Carol Moseley Braun on Universal Health Care

This is my transcription of the speech Carol gave at Gov. Vilsack's health care forum. You can hear the entire forum on cspan, or follow this link directly to the realplayer video.

Carol's remarks begin at about 1:13:30. I've cleaned it up a little for clarity, to remove ahs and uhms and false starts, while still trying to retain the conversational tone. Well, I'm sort of tuckered out with it at the moment. I feel that it's worth sharing so I present it knowing that it's far from perfect.

***

Thank you very much Governor Vilsack, and to Drake University President David Maxwell, Doctor Hansen and Doctor Boxer. Thank you so much for organizing this forum. And thanks to all of you for taking time out to come out and hear the candidates for the Democratic Nomination speak about health care.

I'm delighted to have this chance to talk about this issue because I believe that I offer a different perspective on health care reform, one that gives us a win/win/win solution to this national dilemma, in ways that will invigorate our economy, eliminate insurance insecurity, reduce human suffering and anxiety, and redirect resources in ways that will give us a comprehensive system of universal coverage for quality care.

Before I do that however I'd like to take a moment and give you a sense of who I am and talk to you about how it was that I came to this issue. My mother was a medical technician and she worked in a hospital in the days when the women in the room all were quiet whenever the doctor walked in.

(laughter)

You all remember that. And in fact she had impressed upon me to go and pursue a career in medical care. When I passed out--I was a candy striper, and when I passed out in the emergency room, they sent me to medical records.

(laughter)

I went on to law school at University of Chicago and then in my first job out of law school, as an Assistant United States Attorney, my first big case was defending Jimmy Carter's attempt at health care reform. You may recall came up with the HSA's and tried to restructure the way our health care system worked, and I was lucky enough as a baby lawyer to have a chance to try that case that the AMA filed against the Carter health plan. We lost, as you all are no doubt aware. But that was my first real introduction to health care policy, and it has been a factor in my career ever since.

Following my time in the Assistant U.S. Attorney's Office, I married and started a family and I was home being a homemaker when my neighbors got me engaged in a local environmental effort to save the bobolinks in Jackson Park. We were protesting the removal of the bobolinks' habitat. We lost again.

(laughter)

But what came out of it was an offer by some of my neighbors who had seen me working on that community cause to get involved in electoral politics. And when I first started to talk about it I said, "Oh, I don't know, I don't know anything, I'm not a politician, I don't know anything about this."

And they said, "Oh no, you should run."

And then another group came to see me and said, "No, you shouldn't run for state representive, because you haven't got a chance to win. The blacks won't vote for you because you're not part of the Chicago machine. The whites won't vote for you because you're black. And nobody's going to vote for because you're a woman."

(laughter)

That was all I needed to hear, and that was the beginning of a political career.

(applause)

So I went on to serve in the Illinois General Assembly as State Representative, and in that capacity had occasion once again to get involved with health care legislation at the state level. And among the things that I had occasion to do --and you never know in life what comes back around again--, but the present Speaker of the House, Denny Hastert, and I were co-sponsors of the first PPO legislation that the country had. And of course that was still part of my evolution in this whole process of health care reform.

Following my time in the legislature--and I served for a while as majority leader, I served as Cook Country Recorder of Deeds Now that was the one job that I didn't have a health care issue to deal with exactly. Other than negotiating with FCIU--because understand is represented in this room a little bit.

(laughter)

But in the executive position health care wasn't as much of a concern because our county government did have coverage for all of the employees of that office.

And then I went on to the United States Senate. And of course over the years health care just became more and more and more of a dilemma and a problem for the American people, particularily as our job market began to change and evolve. Following my time in the Senate--Oh, and I had occasion in the Senate to serve...I was the first woman enlisted to serve on the Senate finance committee. And of course we went through the trauma really of the Clintons' health care reform effort, and with all of the pros and the cons--and I don't want to take all of the time talking about that effort, but it was an effort. It was an effort that was directed at at the need to look in the direction of trying to provide universal coverage. It didn't get there, for a variety of reasons. But frankly I think that everybody should applaud the fact that the effort was made, and the undertaking was attempted to try to fix this huge problem.

Following my time as a United States Senator, I was confirmed by the Senate to become Ambassador to New Zealand and Samoa, and I call that time my time as ambassador to paradise. One of the aspects of being ambassador to paradise is that New Zealand had a single-payer system. So I had an opportunity to see a single payer system at work, and to observe how in the fact of the matter it actually happens. If anything, I have gone full circle with this issue. And I have come to the conclusion that the only real solution to this problem lies not in continuing to tinker with a broken industry, but rather to acknowledge that the structure of the industry is flawed, that we cannot fix it at this point, and that we need to have a single payer universal health care coverage in order to provide quality health care to the American people.

(applause, applause)

Now let me suggest, because this issue can be so complicated, that if anything, one of the traps, one of the dangers in it, is that you can get caught up looking at the trees and miss the forest. So if you take a step back and look at the forest in this issue, the question becomes: Is there any rational reason why our health care system, payment to our health care system, is tied to our employment? The answer to that is, there really isn't. And so if we were to step back and look at what is it that we're trying to do here, it is not health care that needs to be reformed. We have the best health care in the world. We know as a nation how to provide for health care. What we don't have is a rational system for paying for it. The Japanese, the Germans, the Italians, the French, all of these nations manage to provide health care to their citizens for less than the 15% almost, 14% of GDP that it costs here in the United States. Ask yourself, are Americans that much sicker than people in the rest of the industrialized world? Or perhaps maybe the answer is there's just a problem with the way that we pay for it.

I submit to you that examples of such a single-payer system actually abound, and we should look to those examples as a way of fixing this broken industry. Right now the federal government has a program of health care coverage for federal employees, the FEHBP, I'm sure you've heard a lot about it. But the Federal Employees Health Benefits Program is for all intents and purposes a single payer system. And under that system all sorts of health care from mental health to dental health to vision health, all of these things get covered in a comprehensive system that winds up costing less than the private insurance system that we have.

Right now we have, if you think about it, two separate traunches* with different divisions. We've got a private system and a public system. The public system is Medicare, Medicaide, Chips, da da da da-- that is, a whole bunch of acronyms for all the different specialty programs for health care, for special diseases and the like, all under here under a public system.

On the other side we have a private system, and that private system depends on every thing from where you live to where you work, to whether or not you're full-time, part-time, or whatever, but there's different iterations. And the insurance companies make contracts to run that private system. The result of the changes in our work force is that we now have 41 and counting million Americans with no coverage, particularily young people, not to mention the costs of all the outlier groups that just don't fit into a category. There's something very strange when members of the middle class can't access health care as well as some one who recieves public assistance. And that is really the reality....

(applause)

So if you step back from the trees and look at the forest for a moment, what becomes really clear is that we're not talking about health care reform, what we're talking about is health industry reform, or health insurance reform. Because, again, the health care part of the equation is not what's broken. It is the way we pay for it. With a single-payer system we would eliminate the leeching away of resources and money that right now is going into paper work on the one hand and profit on the other, and could very well go into providing additions to care, particularily in regards to prevention, and in regards to other kinds of outliers, that could have the effect of improving the health status of the American people, as opposed to just dealing with sickness care at the end of the line.

There's that old expression about closing the barn door before the horse is out--it makes much more sense to focus wellness and providing people with opportunities to access care in a reasonable way on the front end of the process, than trying to do interventions, in an emergency room, in the most expensive setting possible.

(applause)

I have been challenged. We're getting our campaign started. I look forward to putting out the requisite papers. I haven't put out a paper yet, but I have embraced a single payer system, and again, a single payer system not dependent on employment, but rather in which the payments shift to the income tax as a base.

Now, is that a shift? Yes it is. It's not a tax increase, but it will call for a tax shift. Shifting off of the payroll tax, on to the income tax, would have the effect of eliminating the unfair, the disparate impact on working people that the current system has. Right now 80% of the American people pay more in payroll taxes than they do in income taxes. And because of the way it's structured, the payroll tax impacts disproportionately on working people. So that, Michael Jordon--I don't mean to pick on Michael Jordan, but Michael Jordan pays a smaller percentage of his salary for health care than some one who goes to work on a farm every day, or goes to work in a mill everyday.

There's something wrong with that. We can make the system more progressive in the way that we pay for it by shifting it off the payroll tax base, on to the income tax base, and I believe in the course of it we will still wind up saving money. And have a more progressive system, in which health care gets paid for in a more rational way, and out of that rationality, we will have the savings and we will have the capacity building that will allow us to provide for quality health care with universal coverage that is accessible to every one. And that--and this is my last point, but I'm trying to go on, but the last point that I think is very, very important--and a system that also respects and builds on the relationship between patients and providers.

You know there's that old joke-- and this is not a joke anymore because it's kind of sad, but there is that old joke that organized medicine spent so much effort running away from the embrace of socialized medicine that they ran into the clutches of the venture capitalists.

(laughter, mixed applause)

The truth is, the truth is that doctors and nurses and providers of care should be the people making the decisions about how that care will be delivered as opposed to some bureaucrat sitting nowadays somewhere off shore somewhere, not even here, some one making a decision on behalf of an insurance company's bottom line. These strategies were never meant to exclude care. But that's exaclty where it's gone, and that's exactly what has happened, and the result is we are a sicker nation, and we pay more for our health care than any other industrialized country in the world.

We can do better. We have the capacity to create a single payer system in this country, that frankly in my opinion is more creative and more innovative and comprehensive even than some of the systems that have gone before. You know, we've heard the horror stories about the lines in England and Canada, and even in New Zealand. It doesn't have to be that way. With a market as large as ours, with a capacity as deep as ours, I have every confidence that the American people are innovative and creative enough to come up with reform of our payment system for health care in ways that will preserve our values around what health care should do. And those values include providing the best quality care to every one without regard to means, and making certain that physicians and providers are in a position to make decisions that they are best able to make, and that we eliminate the human suffering and the insecurity and the job loss and all the horrors you've heard about, by finally settling on the notion that rationality in the way that we pay for something that is as personal as health care ought to be our first priority.

Thank you all very much.

I have wanted to see detailed position papers on the issues, especially heatlh care, from all the candidates. I hadn't been able to find out much about Mosely-Braun's position. Thanks to you, now I know!

Using income taxes would open the door for using tax increases in the name of single payer healthcare, for defense expenditures and corporate welfare.

The only similar alternative that I would support would be some sort of progressive payroll tax, in which all of the money went into a seperate trust fund.

"I have been challenged. We're getting our campaign started. I look forward to putting out the requisite papers. I haven't put out a paper yet, but I have embraced a single payer system, and again, a single payer system not dependent on employment, but rather in which the payments shift to the income tax as a base."

Until the papers are out there, it is difficult to take this type of speech seriously.

Using income taxes would open the door for using tax increases in the name of single payer healthcare, for defense expenditures and corporate welfare.

That's a problem with all our taxes, isn't it?

Making the payroll tax more progressive is a worthy cause, but when it comes to health care, there is a good argument for completely decoupling it from employment. If we were to leave the coverage of the unemployed, whether temporarily, chronically, or less than fully or whatever in doubt, then we would still have a basic anxiety and insecurity about health care. That anxiety would creep into labor negotiations, politics, etc., and if it ever came to pass--quite likely--that middle class working Americans favored cutting health care for those without a certain class of job, then the whole health care delivery system would be compromised, as one group of Americans who didn't receive the best preventative care available became a burden due to the high cost of emergency room care and the like. Vicious cycle. You know the drill.

The only people whose healthcare should not be tied to employment are the chronically ill, those with serious disabilities, and children. Otherwise being qualified for single-payer healthcare needs to be tied to paying the payroll tax. People will be able to pay into this system regardless of whether they are self-employed, working at Walmart, or two part-time jobs.

It seems to me that the long term solution to saving Medicare will be to double the taxes paid into the program. The only incentive for giving voters and businesses for paying these higher taxes is to give something back in return, hence a single-payer system that serves everyone.

Again, there are many special cases that deserve to have this healthcare without employment..because of severe health problems and disabilities. But to completely cut the link between employment and universal healthcare would drive a stake in the heart of the very Social Security argument, that the same people who pay the taxes and high primiums deserve something back for those hard earned dollars!

We're paying for it anyway. Look at the financials of a major corp. like GM. Talk to a union member whose premiums and copays keep going up and up while wages are flat because at the bargaining table everything goes to preserving health care coverage.

You argue for basing coverage on a kind of fairness where you get back what you put in. Well, you could reform that system, make it more progressive, so that it's more fair, but I think it's missing the fundamental problem. The issue is not about who ought to recieve health care based on what they pay in payroll taxes because: (1) Everybody gets health care now, it's just that some 41 million Americans get absolutely craptacular last-minute health care that costs us all more in the final accounting; (2) we have as Americans and civilized human beings fundamental values that call for us to care for the wellbeing of our fellow citizens; and (3), the social costs of alienating a large group of Americans from the health care system and from government in general are detrimental to our long-term prosperity and progress. Would you really find the alternative of letting tens of millions of people suffer without any health care whatsoever to be acceptable?

On Social Security, do you really trust the Congress not to raid those funds?--but forget that point for a moment, and think of the basic promise of Social Security: A social safety-net for all Americans. And on health care, Medicaide, Medicare, etc., what are these funds really for? Do the honest accounting, put the costs in the budget, share the burden equally according to ideals of progressive taxation, and the end result will be greater security, greater health, less suffering, increased economic productivity, and, as a special bonus, more transparent government.

I think if you're going to be truly pragmatic about it, you've got to take seriously the proposal for a universal single payer system, and to pay for that you don't need to hike taxes on the vast majority of working Americans--if you shift the burden.

First of all, everyone does not get healthcare. I have someone very close to me whose wife was hurt in an car accident which was not her fault. The insurance company pressured his employer to fire him, and rehire him without the insurance. His wife underwent critically needed surgery, but his family his still deeply in debt even today!!!

And this happened 20 years ago!

Your other two arguments sound nice, but are not realistic. It is a rough world out there. People need a contract they can rely on, one that will not take advantage of them. Finally, not everyone cares for the well being of their fellow man. This is why we have a government, and a Democratic Party. We must present realistic solutions to a dissolving community.

It sound's like your friend's wife indeed recieved treatment.

I did not say everybody has health care coverage. That's exactly the problem Carol's talking about. Everybody does get treatment in the end, but the system of paying for it doesn't work. So on the one hand working families are burdened with debt and anxiety--trust me, I know about this too, we all do-- and on the other hand, when people can't pay and hospitals and providers end up writing off costs, those costs get passed on to current insurance payers in the form of higher premiums and worse coverage. It's just not working.

I know a diabetic co-worker who cannot afford to pay for his blood strips needed to monitor his sugar levels, and can no longer afford the pump supplies needed to deliver his insulan. he goes somedays without insulan, and I found him in his apartment in a coma.

Not what I would call getting "treatment"!

Everytime I hear this argument, I think about what he tells me. He hates sticking those needles in himself just to stay healthy, but he can't even afford to do that! And people like you have to add insult to injury by saying, everyone gets treatment. Try walking in my shoes for just one day and meet my co-workers, you'll be singing a different tune.

You won't give a fuck about the money grubbing providers, just the people who are routinely turned way because they did not have the right card or send in the correct little form to the insurance company every single month.

I really don't know why we are in disagreement. We both support single-payer. But think about this, would Social Security work if it was not tied to employment?

It seems to work fine just the way it is, and if you become disabled...Social Security will help to support you once you have paid in the minimum amount of credits. I want a single-payer system, not a single giver system. And I suspect you feel the same way!

and I am very sorry for that, however it is an illustration of the point that was being made. Instead of getting routine care and preventative care and necessary meds, people are allowed to go without basic health care until the very last moment. Has your friend recieved emergency room care or life support of some kind? I don't know anything really about comas, but I imagine that letting people fall into comas before giving them any health care is the most expensive not to mention the cruelest way of dealing with disease.

On Social Security, it is rather about employment, but in any case I don't believe that it's a good model for providing a basic social safety net, because, well, for one thing I don't feel very secure about it. I expect taxes to be raised, that is, I expect the limit on taxable income to be raised, but that won't keep me from wanting private disability insurance or feeling the pressure to make ample investments for retirement. I'd feel a lot better if taxes were more progressive, even if that meant more money taken out of our monthly budget, as long as I knew that there was a basic safetey net in place in the event that something absolutely horrible happened, and, well, I do worry about other people too.

In any case, Social Security is not on the table. Health care is, and decoupling it from employment is one way to make sure that each and every American will have access to the best quality care we can provide.

I called his parents, and his father came over and gave him a shot of insulan. By the end of the day he was still sick, but awake. My friend is in his 30's, but the father is retired.

There is nothing wrong with buying private disability insurance, that is a wise investment on your part. But in case the private market goes bust, or for those of us that have nothing else..Social Security is there.

I know another individual who can no longer work in landscaping because of heart failure. The hospital screwed up and used the wrong anti-biotic in the operation. Then kidney failure resulted. Now this person is on kidney dialysis. What keeps him afloat financially? Social Security...and he is only in his late fifties. His wife also must work. But without the Social Security checks, they would never have enough money for their medical bills!

So that completes my lecture on Social Security. Again I don't know why you oppose Social Security or Single-Payer healthcare. The idea behind single payer...citizens pay a payroll tax progressive or flat, and then have health insurance. The idea behind Social Security, citizens pay the FICA tax..get their credits, and they will be eligable for retirement benefits and disability. What is wrong with this?

If you don't like it, maybe this is the wrong party for you. Society Security was probably the most critical part of the New Deal, abandon it and our party may as well wave the white flag.

On Social Security, I don't oppose it, but I am concerned that it will not be sufficient, that it will become insolvent, or that it isn't enough for people who need it. I don't object to being taxed, but it does bother me that FICA is not progressive: People who are much worse shape than I am are paying too much, while people who are much better off than I am are paying too little. And like I said, I wouldn't object to more taxes in the interests of fairness, and in providing essential social services.

The logic of Social Security, however, with the idea of credits and a personal account, that won't jibe with progressive taxation, because the wealthy or relatively well-off will never get back enough to justify paying more into the system. Well, of course there are justifications for progressive taxation and providing a basic safetey net. Just not under the logic of that system.

There are other issues with Social Security, that have to do with changes in our economy, and the way work is defined, but I won't go into those.

So, no in short, I don't want to break the essential promise of the New Deal, and I most certainly am not in favor of privatizing Social Security, which I believe is the Republican position. Rather, I would like to see a more robust and meaningful social safetey net, funded as much as possible by a progressive tax base, including a tax on inheritance, which I support (as does Moseley Braun for estates larger than 2 million, which I believe would not be unduly burdensome on estates involving small farms or middle class homes in areas where real estate values have skyrocketed). Well all that's neither here or there, except for the idea of universal single-payer health care coverage, which I say again I fully support.

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My goodness, I am sorry for your friend. I have woes of my own, you know, but it's kind of painful for me to talk about just yet.

but that was not the purpose of telling this story. What I was trying to demonstrate was that there are many working individuals and business people who have been saved thanks to safety nets like Sociel Security and Medicare. The worker who suffered the heart attack also ran the landscaping business for several years, and it was a risky investment that eventially paid off. But he had to hand this over to his sons, because of his medical problem. If he had not, his problems could of destroyed what he started.

To save Social Security, the cap may soon have to be removed from the FICA tax. This isn't making it progressive, but it would do much to keep Social Security solvent. If you have problems with the FICA tax not being progressive, why would you have problems with using a progressive payroll tax to fund a single-payer healthcare system?

If there are no surplusses after the repeal of the repeal of the Bush tax cuts, I agree that dramatic actions will have to be taken in terms of changing the inheritance tax. :boring: Have I beaten this subject to death by now?
;-)

The only people whose healthcare should not be tied to employment are the chronically ill, those with serious disabilities, and children. Otherwise being qualified for single-payer healthcare needs to be tied to paying the payroll tax.

So if somebody is unemployed and not chronically ill, seriously disabled or a child: no healthcare?

so like with Social Security, if you lose your job the credits that you pay in are available until you find the next job. In other words the credits go down not when your medical bills are paid, but when you are not paying the tax. They build up when you are paying the tax. Secondly, the idea behind single-payer is that you can get any type of job and still have this healthcare.

Either you give healthcare to everyone who needs it regardless of their employment or you don't. Why have a bureaucracy and calculations and systems pretending that it's dependent on employment unless it really is?

A clearer "case study": if somebody is just a lazy slacker who never had a job and is living on welfare: no healthcare, eh?

this is why we need more caseworkers, and why the blockgranting of welfare was a mistake.

There are people who have training, who have no health problems, and who can get employment. Should they get healthcare...depends how long they have been drawing out of the system. Nothing is free.

This differs from someone who cannot not work because they are on kidney dialysis or another person who is dying of cancer. These individuals, who probably have worked before, should not lose credits for not paying into the system. These sceneros must be worked out on a case by case situation, these are human beings we are talking about..not just our tax dollars.

Finally..until the retraining programs and dollars are out there to help these people get employment, it is wrong to cut people off. But once these reforms are enacted, then there must be some type of limitations to prevent such abuse.