<html><head><meta http-equiv="Content-Type" content="text/html charset=utf-8"></head><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space;" class=""><div style="font-family: Helvetica-Light;" class="">Strikes and Attack Ads: The Hard Roads to Universal Health Care</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">By Quoctrung Bui and Sarah Kliff</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">It is a common refrain from Bernie Sanders on the campaign trail: The United States is the only developed country that does not provide health coverage to all residents.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">“Canada can provide universal health care to all their people at half the cost,” he said at a recent Democratic debate. “The U.K. can do it. France can do it. Germany can do it. All of Europe can do it.”</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Mr. Sanders is right: All these countries provide universal coverage. But what he doesn’t talk about is the excruciating battle they went through to get there.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">It took Canada more than a decade to move from a patchwork of insurance plans to a single-payer system. At one point, doctors were so incensed that they went on strike for 23 days. Doctors from the United States and Britain flew in to help keep the health system going.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Today, most Britons revere their National Health Service: One lawmaker has called it the closest thing the English have to religion, and the 2012 Olympic opening ceremony honored it with a four-minute song-and-dance routine.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">But when it began in the mid-1940s, 89 percent of doctors were opposed. They raised £1.6 million (or £58 million today, equivalent to $76 million) for a “fighting fund” to protest the plan. Some patients showed interest in contributing, too.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Look around the world and you start to see a common theme: Creating universal coverage is hard. The countries with the systems that Mr. Sanders admires went through years of failed legislation, doctor protests and uncertain futures.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Abroad, the arguments made against universal coverage were similar to those we hear today: that it's just too expensive, or gives government too much control over the practice of medicine.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">“No country did this without a huge political conflict,” said Jacob Hacker, a professor of political science at Yale who studies the formation of international health systems. “But once they put in the strong, basic foundations, there was no going back.”</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Mr. Hacker said: “People look at the current levels of support that other systems have, and extrapolate backwards to think that universal coverage was always popular. But that isn’t the case. Everywhere this happened, it was a very fierce fight.”</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">(The article discusses the struggles in Canada, Britain, and Australia.)</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Australia, Canada and Britain all overcame enormous opposition to build health systems that their citizens now support. In each case, politicians stood firm, and eventually the outcry subsided.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Could something similar happen in the United States?</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Those who study the history of other health systems say it is certainly possible — but will probably be more difficult.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">The United States is different in that its medical industry is bigger and more powerful. Health care spending accounts for one-sixth of the American economy, and no industry spends more on lobbying Congress.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Another obstacle comes from the structure of the U.S. government, in which dueling political parties often wield partial control over different branches of government.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">“The American political system makes this harder,” said Mr. Hacker, the Yale professor. “The kind of determined, take-no-prisoners approach that happened in some provinces like Saskatchewan doesn’t work as well here.”</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">That said, there is nothing so structurally different about the United States that leads historians to think of universal coverage as impossible.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class=""><a href="https://www.nytimes.com/interactive/2020/03/10/upshot/the-hard-road-other-countries-single-payer-health-care.html" class="">https://www.nytimes.com/interactive/2020/03/10/upshot/the-hard-road-other-countries-single-payer-health-care.html</a></div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">===</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">Comment by Don McCanne</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">The lesson here is clear. All nations that have universal health care systems experienced significant political struggles to achieve them. The fact that there are political barriers ahead is never a reason to not move forward with reform.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">In the case of the United States, the leading proposal for universal health care - the single payer model of an improved Medicare for All - once enacted and implemented would be the finest health care system in all the world - the pride of all Americans.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">So what are the barriers? It costs too much? No, we are already spending enough to provide comprehensive care for everyone. Doctors and hospitals would be underpaid? No, the hundreds of billions of dollars in administrative waste that would be recovered is enough to adequately fund the system. Waiting times would be too great? No, resource allocation would be improved, helping to reduce some of the excessive queues we now have. Superfluous vested interests such as the private insurers would lose out? Yes, but that would allow health care dollars to be redirected to patient care, where they belong. Anti-government ideologues would be offended? And what is their counter-offer to ensure health care for all? Leave it to the marketplace? Kenneth Arrow taught us that lesson many decades ago.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">So what about the politics of 2020? The Republicans wanted to repeal and replace the Affordable Care Act, but they have not found a replacement that would work. In the meantime there had been a crescendo of support for Medicare for All, but now the Democratic leadership has declared that, in order to defeat Donald Trump in the upcoming presidential election, we must abandon Medicare for All. What? That's a non sequitur. Yet in only one week there was a massive shift of Democratic voters from the candidate supporting Medicare for All to a candidate who was outspoken in opposing it.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class="">There is certainly strong opposition to President Trump within the Democratic Party, but how did the spinmeisters transfer that to voting against one of the most outspoken Trump opponents who happened to be the leading supporter for Medicare for All? As today's article indicates, there will always be significant barriers to enacting a program of universal health care. We have to identify those barriers and knock them down.</div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class=""><br class=""></div><div style="font-family: Helvetica-Light;" class=""><i class="">PNHP advocates for a single payer national health program. We do not support any political candidates or any political parties. Rather we ask that all candidates and political parties join us in supporting health care justice for all though enactment of a single payer national health program.</i></div><div class=""><i class=""><br class=""></i></div></body></html>