Assessing the California Single-Payer Fight

Against the Current, No. 54, January/February 1995

Alan Hanger

IN A YEAR when most working people continued their boycott of the electoral system by not voting, the single-payer initiative in California was buried in the November polls by the anger of those who voted against the government and crooked politicians of both parties. In a one-sided battle of media ads, the insurance companies decisively defeated Proposition 186 by 73.4% in opposition to 26.6% in favor of the single-payer plan.

Over 400 organizations, ninety-two unions, twenty-seven elected officials, and 640 businesses endorsed the single-payer initiative, and over thirty-five groups served on the steering committee. These groups included many health reform organizations, the League of Women Voters, the American Association of Retired Persons, California Congress of Seniors, SEIU, ILWU, California Nurses Association, United Auto Workers, Oil, Chemical, and Atomic Workers, California Teachers Association, Neighbor to Neighbor, and the California Physicians Alliance.

With public and media attention focused on the racist anti-immigrant Proposition 187, it was difficult to get a hearing. Nevertheless, 282 speakers spoke at over 1,160 events that attracted 38,000 people. There were over 100 media speakers on 300 radio talk shows, 600 newspaper articles, fifty opinion editorials, and fifty press conferences. The major focus for the campaign was raising funds at 1,500 house parties attended by 22,000 people who donated almost $1,100,000, which was earmarked for a media campaign of radio and TV ads during the last month of the campaign.

Three-Pronged Attack

Smaller insurance companies and corporate America spent $100 million in Washington to defeat Clinton’s health reform plan, which would have created an oligopoly of insurance companies. As soon as it was clear they had defeated the Clinton plan, they launched their propaganda campaign in California. They were successful in associating the single-payer health initiative with Clinton’s complex plan — one that would have meant a drop in standards of care for most Americans while costing more money. Attacks against the initiative focused on three primary areas: 1) taxes, 2) the health insurance commissioner, and 3) government takeover of peoples’ health.

The initiative would have raised $40 billion dollars in taxes on businesses and $10 billion on individuals to offset the insurance premiums on all but those businesses who don’t now pay health insurance for their employees. Among this despicable and most vocal group were the Federation of Independent Small Businesses, including McDonalds, Pizza Hut, and Pepsico, all groups who pay their employees close to the minimum wage.

The anti-186 campaign was able to take a generalized anti-tax sentiment and confuse people into thinking that they would be paying a new tax for health care — carefully avoiding the fact that citizens and businesses would no longer pay health insurance premiums and would have a significantly lower worker’s compensation tax. For most, the 2-1/2% tax paid by individuals would have been less than today’s deductibles.

An elected health commissioner would have been responsible for organizing the oversight spending of California’s $108 billion health care budget. The commissioner would have been responsible for creating a state agency that would pay bills submitted by doctors and HMOs, set up standards for preventive medicine, and negotiate rates that doctors, drug companies, and HMOs would be paid.

The insurance companies were successful in labeling this person a health czar who would control everyone’s health care. They neglected to mention who currently makes these decisions — the multiple unelected private corporate heads who gross over $10 million each.

Besides attacking the initiative for the 2-1/2% increase in taxes, the anti-186 campaign took advantage of an anti-government sentiment that exists in a large section of the populace. With the average worker’s living standard declining over the last twenty years, the far right has been able to blame “big” government for the decline.

Even though Medicare and Canada’s single-payer plan are able to deliver efficient health care, the insurance industry was able to convince a majority of Californians that the industry was more responsive than a government-administered system would be. Counteracting this myth will not be easy despite the fact that the insurance industry consumes 30% of the health care dollar while administrative costs for Medicare are a mere 4%.

Strategic Errors

There were several mistakes that make the defeat partially self-inflicted. These all boil down to the fact that the Prop 186 campaign was carried out more as a media campaign than a grassroots movement.

The first mistake occurred during petitioning. This was the most historic California petitioning drive for a constitutional amendment: in the number of volunteers (10,000) and in the shortest length of time obtaining 1,100,000 signatures. But the mechanical emphasis on getting signatures overlooked the political need to educate voters who signed the petition. There was no literature to distribute to those who signed the initiative despite repeated requests from volunteers.

Listening too strongly to pollsters and focus groups was the second major mistake. Although the initiative was assigned its ballot number last June, virtually no literature was available until after Labor Day. That is, there were no plans to conduct a grassroots campaign. The campaign leaders felt the only way people could be reached was through TV and radio ads — and media consultants were focused on running a media campaign during September and October.

Six years ago Voter Revolt and other groups organized a petition drive to institute an elected insurance commissioner and reduce auto insurance rates which were, and still are, sky high. Proposition 103 was successful even though it faced overwhelming odds. Those 103 organizers concluded that by duplicating the fundraising through house parties and launching a media blitz they could win Proposition 186.

But the anger people were able to direct against the auto insurance rates in 1988 was not automatically transferrable to people’s anger around their inadequate health care in 1994.

In 1988 voters were able to see where their direct economic interest lay and voted to cut their auto insurance rates. In 1994 the insurance industry was able to raise questions about the single-payer plan that the campaign did not adequately answer. They weren’t convinced a vote for Proposition 186 would give them better health care and lower costs.

Additionally, by listening to the pollsters, who correctly predicted passage of the anti-immigrant Proposition 187, those who wrote the ballot arguments for the Voters Handbook pandered to the prevailing racist sentiment. Rather than sticking with the letter of the initiative, which stated that all California residents would be covered, the arguments specified that only legal residents would be covered. (Since a given referendum must deal only with one issue, the writers of the referendum left the definition of who was a resident up to the state legislature.)

By hoping to sidestep the anti-immigrant campaign, this argument led some gay, Latino, and Asian groups to rescind their endorsement of the initiative (although they would continue to urge their members to vote for it).

Distancing Proposition 186 from those most likely to benefit from single payer actually contributed to the degree by which the single-payer initiative was defeated. While the last month’s mobilization by anti-187 forces was able to turn an 80% to 20% rout into a 60% to 40% defeat, the single-payer forces were able not able to even hold the 30% support that existed in the previous month.

Campaign supporters were told often that we would drop 10% in the polls if we did not pander to the racist sentiments. Yet if all those who opposed 187 had voted for 186, the loss for single payer could have been a mere 5-10%. More votes could have been obtained from those who opposed 187 than from the conservative voters who would oppose 186. As it was, exit polls showed 64% of Latino voters voting for 186, because it was in their economic interest.

The coalition’s strategy was built on the media campaign and therefore made an attempt to put a wall between health care and immigration. Clearly this was wrong. But the progressive community is a lot better at opposing things (imperialist wars, the anti-immigrant Proposition 187) than figuring out how to come together for a positive political struggle. For example, the state National Organization for Women initially opposed the initiative because it did not explicitly call for abortion coverage; Latino groups opposed 186 because it did not specifically call for health for undocumented immigrants.

Finally, most labor bureaucrats did their usual campaign of giving money, a few articles in labor papers, but did nothing to mobilize their members, even in unions that gave large donations and have large numbers of health workers, especially SEIU and the CTA. The labor bureaucrats were too busy trying to get workers to vote for the “lesser” of two evils for governor — Democrat Kathleen Brown. Other than giving money, most unions failed to aid the most significant positive political struggle in decades. The exceptions were the California Nurses Association and the ILWU, who organized house parties and educational campaigns among their members.

Is There a Future for Single Payer?

What should be done after such a resounding defeat as occurred in the single-payer campaign? Some supporters have concluded that more money must be raised while others deduced that it is not possible to pass this type of reform through the initiative process.

Focusing on fundraising is a lost cause that demoralizes and angers activists and only confirms why the average voter hates politics as it is practiced in modern day capitalist America.

Hell will freeze over before Congress and state legislatures will pass meaningful health reform because the vast majority of politicians are bought and paid for by the health industry. There is no other means to reform except the building a movement around health care reform using the initiative process as a focus.

The single-payer initiative that would transform one seventh of California’s economy still has a good chance in the 1996 election. But such a victory will come not from watering down the initiative to make it more palpable to business as some have argued, but by making it more appealing to the people most likely to benefit from single payer. Two possibilities that flow from analyzing the insurance industry’s attacks are:

* Remove the 2-1/2 % tax on incomes below $100,000 and institute a progressive tax schedule on incomes above that amount. The tax on individuals would only raise 10% of the $108 billion spent on California healthcare. This amount could easily be replaced by raising the rate on large corporations from the average of 8.9% to 11%. This step would not hurt government and corporations, but would make it easier for the average person to understand that their health care costs would disappear. Minor adjustments in tax rates for small businesses would be required to make them more progressive. Of course, big business will fight this tax with a lot of money, but they don’t cast the votes that are necessary to win.

* Create regional health care boards rather than a state health care commissioner. These would be closer to the grassroots and therefore potentially more democratic than a state board. No slots should be reserved for doctors or business.

Will there be an ongoing campaign for single payer in California? Will there be another initiative for the 1996 ballot? The organizations comprising the steering committee analyzed this campaign and said that they want to build a movement around single payer with a new initiative being the organizing focus.

If a movement — not a media campaign — is built, then there is a good chance of a single payer initiative winning in 1996. The strategy of engaging in media battles of thirty-second spots on radio and TV against the insurance industry is self-defeating — you can never match their power or money. The $2.6 million dollars raised by the pro-186 forces was outspent by at least five to one by the insurance industry.

Some supporters are saying that we need to do better fundraising next time so that we can match the insurance company spending. This misses the lesson: if pro-single payer advocates raise $10 million, the insurance companies will raise $100 million. They will spend as much as is required to defeat any initiative and maintain their stranglehold on the health industry. There is no way to win on the fundraising and media battlefield without altering the political structure through imposing campaign funding limits and opening up the media to the average citizen.

The focus of the single-payer movement needs to be on educating and organizing, rather than seeing petitioning and fundraising as merely technical tasks. To carry out this grassroots educational effort, the campaign structure and staff need to be decentralized. In fact, over the next year building regional health care coalitions should be seen as a priority.

The average worker needs complete information in detailed literature with graphs, charts, and cartoons. Video cassettes should be used to impart detailed information to voters. The $1 million spent on TV and radio ads would pay for about a million video cassettes to deliver the message to that many voters, who would probably contribute at least that much money.

ATC 54, January-February 1995