New fault line forms in health care fight
By: Chris Frates
December 1, 2008 04:03 PM EST

A new fault line is forming in the health care reform debate that could prove to be just as bruising as the conservative-vs.-progressive battles: the schism between single-payer and public-private advocates.

Both sides are pushing for universal health care, but the more purist single-payer advocates believe that any approach that retains the insurance industry is doomed to fail.

"Private health insurance is no longer a workable model for health care reform, because the insurance companies sell a defective product and health care costs are so high that even moderate-income families can no longer afford the premiums, co-pays and deductibles," said Ida Hellander, executive director of Physicians for a National Health Program, a group of 15,000 doctors who support a single-payer system.

So far, though, groups working to create a public insurance plan that exists alongside tightly regulated private plans have grabbed the political high ground — largely because many deem a single-payer system too easy to demonize as socialized medicine.

Many of the progressives charting a course for the public-private mix were single-payer advocates who emerged from the health care battles of the early 1990s. They realized that "we need to focus on the goal of quality, affordable health care and make that goal paramount instead of any particular solution in getting there," said Richard Kirsch, national campaign manager for Health Care for America Now.

Kirsch's group is a large progressive force pushing for a public-private scheme. HCAN claims 530 organizations as members — including a number of unions, a fact not lost on its single-payer detractors.

"These guys have unions as part of their coalition, but apparently they don't understand collective bargaining. If you don't ask for something, you'll never get it," said Chuck Idelson, spokesman for the California Nurses Association/National Nurses Organizing Committee, the nation's largest nurses union.

The nurses union believes that by not pushing for a single-payer system, HCAN and its allies are setting Americans up for failure.

"President Obama, we believe, seriously wants to reform our health care system in a way that solves a problem," Idelson said. "He's not going to be helped by those people who are advocating health care reform that won't work but would leave people looking for real change disillusioned."

HCAN argues that its plan will work and that single-payer advocates need to realize that their approach is politically untenable — a notion that Idelson dismissed. "Every significant reform in American history has been mocked ... as out of the political mainstream," he said.

"There are well-meaning players within HCAN who have made a tragic decision to settle for what is politically practical, regardless of whether it works," Idelson said. "Then there's the service employees union that has elevated expediency to the point of principle and will sign anything with anyone to benefit themselves at the expense of the public interest."

Said Service Employees International Union President Andy Stern: "The one thing we know is that the longer we wait, the worse it gets. SEIU is on the ground, ready to help President-elect Obama fix our health care system so that it provides quality, affordable health care for every man, woman and child in America."

Kirsch added that the attacks by single-payer advocates are aimed in the wrong direction and "are more of a distraction than anything else."

"It's great for them to go out and advocate for single-payer, but we think they're misplacing their energies by attacking us," Kirsch said. "They should be focusing their energies on those that don't want to see any public health insurance plan and don't want to see stringent regulations of the private insurance industry."

The upside to having single-payer advocates in the fight, Kirsch said, is that they help "keep pressure on Congress and the president to support a public health choice."

"How nice of them to be so condescending," Idelson said.

And for the moment, it seems, not even the shared adversaries of insurance companies and conservatives who would kill any kind of public plan, single-payer or otherwise, can bring the two progressive factions together.

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Why Does Celinda Lake Oppose Single Payer?

Self-described as "one of the Democratic Party's leading political strategists," Celinda Lake has claimed that single-payer reform lacks meaningful popular support. Lake's research, done for the Herndon Alliance, has consistently supported reform based upon private health insurance. She and the Herndon Alliance are largely responsible for the notion that a single payer Medicare-for-all healthcare system is ‘not politically feasible.’

Lake’s findings are in sharp contradiction to numerous polls showing that single payer is enormously popular.

* In a New York Times/CBS News poll in February 2007, 64% said that the federal government should guarantee health insurance for all Americans.

* In October 2003, 62% of respondents to a Washington Post/ABC News poll said they preferred "a universal health insurance program, in which everybody is covered under a program like Medicare that's run by the government and financed by taxpayers."

* These findings were repeated in a 2007 Associated Press-Yahoo poll in which 65% supported a Medicare-for-all system.

Kip Sullivan, an attorney and health systems analyst, has been at work on a soon-to-be published analysis of the research methods and methodology used by Celinda Lake to conduct her work on behalf of the Herndon Alliance.

Sullivan has written over 100 articles on health policy, many of which appeared in national newspapers, magazines and journals such as American Journal of Public Health, Health Affairs, Los Angeles Times, The Nation, New England Journal of Medicine, New York Times, and Washington Monthly. He is the author of “The Health Care Mess: How We Got Into It and How We'll Get Out of It” (AuthorHouse, 2006). He has a BA from Pomona College and JD from Harvard Law School.

Below is Sullivan’s executive summary. For a copy of the article, contact Sullivan at kiprs (at) usinternet.com.



An analysis of Celinda Lake’s slide show, “How to talk to voters about health care”

By Kip Sullivan, November 29, 2008



Executive Summary



Celinda Lake is a pollster who has developed a slide show entitled, “How to talk to voters about health care.” Based on research Lake did for the Herndon Alliance, a coalition formed in 2005, Lake offers an explanation of how “Americans” view “health care reform.” According to Lake, “Americans” have surprisingly conservative “values” about this topic. According to Lake, this means advocates for “health care reform” must not only use and avoid certain words, but they must endorse and avoid certain policies.



Examples of Lake’s findings include:



* Americans think Medicare is “frighteningly flawed” and, consequently, Americans oppose a national health insurance program based on Medicare or which resembles Medicare;

* Americans who have private health insurance not only like it, but like it so much they will resist a Medicare-for-all solution to the health care crisis because it does not leave them the option of continuing to receive coverage from a health insurance company;

* Americans don’t want to pay for health insurance for “the undeserving,” a category which includes even the parents of average Americans;

* Americans don’t like the phrase “universal coverage” or “universal health insurance,” and prefer “quality, affordable health care”;

* Similarly, activists should never say “Medicare for all,” and instead say “choice of public and private plans,” which is, of course, equivalent to saying no one should support a Medicare-for-all (or single-payer bill) and should instead only support legislation that allows the health insurance industry to continue to take in tax dollars and premium payments. (Under a Medicare-for-all system, one payer like Medicare would replace the nation’s 1,500 health insurance company as the sole payer of clinics, hospitals and other providers.)



To understand why Lake would depict Americans as Scrooges who like their health insurance company and are afraid of Medicare, it helps to understand why the Herndon Alliance was formed. The Alliance was founded by individuals who have either opposed or refused to support Medicare-for-all legislation and instead supported legislation like President Bill Clinton’s 1993 Health Security Act, a bill that would have pushed all but the wealthiest Americans into HMOs. In 2005, several individuals who would play leading roles in creating the Herndon Alliance met to discuss why they “keep losing,” that is, why none of the bills they had supported in the past were enacted or, if enacted, stayed enacted. These individuals decided that the primary problem was the “values” of the American people. According to this diagnosis of the problem, their failure to achieve universal coverage was not due primarily to the power of the insurance industry or the unattractiveness of the legislation they had supported, but rather to the “values” of the average American.



But this diagnosis conflicts with a large body of research which shows that 65 to 85 percent of Americans support universal health insurance, and 60 to 70 percent support a Medicare-for-all program. For example, a 2007 poll by AP-Yahoo asked respondents whether they agreed or disagreed with this statement: “The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” Sixty-five percent said yes.



If the Herndon Alliance founders had said that a large majority of Americans support universal coverage and Medicare-for-all programs, and this support can be reduced by false propaganda against such programs, that would have been an accurate diagnosis. But they didn’t. Instead, they adopted the much more questionable assumption that most Americans harbor “values” that cause them not support universal coverage. It is reasonable to infer that Lake was hired by the Herndon Alliance to produce research to confirm their armchair diagnosis of the American pyche.



Lake’s research occurred in three stages: a “mapping values” stage, a focus group stage, and a polling stage. There were serious defects in all three stages.



In the first stage, as Lake put it, “[O]ur research … explor[ed] … the core values that shape … views on health care….” The result of this first stage was a report by a firm called American Environics (AE) that claimed to identify 117 “values” held by Americans that allegedly have some influence over how we think about health care reform. These “values” had names like “brand apathy,” “discount consumerism,” “more power for big business,” “meaningful moments,” and “sexual permissiveness.” The “value” known as “meaningful moments,” for example, was defined this way: “The sense of impermanence that accompanies momentary connections with others does not diminish the value of the moment.” Lake and AE refuse to explain where these “values” come from or how any of them relate to “health care reform,” much less deserve to be called “core values that shape … views on health care.”



On the basis of these “values,” AE divided Americans into eight groups or “clusters” with names as fanciful as the “values” AE says we hold. The three largest groups, in order of size, were “Proper Patriots” (34 percent), “Marginalized Middle-Agers” (17 percent), and “Mobile Materialists” (13 percent). AE describes the millions of people in these “clusters” in terms that can only be called psychobabble. Here is how AE stereotypes Mobile Materialists:



This group tries to impress others with their homes, cars, clothes and looks, scoring high on Status via Home, Buying on Impulse, Importance of Brand, Joy of Consumption, Crude Materialism and Ostentatious Consumption. … [T]he new rims for their car or yet more designer handbags are welcome escapes from everyday drudgery. They tune out after work by watching MTV Cribs (Living Virtually) and feel best when they make time for a workout at the gym or a mani-pedi (Look Good Feel Good, Concern for Appearance).



The second and third stages of Lake’s research were based on the bizarre results of the first stage. For her focus groups, Lake selected people who represented the strange “clusters” concocted by AE. Lake does not tell us how she determined that the people she selected fell into one of the “clusters,” or what questions she asked them. All we hear from Lake are her conclusions about what allegedly went on in the focus groups. It was from these focus groups that Lake allegedly learned that Americans don’t support “universal coverage,” fear Medicare, feel good about their health insurance company, and think their own parents are among “the undeserving.”



In the third stage, Lake conducted a poll designed to see how people felt about a health care reform proposal she developed during the second stage (called “guaranteed affordable choice”) compared with single-payer. She wrote the question in a way that ensured the respondents would favor “guaranteed affordable choice” (GAC) over the single-payer proposal. To offer just one example: Lake declined to tell her respondents that patients would continue to have limited choice of doctors and hospitals under the GAC plan while under the single-payer plan patients would have complete freedom to choose their doctors and other providers.



In short, Lake delivered to the Herndon Alliance the results the founders of the Alliance were looking for. She told them, in effect, that they were right all along to support legislation that leaves the insurance industry at the top of the health care food chain and not to support a Medicare-for-all or single-payer proposal. And she gave them the rationale they wanted to hear – that they were justified in abandoning single-payer and supporting a role for the health insurance industry because that’s what Americans want them to do.



But to give the Herndon Alliance the results they wanted, Lake had to rely on secretive and biased methods. Until Lake reveals her methods and offers a reasonable explanation for why her results are so different from those of other researchers, the public should treat Lake’s research as junk science.