overcome the for-profit health
institutions that are heavily invested in maintaining the status quo. The
healthcare movement needs to collaborate with those who are fighting for
other rights.

Beyond the Human Rights Framework We Need Clarity

While the human rights framework is necessary for public education and
connecting movements, it is not sufficient when it comes down to the details
of policy and this is where clarity is key. This is one area that was
problematic for the healthcare campaign in Vermont which resulted in the
current failure of the health law and greater confusion about single payer
health care.

The approach of the Vermont campaign was to first pass a law in 2010
requiring the state to hire a consultant to develop three health systems
that meet the five human rights principles. The Health Care is a Human Right
campaign organized across the state and built a strong grassroots base that
not only led to passage of that law, but made single payer health care a
major component of the gubernatorial race that year. Peter Shumlin, who won
that election, spoke out strongly and publicly for single payer health care.

Once the law was passed and Shumlin was in, the grassroots told lawmakers
that it was up to them to design a system that met the human rights
principles. The grassroots did not demand that it be a single payer system.
And the ultimate choice for a health system in Vermont was not a single
payer system but a multi-payer system with a tax-funded public option to be
available to whomever did not qualify for Medicaid or Medicare and did not
have private insurance.

 <https://www.popularresistance.org/wp-content/uploads/2015/01/1pnhp.jpg>
Description: 1pnhpThis is where the lack of clarity caused significant
problems. First, a single payer healthcare system is the only way to solve
the healthcare crisis. The type of healthcare system that Physicians for a
National Healthcare Program <http://www.pnhp.org/>  and other single payer
advocacy groups have pushed for would create a unified system in which
everyone is included that provides comprehensive benefits and is financed
through a progressive tax. These are the essential ingredients that create a
system which places health, not profit, as the priority and that has
built-in cost savings that make such a system affordable. Because the
Vermont plan lacked necessary cost-control features, it was unlikely to
succeed.

Another problem has arisen because although the Vermont plan is not a single
payer system, some health advocates, the Governor and other lawmakers and
the media have been calling it a single payer system. Now that it has
failed, the message that the public is hearing is that "single payer is too
expensive." This is the opposite of the truth. Numerous studies
<http://www.pnhp.org/facts/single-payer-system-cost>  and practical
experience in the US and abroad have shown that the US' current market-based
system is the most expensive and single payer systems are the most cost
effective.

Clarity on the details of what does and does not work is critical because it
is common for health laws to be called universal, affordable and guaranteed
when the reality is that they are none of those things. We saw this when the
Affordable Care Act was signed into law. That is why it is imperative that
the grassroots not only understand the human rights principles, but is also
clear about what policies will and will not accomplish the end goal.

Human Rights Principles Also Apply to the Political Process

Another obstacle for the health reform process in Vermont is that the
process itself did not meet the human rights principles, particularly of
transparency, accountability and participation. Early on, as the legislation
was being formed in the state house, members of the grassroots were heavily
involved and watchful of each change to the bill. When they noticed changes
that were negative, they applied pressure on lawmakers to have them changed
or dropped. This vigilance and pressure were critical to shaping the law in
favor of the people.

Once the law was passed and signed, the next steps were the implementation
of the various pieces of it such as the public insurance, called Green
Mountain Care, and the financing mechanism, which was to be determined by
the Governor. It was the process of determining the financing that was
problematic. Governor Shumlin ignored requests from the grassroots to
include health finance experts that were proponents of a single payer system
and instead met behind closed doors with business leaders.

Pro-market-based healthcare reform advocates were also close advisers. A
chief consultant to the health reform process was Anya Rader Wallackcame who
came directly from the Blue Cross Foundation. Blue Cross is the largest
private insurer in Vermont. She is now leaving Vermont to go to Rhode Island
to work on the health insurance exchange (essentially the government selling
health insurance).

The Governor also used a flawed economic model which is known to
overestimate health care spending developed by Jonathan Gruber, a former
White House adviser during the 2009 national health reform process. Not only
does he support the health insurance dominated Affordable Care Act, but he
supports privatization of Medicare by pushing the elderly and chronically
ill into the insurance exchanges.

<https://www.popularresistance.org/wp-content/uploads/2014/12/Shame-on-Shuml
in-rally-6.jpg> Description: From WPTZ

>From WPTZ

The Governor delayed his announcement of the financing for the system,
ignoring the deadline set by the law that it be completed in 2013, until
after the election in 2014. In mid-December, he held a press conference
where he said that the cost of the system was too expensive and therefore,
it would be impossible. The grassroots movement, led by the Vermont Workers
Center, immediately responded with a protest of the Governor calling his
career
<http://vtdigger.org/2014/12/18/protesters-demand-action-single-payer-condem
n-shumlins-betrayal/> "toast" for his failure to meet his obligation
established by the health law.

Holding Politicians Accountable

In my experience, lawmakers have an endless supply of excuses to explain why
they fail to meet the needs of the people and most of them are manufactured.
It is unlikely that Governor Shumlin would have reached the same conclusion
about the financing of the health system if he had used an open and
transparent process that allowed participation of the grassroots base and
health finance experts that are proponents of single payer systems rather
than of market-based systems. Even if he did reach the same conclusion, a
more open and participatory process would have allowed the public a deeper
understanding of the reasons for it.

This is why the grassroots must insist on transparency and participation.
And if these demands are not met, then politicians must be held accountable.
Secrecy only exists in public policy when the needs and desires of the
people are being disregarded.

Governor Shumlin has not yet won re-election in Vermont because he did not
win more than 50% of the votes. The state legislature will decide the next
governor in early January. This is the time for the grassroots in Vermont to
demand that he not be elected. If the movement is to have any muscle, they
must be willing to flex it. Unseating Shumlin now means that future
lawmakers will think twice before selling out their constituents on this
issue. If the grassroots does not demand that Shumlin be unseated, they will
have revealed that they are weak and ineffective. If Shumlin is unseated,
that gives two years for the movement to continue to move the health law
forward and to find a candidate that will work with them.

Political muscle is critical for progressive legislature which defies the
interest of the big industries that are in control of the system. Take the
recent fracking ban in New York. That only came about because a strong
grassroots demanded studies of the effects of fracking and hounded Governor
Cuomo literally everywhere he went for six years.

Randy Shaw, author of "The Activist
<http://www.ucpress.edu/book.php?isbn=9780520274051> 's Handbook", said that
the proper relationship between the grassroots and lawmakers is fear and
loathing. Too often when activists become close with lawmakers, they are
pulled into compromising for a political agenda rather than holding true to
their mission. In New York, because protesters showed up with anti-fracking
signs everywhere he went, Governor Cuomo reportedly told his staff that he
hated them
<https://www.popularresistance.org/cuomo-didnt-stop-fracking-the-communities
-did/> . And he did poorly in the primary in counties that had strong
anti-fracking movements.

Recommendations for Single Payer Healthcare Activists

If we are to succeed in gaining single payer healthcare systems at the state
or national level, we need more than the facts on our side. We must have
political muscle that we are willing to flex.

After the 2009-10 national health reform process, I wrote an article
<http://www.pnhp.org/news/2010/may/after-the-reform-aiming-high-for-health-j
ustice>  that outlined three key elements for the single payer movement,
callomg it "I.C.U." The "I" stands for independence because the movement
must remain independent of political parties and their agendas; "C" for
clarity, knowing what policies are real solutions and what are false
solutions so that you can evaluate proposed policies; and "U" for
uncompromising because as Gandhi said, "You cannot compromise on
fundamentals for it is all give and no take." We will keep getting crumbs if
we are willing to take them.

Here is a summary of a few more recommendations:
1. Organize a broad base using the human rights framework with the
understanding that the struggle for health care is part of the broader
struggle for social, economic and environmental justice.
2. Understand how political power works so that the strategy and tactics
that are used are effective. I think of it as a scientific approach that
does not apply placebos but uses proven methods for social change.
3. Demand that the reform process is transparent and allows public
participation.
4. Cultivate a proper relationship with lawmakers who are opposed to your
position, one of persistent pressure on them that creates fear and loathing.
5. Hold politicians accountable for their actions.
6. Don't be afraid to use your power. If the movement shows weakness, it
will be exploited. If it shows strength, it will be respected.

The healthcare crisis and many crises continue in the United States. Our
struggles will continue despite temporary setbacks. We must not give up.
Let's continue the conversation about next steps in our work for healthcare
justice.

Vermont Bails On Universal Healthcare

<http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Item
id=74&jumival=12947> Description: 1trnn