Health Care: It's Time for a Major Overhaul


Back in early September, a microcosm of the looming health care debate played out on the stage of the Albuquerque Chamber of Commerce. Karen Ignagni, CEO of the insurers' largest industry association, was leading a roundtable discussion as part of a national "listening tour" organized by her organization, America's Health Insurance Plans. Waiting for Ignagni in the auditorium were activists from the local chapter of ACORN, who had come to share their thoughts on the CEO's market-based reform ideas. It didn't take long before the line of questioning became a little too heated for the Chamber of Commerce moderator.

"What do you expect?" he exploded in front of a stunned audience. "The insurance industry has to make a profit -- that's what they do!"

Following the Albuquerque confrontation, the insurers' group quickly lowered the profile of subsequent roundtables.

Ignagni may or may not have known at the time that those targeting her with ACORN-shaped rhetorical darts represented the activist wing of Health Care for America Now, an umbrella organization launched in July to win a "guarantee of quality, affordable health care for all" by the end of 2009. ACORN is one of 16 groups on the HCAN steering committee, which is a veritable Who's Who of progressive grassroots, netroots, and labor groups, including USAction, MoveOn, SEIU and the AFL-CIO. Four months after launching with a press conference in the National Press Building, HCAN now consists of more than 500 organizations and boasts the backing of the president-elect, his incoming chief of staff and 151 Democratic members of Congress, among them leading progressives and "pro-business" Blue Dogs alike.

As Karen Ignagni and her colleagues in the pharmaceutical and insurance industries are by now well aware, HCAN constitutes a double-threat to those standing in the way of solving America's health care crisis. As it was built to do, the well-funded coalition wields influence inside Washington and out, where it controls a millions-strong activist army, with constituent group organizations complimented by 80 full-time HCAN field staff in 42 states. "We represent the deepest single-issue coalition in modern American history," says Jeff Blum, HCAN co-chairman and USAction director.

The campaign was hatched during a conversation between Blum and Richard Kirsch, one of his board members and current director of HCAN. They were imagining what it would take to push through universal health care, once and for all, sooner rather than later. The wish list that resulted from their musings -- legions of activists, more resources, better research -- led to the idea of a broad coalition that combined Beltway influence and grassroots muscle. Blum and Kirsch first brought together SEIU and AFSCME, two unions with large memberships in the health care sector. The directors of those two groups plus USAction became the founding three co-chairs. By the time HCAN launched the following July, the steering board included community organizations like ACORN, and health care provider organizations like the American Nurses Association and the American Academy of Pediatrics. The Center for American Progress provides the coalition with think-tank heft, as well as further links to the incoming administration and Congress.

HCAN's constituent groups sometimes overlap, yet each brings a unique set of experiences and expertise to the table. "The coalition has a very smart design to it," says Lisa Codispoti of the National Women's Law Center, which sits on HCAN's steering board. "There is a synergy between all of the groups, each of which adds to the narrative." As an example, Codispoti points to a recent National Women's Law Center report detailing how women pay higher premiums in the private health insurance market. Other HCAN groups -- from the Children's Defense Fund to the National Council of La Raza -- have produced similar studies focused on other segments of the population. The result is a tapestry of expertise that forms a comprehensive condemnation of America's private-employer-based system. This expertise is useful to both challenge industry propaganda and guide lawmakers as they debate and craft a final bill.

"We're part of a lot of coalitions, but HCAN is edgy in a unique way," says Linda Tran, an SEIU spokeswoman. "It has a 'street heat' that we're known for, as well. The combination of grassroots and new media and online organizing gives it a special force and energy."

Defeating the Republican and Big Business message machines while uniting Democrats of different stripes behind bold reform will demand nothing less. Although hardly cash-poor, HCAN and reform advocates continue to play David to the industry's Goliath in terms of finances. The $10 million seed grant that HCAN received from Atlantic Charities is roughly equal to the cost of the insurers-sponsored "Harry and Louise" ad campaign of 1993, which helped torpedo the last reform drive.

HCAN is determined to avoid a repeat of that failure. The campaign continues to bolster its coffers and plans to buy $20 million in ads promoting its vision of a public health care alternative coupled with stricter government regulation of the private health care market. Another key difference between the 1990s and now is an opposition in disarray. The Republicans understand that simply screaming "socialism" is no longer sufficient to derail reform, but they lag far behind Democratic efforts to craft policy and build the coalitions needed to push it through. Even if Republicans do manage to unite behind a market-based reform plan, the health care debate has shifted so much over the last 15 years that they will likely find it difficult to defeat a Democratic plan that guarantees affordable coverage to all Americans.

Sen. Jim DeMint, R-S.C., recently summed up the dilemma in an interview with Politico, saying, "The big thing for Republicans is to communicate that it is not acceptable for 40 million people in America not to have health insurance. But it's also unacceptable to turn our whole health care system over to the same people who ran Katrina and ran the Iraq war and [are] running the bailout."

Those "same people" are, of course, Republicans. Such are the obstacles the GOP faces in the looming health care battle.

Which isn't to say that anybody is predicting a cakewalk. Uniting progressive and fiscally conservative Democrats will require applying sustained heat and effort. And, as they did 16 years ago, the billion-dollar industries can be expected to defend their bottom lines with ferocity and guile. Indeed, the message war is already begun. The Pharmaceutical Research & Manufacturers of America (PhRMA) in mid-November unleashed the first ad in a multistaged campaign designed to frighten Americans away from the idea that the government should negotiate drug prices on behalf of Medicare, as president-elect Obama has pledged to do.

"There's no question that next year will be a challenging year," Ken Johnson, senior vice president of PhRMA, recently told the Washington Times. "We've been moving the pieces on the chessboard around for some time now, and we've got a great game plan in place. We've earned a right at the table, and we're optimistic that the majority of members of Congress will recognize the importance of the pharmaceutical industry to health care." Among those "pieces on the chessboard" are the millions of dollars the pharmaceutical and biotech industries gave to Democrats over the last two cycles.

The insurance industry has likewise begun positioning itself in anticipation of the coming showdown. Two weeks ago, American Health Insurance Plans unveiled its own reform proposal in an attempt to shape the debate before it is shaped by it. At the heart of the AHIP proposal is a deal whereby insurers would accept all comers regardless of prior conditions, but only if there is a federal mandate for universal coverage. Crucially, the plan does not mention "community pricing" (standard rates), meaning millions of sick or high-risk Americans would still be priced out of coverage. Along with helping to influence the shape of a final bill through its legislative outreach team, which has been working on the Hill since summer, HCAN plans to expose and kill such sham industry-reform proposals in the crib.

In its first post-election ad buy, HCAN recently launched a spot in the Washington-area aimed at Congress. The 30-second ad features footage from an Oct. 4 speech Barack Obama gave in Newport News, Va., in which the then-candidate described health care as central to the broader project of rescuing the economy and rebuilding the middle class.

"We are reminding Congress and the incoming administration of the commitment to health care that won the White House and increased majorities," says HCAN Director Richard Kirsch.

HCAN intends to turn up the pressure on Congress after the inauguration and focus resources on stiffening the spines of centrist Democrats as the debate intensifies, which a mounting number of signals indicate will happen earlier in 2009 than many expected. Along with the funds for strategic media buys, HCAN's not-so-secret weapon is an intimidating, indeed historic, activist base.

"The vision from the beginning was to bring together the largest membership groups in the country to form a coalition that combines impact in Washington with a massive field presence across the country," says Kirsch.

Once the health care battle is won, could the HCAN coalition stay together to fight for other planks on a progressive agenda? Kirsch says the coalition does not anticipate outlasting the current mission, but believes the new relationships developed among its members "should provide new openings for progressive organizing in the future." But first things first.

"HCAN was formed to win health care for all," says Kirsch. "Right now we are very focused on doing just that."

Learn more about Health Care for America Now

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