In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.

For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide — Tommy Douglas. 

While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders'  S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well.

It's worth recalling that Supreme Court Justice Louis Brandeis famously called states “the laboratories of democracy.” As columnist Froma Harrop has suggested, “being closer to the people and more attuned to the local culture, states are better equipped than the federal government to introduce new social policies. Innovations are usually first tried in the places most receptive to them.”

More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states.  Here's a roundup of some of the state bills:

California

The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.

In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that “nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars.”

UC Irvine medical student Parker Duncan said that he did not want to “be in a world not doing what I was trained to do,” referring to the paperwork that is one of the expensive burdens that undermine the ability of the current system to deliver health care.

Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.

Colorado

House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.

“Our current health-care system is not well,” Kefalas said. “Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically.”

Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.

Illinois

HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.

At an introductory press conference, Brenda Langford, Cook County RN, said that “Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage.  We see far too much of this at Cook County hospitals—and that’s why we support guaranteed healthcare through a single-payer system.”

Maine

LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.

The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.

As Cathy Herlihy of the Maine State Nurses Association put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the “the only solution,” she said. “We do not have time to wait. Our health should not be sacrificed for limited reforms.”

Pennsylvania

Two single payer bills are alive in the state, House Bill 1660, the “Family and Business Healthcare Security Act of 2009,” and Senate Bill 300.

Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.

The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters..

The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system. 

Other states

Single payer bills are also on the docket in Minnesota, Missouri, and Washington.

 

Hundreds of people, nurses, doctors, medical students, grassroots activists, and California School Employees Association members gathered in downtown Los Angeles Monday to deliver an unequivocal message about the nature of the healthcare reform Americans so desperately need.

For those inside the tightly scripted White House Forum or anyone watching the live feed on line, that message was blacked out. Inside the pre-selected speakers kept within the accepted framework: we need reform, costs are out of control, Americans are hurting, and preventive care will solve all our problems ('fraid not). Unfortunately nothing proposed in the forum is likely to cure this crisis.

The “official forum” was so short on content, the Los Angeles Times was moved to note, that “the presentation was light on details. Universal coverage — health insurance for all Americans — was widely touted, but there was no discussion of how to achieve that goal.” 

In other words, the public forums amount to little more than, “window dressing,” as the Times quoted Deborah Burger, co-president of the California Nurses Association/National Nurses Organizing Committee.

Indeed all the real work is being done by a handful of Congress members. Even the White House is largely AWOL, writes Trudy Lieberman in the Columbia Journalism Review:

It looks more like Congress’s overhaul, and the word “overhaul” might be a stretch. The private insurance system looks alive and well; it will just have more people in it. The danger of leaving the details of reform up to Congress is that the special interests cozy with members have a good shot at getting what they want.”

What they want is individual mandate — forcing everyone to buy private insurance, a massive bailout for the insurance industry.

What they don't want is anything that will disrupt their comfortable profit making machine, the real reason why discussion of single payer, as in the Medicare for all bill, HR 676,  has been shut out of the debate.

The failure to include single payer as an option, despite its broad popular support among the American public, majority support among doctors and nurses, and an army of grassroots activists, means that all the pressure inside the hallowed halls of Congress is coming from the right. Not surprisingly, it means all the compromises and concessions will go to appease that crowd — the insurance industry and the right — as well. The result is that even the cherished goal of the liberal establishment, the more limited public plan alternative to private insurance, is greatly imperiled. 

Fortunately, those on the outside are not going away.

“We know there is a conscious attempt to stifle our voices,” said CNA/NNOC co-president Geri Jenkins said at the Los Angeles rally. “As a nurse who still works at the beside I see up front and personal what this fractured and dysfunctional system has done to our patients and the public. We need to get for the for-profit insurance industry out of the delivery of care in this country, so we can have a just and equal system with a single standard of care that everyone is entitled to.”

While California Gov. Arnold Schwarzenegger was inside trying to sell the nation on the type of reform he proposed in California which was rejected because of its call for forced insurance and its failure to rein in the insurance industry, the state's Lieutenant Gov. and former state insurance commissioner John Garamendi was outside with a very different message:

“As a former insurance commissioner, I know the insurance industry very well. They have but one purpose, the bottom line… They will manipulate the system so they do not have to pay” and spend one-third of every health care dollar on administrative costs “so they can deny claims and push people aside. It has to end, and it will end.”

How? “41 years ago we figured out how to solve this problem. Americans created a single payer, universal health care system that covers everyone who is over 65, allows you to choose your doctor and have a comprehensive benefit package. We know how to do it. All we have to do is take the 65, erase it, write in 0, and you send your premium to Medicare. That's change we can believe in and the change America needs.”

“We're here to send a message to the President” and the Congress “to put HR 676 on the table,”, said Reggie Cervantes, a 9/11 rescue worker whose own fight for healthcare was so well chronicled in Michael Moore's “SiCKO“. “I will not go silently into that good night.” Nor should any of us.

AHIP, America’s Health Insurance Plans, decided downtown San Francisco would be a good place for the health insurance company lobbyists and executives to hold their convention. Not surprisingly, thousands of people will take to the streets at noon on June 19th at the Moscone center to protest getting ripped off by the health insurance companies and rally for SB 840 in California and HR 676 nationally.

One of the key people being protested is none other than former DNC Chair Terry McAuliffe who is a keynote speaker for the industry. Which adds some context to his quotes in yesterday’s New York Times on the Clintons’ enemies list and rewarding of friends:

“The Clintons get hundreds of requests for favors every week,” said Terry McAuliffe, the chairman of Mrs. Clinton’s presidential campaign. “Clearly, the people you’re going to do stuff for in the future are the people who have been there for you.”

Finally, we’ve recovered from McAuliffe’s disaster as DNC Chair when he ran it like the DLC and was proven incapable of moving beyond transactional politics to a post-McCain/Feingold fundraising party that isn’t a subsidiary of special interests. And yes, we’ve also moved beyond his success in perfectly executing a Clinton campaign strategy that took her from undisputed presidential front-runner to junior senator. But there is he is, using his name and connections to help out those who have helped them while Americans suffer.

In my opinion, one of the most important outcomes of Clinton’s loss was that they won’t get back control of the DNC — which is great news for Democrats. But T-Mac is a reminder that we all need due diligence in the process of choosing the next California Democratic Party Chair so that we can reform the CDP to also move into the 21st century.

Currently, there are 1,904 pledged attendees at the rally according to the neat online organizing tool. Check to see which groups have currently pledged how many, get your group involved, and join in this important event.

450 – California School Employees Assn.

400 – California Nurses Assn.

200 – California Alliance for Retired Americans

200 – California Universal Health Care Organizing Project

100 – Cindy Sheehan for Congress

54 – Others

50 – Green Party SF

47 – Health Care for All-Marin

40 – American Medical Student Association

30 – Gray Panthers SF

25 – Wellstone Democratic Renewal Club

25 – United Educators of San Francisco

20 – Amer. Fed. of Teachers, local 2121

20 – Neighbor to Neighbor

20 – West Country Seniors

20 – Senior Action Network

20 – Older Women’s League of San Francisco

20 – Hermanson for Congress

20 – HAT

20 – Green Party San Meteo

15 – California Physicians Alliance

15 – Socialist Action

14 – Health Care for All-Santa Cruz

12 – International Longshore and Warehouse Union, local 6

10 – California Alliance for Legislative Action

10 – Office and Professional Employees International Union, local 3

10 – San Francisco for Democracy

9 – American Postal Workers Union – SF

9 – UC-Santa Cruz students for Single Payer

5 – Chris Jackson for Community College Bd

5 – Young Workers United

4 – Health Care for All-Sonoma

4 – FORUM SF

This year’s extended primary just might be great for healthcare reform as the Clinton campaign’s failure may have killed off the terrible idea of insurance mandates.  She ran on it, and lost–just like Arnold did in California last year.

If so, great news all around.  Working people, already struggling, will not face the prospects of having their wages garnished to pay off Blue Cross’ inflated premiums, overhead, and denials.  Healthcare reformers can focus their work towards enacting genuine solutions, rather than fighting off this insurance marketing scheme masquerading as health care policy.  And all of us can debate the real issues at hand here, like the new report finding the number of underinsured is spiking as our healthcare system continues its death-by-insurer spiral.

We’ll take a look at this and updates from single-payer movement below!

The big political advantage of health insurance mandates (laws forcing people to buy private insurance, no matter the cost or quality) is that insurance companies love them, and can create big coalitions of business-friendly groups that seem safely centrist but also reasonably effective.  They seem so dang politically viable.

But the Wall St. Journal points out they’re not and argues that Clinton’s Exit Deals Setback to the Push for Health-Care Mandates

Sen. Hillary Clinton’s exit from the presidential race will deal a blow to supporters of a key element in the tussle over universal health coverage: the idea that all Americans be required to buy or have health insurance.

After gaining considerable political ground, especially at the state level, the concept has suffered other setbacks lately, too. Despite years of entrenched political opposition to the idea of a mandate, it was a key part of the 2006 universal health care legislation enacted in Massachusetts and of California Gov. Arnold Schwarzenegger’s plan to overhaul health care in that state….

The Schwarzenegger plan, though, failed this year, in part because unions and business groups objected to its individual and employer mandates. In Massachusetts, results have been mixed. While the overall plan has cut the number of uninsured adults in that state by roughly half, the state authority responsible for overseeing the program has exempted nearly 20% of uninsured residents because it has deemed they can’t afford the policy premiums on offer.

The California plan died when the public and legislators learned that nurses and labor unions were strongly opposed to the idea-and that their wages could have been garnished or a lien put on their home.  This same strategy will kill similar proposals nationally.  It is generous to call Massachusetts’ experiment mixed; check out Dr. Steve B’s more informed comments.

There are a number of problems with mandates.  On a macro level, they make genuine healthcare reforms-single-payer-impossible by showering for-profit insurers with millions of new customers and billions in new revenues and subsidies.  On a micro level, they trap patients into this broken system and saddle them with junk insurance that will drain their bank accounts only to offer them no protection in the case of a health crisis.

A new study today elaborates on this very problem of underinsurance:

About 25 million Americans – or approximately one of every five adults younger than age 65 with health insurance – did not have sufficient coverage last year to shield them from financial hardship if they ended up in the emergency room or were seriously ill, according to a new study to be released on Tuesday by the Commonwealth Fund.

I actually think that number is really low, but at least it focuses our attention on this:

As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, the president of the Commonwealth Fund.  “Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage,” she said.

Meanwhile, hilarity ensues as The head of Blue Shield of California begs health reformers: “Stop demonizing health plans.”  I don’t think so.

Chellie Pingree is about to become a great Congresswoman from Maine, and she is running on a single-payer platform.  Rose Ann DeMoro from the California Nurses Association/National Nurses Organizing Committee,  finds a gold rush town that symbolized our healthcare crisis.

Elsewhere, a writer in the Tennessean reminds us why we don’t have single-payer healthcare…the war…and the trend of getting married for health insurance continues.

Finally, Elizabeth Edwards, well, um, eviscerates John McCain’s so-called health care plan.  Snap!