As the Democratic presidential candidates' positions on health care policy reform have solidified, the issue of mandates has become increasingly important as it is one of the few differences between the various plans. While the right has towed the free market company line on health care, and while the Democrats' paths differ from the Republicans', the destination is the same: a huge payday for insurance companies. According to Shum Preston of the California Nurses Association (CNA), "Individual mandates are a step backward
Insurance companies support individual mandate plans because they guarantee them more customers, revenues, and influence over medical decision making. What's not for them to like?" Any health care proposal that includes mandates without addressing the problems that corporate health care and insurance companies pose maintains the status quo. Barack Obama's and Hillary Clinton's plans differ in that Obama's plan doesn't include mandates, while Clinton's does. What remains identical between the two candidates' plans is the desire for universal health insurance, which is not to be mistaken for universal health care. John Edwards' populist message includes a mandate and an option between public and private care, which detractors say will compromise the public option in the end.
Mandates, say Preston, "Force patients to sign up for expensive, wasteful, for-profit insurance products without guaranteeing care or protecting them from cost increases." The CNA and its national wing, the National Nurses Organizing Committee, are a major lobbying force in the health care debate, one of the only organizations pushing for a universal single-payer model.
In a whirlwind past couple of weeks, CNA and NNOC placed advertisements in 10 Iowa newspapers that made national news, went on a two day strike in Northern California, and organized a national protest against the health insurance company Cigna HealthCare, which let a young woman die by refusing to cover her liver transplant. The message they are trying to convey in all of these actions is that the problem with the health care system isn't just that not everyone is covered; it is that the companies that run it succeed financially by denying access and care. Mandated care doesn't solve this problem.
The advertisement shocked many media outlets around the country as it declared that were he not on the government's health care plan, Vice President Cheney "would probably be dead by now." According to the union, his past medical history—which includes four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator—would disqualify him from signing up for any insurance plan other than the government's. A Cheney spokeswoman responded to the ad by calling it "outrageous."
Much of CNA's lobbying for single-payer care falls in line with its actions as a union. The recent strike at Sutter Hospitals in Northern California was in response to nurses at those hospitals working without a contract for several months, and to press Sutter to meet statewide safety standards. The company is also attempting to close three Bay Area hospitals that have traditionally served the underserved.
The tragic death of 17-year-old Natalie Sarkisyan on December 21st illustrates many of these issues and the immediate need for reform. Sarkisyan's liver had shut down after chemotherapy treatments for two bouts of cancer at the UCLA Medical Center. On December 11th Cigna denied her treatment while she was in critical condition. Four doctors wrote to Cigna that same day saying that she was ready for the transplant and that there was a good chance that her other organs would recover on their own if she had a new liver. On December 14th Cigna replied that a healthy liver was available, but insurance wouldn't cover it and the family would have to make a $75,000 down payment on the liver, which they could not afford. The CNA and the NNOC organized a massive protest and put enough pressure on Cigna to force it to capitulate on December 20th. It was too late, however, and Sarkisyan died soon after. Rose Ann DeMoro, president of CNA, called it "a horrific tragedy that demonstrates what is so fundamentally wrong with our health care system today. Insurance companies have a stranglehold on our health. Their first priority is to make profits for their shareholders—and the way they do that is by denying care."
While CNA will only actively support a single-payer model, "any plan without mandates is better than any with mandates," says Preston. Obama has taken heat from the Clinton camp for not mandating health care for adults, but in lieu of a single-payer plan, Obama's is the only plan that doesn't bow completely to the insurance companies. Edwards suggests that people have the option of choosing public or private plans, yet according to Preston, "if we allow [insurance companies] to compete with public health programs, they'll cherry pick the best customers and shuffle high risk patients on to the public dime. The idea that we can hope and regulate them to become good people isn't going to work." It seems as though while health care is supposedly a major issue in this upcoming election, there won't be significant reform, no matter who comes out on top.