Health Democracy: Liberating Americans from Medical Insurance Companies

National Health Insurance Begins at Home

By Paul Glover

click to purchase book

Americans deserve universal health coverage and will get it when corporate insurers, pharmaceutical companies, major media, bankers, investors, and the Congress they own are forced to sacrifice profit. The health-care industry, which today commands about 17 percent of the GDP, is tougher than ever to tame. Roosevelt and Truman could not prevail against that plutocracy; neither could Nixon or Clinton. In short, while demanding single-payer health insurance, we can't wait for politicians or private corporations to enact it. The solution will arise partly from localities.

Even as we rally and march for national health care, we should create and embrace regional member-based health plans, which activate the uninsured and pay at least some of our bills. Such grassroots nonprofit health systems, established nationwide, will reassure American taxpayers that cost-effective nonprofit services work, and would be broadly available were national bills like Medicare for All (HR 676) to pass.

Solution within the Solution

The Canadian single-payer campaign was begun in 1948 by Swift Current, Saskatchewan, a farm town of 15,000. They organized a local plan that became so successful that Saskatchewanians demanded their province adopt that locality's model. The plan was enacted in 1962, despite solid media opposition and a strike by doctors. By 1971 all Canadians followed Saskatchewan, enacting universal health-care access. Even today, while besieged and underfunded by Canada's conservative politicians, the single-payer initiative is endorsed by over 90 percent of Canadians. Only 8 percent prefer the U.S. system (Mendelsohn report, 2001; American Journal of Public Health, 2003).

By 1997, residents of Ithaca, New York, were likewise not waiting for the government to become humane. They began a local nonprofit, member-owned self-insuring system. Ithaca Health Alliance members pay $100 per year (or $50/year/child), entitling them to receive substantial payments for several categories of preventive care (exams, treatments, sterilization) and common emergencies such as broken bones, stitches, burns, appendectomies, and dental repair. The Ithaca Health Alliance locates and pays any healer anywhere to care for a co-op member, usually within twenty-four hours. They operate a free clinic for the entire community; offer interest-free loans to members, local organic farmers, and healers; and have also secured discounts with 120 Ithaca area health providers. In fact, the

Alliance is so successful that the $100 annual membership fee has not increased since 1997, while the payment menu has expanded from two categories to twenty. It's still rudimentary, but if you cannot afford insurance, even this level of security is impressive.

How can the Alliance afford these health services? As more people have joined and renewed annually, both the general fund and size of payments has steadily increased. Were membership to stabilize or decline, so would payments. During the past decade the Alliance has created its own actuarial expertise by graphing the frequency and amplitude of payments, by category. At full scale, the plan is capable of proving that HMOs are not necessary.

Health Democracy

The Ithaca Health Alliance was part of the Health Democracy movement, a network of co-operatives whose members own health systems.

Direct democratic control is strengthened through bylaws that require that all medical payments that are made to members, or declined, are seen on the Alliance website [ithacahealth.org]. Members are invited, via newsletter and listserv, to suggest how coverage should expand, serve on the board and committees, and elect board members. The board meets publicly each month. The maximum salary for administrative staff (about one employee per 2,000 members) is twice the local livable wage, to ensure that top staff are more dedicated to the mission than to money.

The Alliance's co-operative nature is underscored by the fact that membership fees are the same for everyone, since they ally to help one another, rather than exploit weakness for profit. Ithaca's community currency is accepted for membership dues. Love, not marriage, defines eligibility for domestic partner discounts.

Health co-ops support people's preferences for gentler, preventive healing. Were Medicare made universal overnight, the medical technology pills-and-surgery sickness system would keep prices unnecessarily high. Health Democracy stresses changing the basis of the medical health-care system, encouraging healthier living and holistic care.

Most outstandingly, Health Democracy co-ops sponsor public health committees to confront health damage from larger issues: consumerism, which leads to overdoses of sugar and fats; polluted soil, water and air; and war, which is notoriously unhealthy.

From Local to National

Propelled by the faliures of the public and private sectors, the co-op sector intends to weave a national health system that is democratic, nonprofit, efficient, preventive, holistic, and generous.

Here's where the top-down relies on the bottom-up. The United States Health Alliance will link co-op health plans to one another, creating a movement both practical and political, which heals the nation. This is the infrastructure universal coverage needs and deserves.

Paul Glover is founder of the Ithaca Health Alliance, PhilaHealthia, Ithaca HOURS local currency, Citizen Planners of Los Angeles, and author of Health Democracy [healthdemocracy.org]. He appeared on several Green Party 2004 presidential primary ballots. He is a "consultivist" for community economic development: paulglover.org.

Health Democracy: Liberating Americans from Medical Insurance Companies book explains how to start and expand a locally-controlled, self-financing health co-operative.  Based on the Ithaca Health Alliance, founded by the author.

Real Patriots: Cooperative Medicine: Ithaca's Model of Health-Caring