At 96, Irene Hull is old enough to remember the Great Depression, the passage of Social Security and the creation of Medicare, which she depends on today to pay her doctor bills at Group Health.
She's not afraid of "big government." In fact, she says she wants a federal single-payer healthcare system similar to Medicare to cover all Americans so that insurance companies and HMOs like Group Health spend their money on medical care and not overhead, like paperwork that costs $150 billion a year just because insurers have different forms.
Martha Koester wants a single-payer system, too. At 62, she isn't old enough to get Medicare yet and says she's nearing the end of the six months of health coverage she was entitled to after she took an early retirement rather than get laid off from lumber giant Weyerhaeuser, which will let go of 1,500 people by year's end.
Hull and Koester are among thousands across the nation pushing for national single-payer healthcare coverage. But the tide of change that brought President Barack Obama to office may not bring a nationwide single-payer system like Canada's any time soon, says U.S. Rep. Jim McDermott, Seattle's 13-term Democrat in Congress.
Obama has put healthcare reform on the table, holding forums and, on May 11, getting a pledge from the healthcare industry that it will reduce its costs $2 trillion over the next decade. But Obama is determined not to repeat what happened to then-first lady Hillary Clinton in 1993, when McDermott says insurance companies launched a massive ad campaign, one in which the characters Harry and Louise scared people that reform would cost them their private coverage and they'd be put on a government plan.
This time out, McDermott says, Obama's strategy is to leave private health plans in place. That neutralizes fear and industry opposition so that lawmakers can look at including a mini single-payer system -- the so-called "public option" -- in reform bills that are expected soon in Congress, with the House's Democratic leadership promising legislation that will be introduced in June, McDermott says.
But the hybrid means, for now, that the industry is still in the picture -- a decision of Obama's that rules out a national single-payer system in the near term, McDermott says.
"I would like to have [healthcare reform] in one step, [but Obama] figured out what happened to Mrs. Clinton," McDermott says. "The president decided, rather than take on the whole issue at once, I'm going to bite off a piece."
"That's how you eat an elephant, by the way ... one bite at a time."
McDermott spoke May 16 at Winning Healthcare for All, a forum that drew 200 to Seattle's Town Hall -- one of a series of actions and events in recent months geared toward healthcare reform, including the recent passage of a state bill and an upcoming May 30 march planned from the Central District to downtown.
On May 18, Gov. Christine Gregoire signed Senate Bill 5945, which promises coverage for every Washingtonian by the year 2014. But, like national reform, no one knows yet exactly how that will be accomplished or, more importantly, funded.
At the same time, a $9 billion revenue deficit led the state to cut 40,000 people from the rolls of its low-income Basic Health Plan, a program that McDermott spearheaded years ago as a lawmaker in Olympia. Since 1993, McDermott has introduced legislation in every session of Congress -- House Resolution 1200, the American Health Security Act -- that would give federal money for the states to create universal health plans with federally mandated benefits, financed by a payroll tax shared by employers and workers.
Another bill introduced by Michigan Rep. John Conyers -- House Resolution 676 -- would expand Medicare (and its payroll taxes) to cover people from birth to death, McDermott says.
There are currently 47 million Americans who have no insurance and another 25 million, McDermott says, who are under-insured with a marginal plan. Besides Obama, what makes this year's attempt at reform different, he says, is that labor is on board and the healthcare industry is on the defensive -- one reason it's participating in the president's forums and promising the $2 trillion in cost reductions, which he says the industry has already backpedaled on.
Insurance companies "know something's going to happen and they're trying to take control of it," McDermott says, specifically by seeing to it that the sick or aging with chronic conditions end up in whatever the public program is, not on their insurance rolls.
"The reason they're at the table is they want to figure out [how] to make that public option a place to put all of you that they don't want to take care of," McDermott says. If Americans aren't mindful, "the public option could become a dumping ground for all the problems in our healthcare delivery system."
Industry executives "would voluntarily reduce healthcare inflation over the next 10 years," says Dr. David McLanahan, co-founder of Seattle's Physicians for a National Health Program and a speaker at the forum. "But, noticeably, they didn't talk about changing their business model that requires them to offer their products to the well and avoid the sick."
"Our private insurance industry ... spends 31 percent of every healthcare dollar on administrative tasks," he says. If the U.S. moved to a single-payer system similar to Canada's, "we'd save $400 billion a year," McLanahan says, "enough to cover every uninsured American and eliminate under-insurance and co-pays for every American."