Health-care reform: It’s complicated


West Marin cares about health care. Over 200 locals came out on Friday night to listen to an earnest and complex town hall-style presentation on the nuts and bolts of health care reform from the local to the national level, illuminated by the presence of United States Congressman Jared Huffman and county Supervisor Dennis Rodoni. The health care committee of West Marin Standing Together produced the event, part of a series of public presentations around concerns arising from the national political climate.   

Sharing the podium with the politicians were two long-term health care activists, Judy Spelman, of Inverness, and Ellen Karel, of Lagunitas, who presented on health care options being debated in the state and nation. Liza Goldblatt, a Point Reyes Station resident, moderated the program, held in the West Marin School gymnasium.

Rep. Huffman, who stated in his opening remarks that he “looked forward to being ‘wonked out’ on health care for all,” was participating in his 23rd town hall in the Trump era. His district includes all of the coastal counties from Marin to the Oregon border.

As Ms. Goldblatt noted, recent polls show that 60 percent of Americans support universal health care; how to achieve it is the crux of the matter. The United States is the only industrialized democracy without health care for all, and the system created by the Affordable Care Act is under siege—for good and bad reasons. (The A.C.A. is not health care for all, as 28 million Americans are still uninsured.)

The basic changes sought in the current debate are universal health care, in which everyone has insurance, and improvements to the financing and delivery of care that stabilize and strengthen the system. A state or national single-payer system, such as Medicare for all, could achieve this, just as it has in other countries. These systems replace premiums, co-pays,  deductibles and health insurer profits, with taxes and fees that have been shown in multiple studies to save money for individuals, families and the system itself. Yet this level of taxation is anathema to conservative forces in America.

On Friday, speakers plunged into the details that both divide and unify the political will; it was the wonk talk Rep. Huffman was looking forward to. Ms. Karel, vice-chair of Health Care for All—California, a single-payer advocacy group formed over 20 years ago, said Californians have the potential of achieving a state-level universal health care proposal. The Healthy California Act—Senate Bill 562,—passed the state senate this year, is currently stalled in the assembly rules committee over concerns about how to finance it. 

At the same time, on the national level, congressional Democrats have bills calling for universal health care. There is the “Medicare for all” bill introduced by Sen. Bernie Sanders and Rep. John Conyers’s bill for comprehensive health insurance in the House, of which Rep. Huffman is a co-sponsor, along with 118 other Democrats. Both bills are gaining support from Democrats; 16 senators, a third of the Democratic caucus, have endorsed the Sanders bill. 

But the fate of these proposals lies in the tangle of partisan politics. Though he is a long-time advocate of a single-payer system, Rep. Huffman described some “incremental solutions” to problems within the A.C.A. that are being proposed to shore it up. In July, he introduced a bill, “The Medicare Buy-In and Health Care Stabilization Act,” that lowers the Medicare eligibility age to 55.

The model of “Medicare for all” is the single-payer system that was the centerpiece of Ms. Spelman’s presentation at the town hall, one she contrasted with a state single-payer system such as S.B 562. She said a national plan has policy and political advantages over a state-based plan because economies of scale can save a lot of money. And, she cautioned, “Multiple state-based single-payer campaigns can fracture and weaken a national political voice.” Ms. Spelman worked as health consultant to state Sen. Sheila Kuehl, writing two single-payer universal health plans that were passed by the legislature but vetoed by Gov. Arnold Schwarzenegger. As Ms. Karel noted in her talk, the path to universal health care in California has been a 30-year journey with many detours and dead ends.

At the national level, just hanging on to what we have is a battle with our Republican congress and equivocating president. “Is Trump going to try to gut Medicare?” was one of the questions from the floor on Friday night. Rep. Huffman’s answer was swift: “He’s going to try, and we’re going to stop him.” 

A lot of other ground was covered during the evening, with remarks from Supervisor Rodoni on the local state of affairs adding more information to an information-packed night. Being an activist in this age takes hard mental work. And if a wonk is defined as “a person who takes an excessive interest in minor details of political policy,” it’s a good thing there are wonks among us. We need them.


Elizabeth Whitney is a West Marin-based writer.