“[A] single-payer system would make a clear statement that health care is a human right. This framework recognizes health care as a universal necessity, not a commodity reserved for those lucky enough to have won the economic lottery, and most definitely not a scheme for denial and discrimination. While implementing a single-payer insurance program will not solve all of our nation’s health, racial or social inequities, it is clearly a step in that direction.”

 
That’s the concluding sentence from an article in the July 2015 issue of the Harvard Public Health Review entitled “Single-Payer Health Reform: A Step Toward Reducing Structural Racism in Health Care”.  The whole thing is worth reading.

The U.S. press has been filled with stories—before the November 8th election and since—about charges that the U.S. presidential election was “rigged.”  The media has reported endlessly on allegations that the Russians tried to rig things in various ways, and Donald Trump’s charges that the election was rigged have gotten massive coverage.  But there is very clear evidence—eliciting far less outrage—of a structure that’s built into the election system itself that had the effect of “rigging” the 2016 election by limiting the votes of people more likely to vote Democratic than Republican.  Actually, it’s been going on for a long time, with 2016 being only the most recent example of a rigged election process at work.

I’m speaking here of the practice of felon disenfranchisement, which is when USAmericans are barred from voting if they’ve been convicted of felony-level crimes.  Nationwide, 6.1 million people are thus disenfranchised.

Many people are aware that the Democratic candidate for President in 2016 received 2,864,974 more votes than the nominal Republican who is now President.  The fact that he is indeed the President is due to the Electoral College, in which most states (all but two) require that their electoral college votes be awarded to the winner of the popular vote in the state.

Now let’s look at two states whose electoral votes went to the Republican candidate: Arizona and Florida.  Arizona has 11 electoral votes, Florida has 29, so together they have 40.  A swing of 38 electoral college votes would have given us a different President.  In these two states, votes missing due to felon disenfranchisement likely changed the outcome.  Here are some details:

In Arizona the Republican won the popular vote by 91,000 votes, and in Florida the Republican won by 112,000 votes.  In Arizona 221,000 people are barred from voting due to felony disenfranchisement.  In Florida that number is a staggering 1,600,000.

Now consider that, in the words of The Leadership Conference on Civil and Human Rights,  “state disenfranchisement laws are problematic not only due to the vast numbers of potential voters they affect, but also their disproportionate impact on racial minorities, particularly African Americans and Hispanics.”

Now consider that nationwide, eighty percent of Blacks voted for Hilary Clinton and the number for Latinos was 65 percent.  I haven’t even talked about the enforcement and sentencing in the so-called “War on Drugs” which, says the ACLU, has “had a staggeringly disproportionate impact on African-Americans.”

Add it all up and we can see that it is at least possible that neither Donald Trump nor George W. Bush would have been elected were felon disenfranchisement not the law of the land in so many states.  Of course, we can’t know if that’s true.  Which is why the nation should be up in arms about this issue.  The issue, after all, is whether our elections—the centerpiece of our form of representative democracy—may not reflect the will of the people.

The media is certainly not up in arms about this.  A Lexis/Nexis database search of major U.S. newspapers looking for articles with the words “Election” and “Rigged” since November 1st yields 1,170 results.  Adding in “disenfranchised” drops it to 61 stories.  Substitute “felons” for “disenfranchised” and it goes down even further, to 41 articles.  Keeping the focus on Trump—even if the focus is on rebutting his charges—keeps the focus OFF of the issue of voting rights.

The urgency we should be feeling to report on, and to address, the issue of felon disenfranchisement is heightened when we consider the overtly racist roots of the practice.   Writing in 2014 in the New York Times, editorialist Brent Staples notes that laws prohibiting voting by people with felony convictions “exploded in number” after the Civil War, “when Southern lawmakers were working feverishly to neutralize the black electorate.”

Staples’ third paragraph says it well: “This racially freighted system has normalized disenfranchisement in the United States—at a time when our peers in the democratic world rightly see it as an aberration. It has also stripped one in every 13 black persons of the right to vote—a rate four times that of nonblacks nationally. At the same time, it has allowed disenfranchisement to move beyond that black population—which makes up 38 percent of those denied the vote—into the body politic as a whole. One lesson here is that punishments designed for one pariah group can be easily expanded to include others as well.”

So here we have yet another example of how our nation’s racist history lives on in the present, with dire consequences not just for communities of color, but for all of us.

It would be great to eliminate the Electoral College, as a growing movement is demanding.  But that’s not all we need.  The larger issue of voting rights and disenfranchisement merits a major investigation, Congressional hearings, subpoenas of election officials, and interrogations of the sponsors of felon disenfranchisement laws.  It merits time on all the talk shows, ongoing coverage in the daily news media, and demands for meaningful steps to at least attempt to rectify this outrageous situation.

The time to address this issue is now, not during the next campaign, when it will be too late.  Here are two organizations that never stop working on voting rights and the disenfranchisement of 1.6 million of our fellow USAmericans:

The Sentencing Project has a focus on felony disenfranchisement.

The Brennan Center also focuses on voting rights.

In his book “Racism Without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America,” author Eduardo Bonilla-Silva talks about what he calls the “New Racism” that has arisen in the period since the demise of formal Jim Crow structures.  He tells us that “Today, ‘new racism’ practices have emerged that are more sophisticated and subtle than those typical of the Jim Crow era.”

Sometimes the “sophisticated and subtle” racist effects of laws and policies are rendered more subtle when our daily news fails to see the “racial angle” when reporting on a seemingly (to many white people) race-neutral story.  A great example came my way on February 9th, when my local newspaper, the Star Tribune, ran a story headlined “Proposal to Legalize Marijuana ‘A Conversation Starter.’”

[Note: The Democratic Party in Minnesota is known as the “Democratic-Farmer-Labor Party”, for reasons I won’t go into here.]

“A handful of DFL lawmakers want to legalize marijuana for personal use,” reported the Star Trib, noting that the Democrats consider Minnesota’s marijuana prohibition to be “costly, harmful and antiquated.”  The problems listed included “wasting police resources, leading users to interact with drug dealers and preventing Minnesotans who get arrested and jailed from finding housing and work later in life.” The paper quoted a Democratic legislator who stated that “In 2015 Minnesota law enforcement made 6,829 arrests for marijuana, which was 39 percent of all drug arrests.”

It was Democratic lawmaker Jason Metsa, from Northeastern Minnesota, who said that this unlikely-to-pass legislation was still important, as it would function as “a conversation starter.”  But one crucial part of the conversation appears to be missing from the news report: The issue of race was never mentioned.

This omission is quite remarkable, given the incredible racial disparity in enforcement of our “costly, harmful and antiquated” marijuana laws. Whether the failure to mention race was a failure on the part of the legislators or on the part of the newspaper, we don’t know.  But it’s a serious omission either way.

Here are some of the racial realities that, had they been mentioned by the Star Tribune or their legislative sources, might have helped readers to understand the “harmful” part of “costly, harmful, and antiquated”:

The first thing that should be known is that whites, blacks, and Latinos use marijuana drugs at relatively similar rates.  In fact, statistics from the federal Substance Abuse and Mental Health Services Administration indicate that white people overall use marijuana at a higher rate than either blacks or “hispanics” (the SAMHSA term).

The American Civil Liberties Union reports that, in Minnesota, Blacks represent only 5% of the population, but account for 31% of the marijuana possession arrests.  The ACLU also tells us that Minnesota ranks third among states with the largest racial disparities in marijuana possession arrest rates; Blacks in Minnesota are 7.81 times more likely to be arrested than whites.  And, while Minnesota stands out, it is not unique, says the ACLU: “Such racial disparities in marijuana possession arrests exist in all regions of the country, in counties large and small, urban and rural, wealthy and poor, and with large and small Black populations.”

The Sentencing Project, in a 2009 report, says that “Overall, two-thirds of persons incarcerated for a drug offense in state prison are African American or Latino. These figures are far out of proportion to the degree that these groups use or sell drugs. A wealth of research demonstrates that much of this disparity is fueled by disparate law enforcement practices.  In effect, police agencies have frequently targeted drug law violations in low-income communities of color for enforcement operations, while substance abuse in communities with substantial resources is more likely to be addressed as a family or public health problem.”

The now-defunct think tank Minnesota 2020, in a 2014 report, recommended that Minnesota legislators “consider whether current marijuana laws are actually doing more harm than good.”  After recommending several changes to existing marijuana laws, the report stated, “Minnesota lawmakers should consider the prevalence of marijuana use in Minnesota and the U.S. as a whole. The costs and consequences of marijuana possession are being disproportionately shouldered by blacks in Minnesota when close to 40% of Americans admit to using marijuana at least once in their lifetime. Laws and policies that so selectively punish a behavior that is so widespread and considered harmless (and even beneficial) by many are clearly in need of revision.”

The Minnesota 2020 report mentions that “some chapters of the NAACP have framed racial disparities in marijuana possession arrests as a civil rights issue.”  And here is where we see the implications of the failure to report on the damage done by our drug laws and the racist enforcement of them.

The Black Lives Matter movement has prompted many white people to ask “What can I do to help undo the effects of racism in our culture?”  One answer might be that white people could add their voices to the many voices already demanding that the racist and ineffective “War on Drugs” come to an end. And any media outlet reporting on drug laws that fails to report on their disproportionate effects on the lives of people of color—intentionally or not, it doesn’t matter—needs to hear from those of us who are aware of this particular manifestation of racial disparities in law enforcement.

I’ll close by quoting Michelle Alexander, author of “The New Jim Crow: Mass Incarceration in the Age of Colorblindness.”  An article on Alternet in 2014 reported, “Alexander cautioned that drug policy activists need to keep this [racial] disparity in mind and cultivate a conversation about repairing the damages done by the systemic racism of the war on drugs, before cashing in on legalization.

“‘After waging a brutal war on poor communities of color, a drug war that has decimated families, spread despair and hopelessness through entire communities, and a war that has fanned the flames of the very violence it was supposedly intended to address and control; after pouring billions of dollars into prisons and allowing schools to fail; we’re gonna simply say, we’re done now?’ Alexander said. ‘I think we have to be willing, as we’re talking about legalization, to also start talking about reparations for the war on drugs, how to repair the harm caused.’”

Repairing the damage of the racist and unjust “War on Drugs” is a subject for a future Nygaard Notes.  But before any movement on such a project is even imaginable, our media has to help—at least a little bit—to give people a chance to see that marijuana law reform is more than just “A Conversation Starter.”

 
***

The four main sources (not the only ones) for the information in this article are:

 
“The War on Marijuana in Black and White,” published by the American Civil Liberties Union in June of 2013
“Collateral Costs: Racial Disparities and Injustice in Minnesota’s Marijuana Laws,” published by Minnesota 2020 in April of 2014
“The Changing Racial Dynamics of the War on Drugs,” published by The Sentencing Project in  April of 2009
“The Colors of Cannabis: Race and Marijuana” by Steven Bender, UC Davis Law Review  Vol. 50, No. 3, February 2017

Texas Republican Pete Sessions on March 1st introduced a bill—H.R.1275—the title of which is “World’s Greatest Healthcare Plan of 2017.”  (I’m not making this up!)  But that 118-page disaster is not what everyone in Washington, and everyone on every news station, is talking about.  What everyone is talking about is the bill introduced by Republicans, with much fanfare if a less-grandiose title, on March 6th.  Formally known as the “American Health Care Act,” the highlights of this 123-page bill (also a disaster) have been widely reported: Severe cuts to Medicaid; tax breaks for the rich; no insurance mandate; age-based premiums; keep some ObamaCare provisions; etc.  Five of the 123 pages of the AHCA are about “Letting States Disenroll High Dollar Lottery Winners.”  I’m not kidding here, either!

Meanwhile, a 30-page alternative to both of the above right-wing fantasies was introduced in the U.S. House of Representatives seven weeks ago.  That bill, H.R. 676, “The Expanded and Improved Medicare for All Act,” was introduced on January 24th by Michigan Democrat John Conyers and 63 co-sponsors.  H.R. 676 is a proposal for a single-payer universal health care system in the United States.

I can hear people saying, “But that will never pass in a million years in a Republican Congress!”  To which I respond: You never know.  Remember that the President is unpredictable and tends to make moves that destabilize existing structures.  And remember also that Republicans are far from unified on this issue.  Just read your daily news.

Then consider that a solid majority of people in the U.S. favor a single-payer system.  It was back in December of 2015, not so long ago, that the respected Kaiser Family Foundation conducted a “Health Tracking Poll” and reported,  “When asked their opinion, nearly 6 in 10 Americans (58 percent) say they favor the idea of Medicare-for-all, including 34 percent who say they strongly favor it. This is compared to 34 percent who say they oppose it, including 25 percent who strongly oppose it.”

Just last May (2016) Gallup surveyed United Statesians on the subject, and they reported, “Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.”

A survey released by the Pew Research Center on January 13th, just 11 days before H.R. 676 was introduced in Congress, reported that “Currently, 60% of Americans say the government should be responsible for ensuring health care coverage for all Americans, compared with 38% who say this should not be the government’s responsibility. The share saying it is the government’s responsibility has increased from 51% last year and now stands at its highest point in nearly a decade.”

Why haven’t you heard about a major legislative initiative that is supported by a majority of USAmericans?  Well, I searched the major media for the terms “Medicare for All” and “Conyers” from the time Conyers introduced the legislation until now, and found a total of three citations.  One was a letter to the editor.  One was a single sentence in an article about a possible single-payer system in CA.  The third was not a news story, but a commentary in the business section of the LA Times (referenced elsewhere in this issue of the Notes.)

Is there a racial disparity in health insurance rates?  Yes, there is: Nationwide, the highest percentages of uninsured people are found in communities of color.  So it’s not surprising to find, as a January 2017 poll by the Pew Research Center found, that “A large majority of blacks and Hispanics (85% and 84%, respectively) say the government should be responsible for [ensuring health care coverage for all Americans], while non-Hispanic whites are split on the issue (49% agree, 49% disagree).”

Among the many virtues of a single-payer plan is that eligibility would be defined by humanity: everybody in, nobody out.  This wouldn’t get rid of racism in the health care system, but it would be a big step in the right direction.

I’m not prepared to say that the media is the “enemy of the people,” but I will say that they often fail to report on issues of importance to the general public, while devoting all of their energy to reporting on lesser issues about which powerful sectors disagree.  Health care is a classic case in point.  We get endless reporting on health care proposals supported by a minority of citizens, while legislation that appears to have majority support among the population is ignored.  Power is thus served.

Next I’ll offer a few highlights of H.R. 676, followed by a list of resource that you may wish to examine so you’ll know what you’re talking about when you join the campaign for single-payer health care in the United States.

Of course there will be trillions of details and arguments about implementation of a transformation of the U.S. health care “system” from the current mish-mash to a unified single-payer system.  But, among its many virtues, the bill itself—H.R. 676, “The Expanded and Improved Medicare for All Act”—is quite simple.  By way of illustration, here are a few excerpts taken verbatim from the text of the bill.  I think you’ll understand them:

Page 5 SEC. 102. BENEFITS AND PORTABILITY.  (a) IN GENERAL.—The health care benefits under this Act cover all medically necessary services, including at least the following:
(1) Primary care and prevention.
(2) Approved dietary and nutritional therapies.
(3) Inpatient care.
(4) Outpatient care.
(5) Emergency care.
(6) Prescription drugs.
(7) Durable medical equipment.
(8) Long-term care.
(9) Palliative care.
(10) Mental health services.
(11) The full scope of dental services, services, including periodontics, oral surgery, and
endodontics, but not including cosmetic dentistry.
(12) Substance abuse treatment services.
(13) Chiropractic services, not including electrical stimulation.
(14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(15) Hearing services, including coverage of hearing aids.
(16) Podiatric care.

Page 6  PORTABILITY: “Such benefits [as listed above] are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.”

Page 6  NO COST-SHARING.  No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

Page 9  FREEDOM OF CHOICE.  Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.

Page 17  SEC. 203. PAYMENT FOR LONG-TERM CARE. (a) ALLOTMENT FOR REGIONS.—The Program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this Act.

Page 17  FAVORING NON-INSTITUTIONAL CARE.  All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.

Like anything else, a single-payer system will only be as good as popular organization and pressure make it.  That is, even after it is enacted, H.R. 676 will be constantly under attack.  If you don’t think so, consider the vehemence of the opposition to “ObamaCare,” which after all is a market-oriented system.  Donald Trump reminded the nation a few days ago that “it’s a disaster, folks, OK?”  And who can forget former presidential candidate Ben Carson, speaking  in 2014, saying that ObamaCare was “the worst thing that has happened in this nation since slavery.”?

Just a few days ago I heard a call-in show on health care during which a caller asked why a single-payer system is never talked about.  One of the “experts” dismissed the idea by saying that it would cost “trillions” of dollars.  Left unsaid was any consideration of economic trade-offs.  Economist Gerald Friedman, for example, published a study in 2013 which found that H.R. 676, due to its progressive federal tax payments “would cost less for 95% of households” than the current system of deductibles, premiums and copayments.

I realize that I am writing this at a time when a single-payer system likely seems more remote than ever.  So let’s end on a positive note: A February 3rd column in the LA Times quoted Michigan Congressman John Conyers, sponsor of H.R. 676, speaking of the possible adoption of the Republican health care bill. “Taking 20 million people out of Obamacare is going to help our cause,” said Conyers, adding “We’ve got all the arguments on our side.”

If I do say so myself, perhaps the best summary of the basic idea of a single-payer health care system for the United States appeared in Nygaard Notes #241.  That entire edition of the Notes was my summary of the “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” that ran in the August 13, 2003 issue of the prestigious Journal of the American Medical Association.

If you want a much shorter summary of the 2017 proposal for single-payer health care, I recommend that you read a February 3rd column in the Business section of the LA Times by David Lazarus, called “Looking for a Really Good Obamacare Replacement? Here it Is.”

For more detail on the 2017 legislation, visit the H.R. 676 page on the website of Physicians for a National Health Program (PNHP).

There are a couple of activist groups you may wish to join or otherwise support.  One is called “Health Care Now!”  and the other is “Single Payer Action”.

To see the actual legislation (HR 676), co-sponsors etc, go to Congress.Gov

The single best source for information on single payer has long been, and still is, the Physicians for a National Health Program, or PNHP.