Anne Steel (l.) of Missourians for Single Payer, Rachel DeGolia of UHCAN, Earl Smith of the Illinois Conference of Churches and UCC member Loretta Richardson of Maryland Citizens Health Initiative (UCC/Md.) listen to the discussion at the annual UHCAN meeting in Baltimore. W. Evan Golder photo.
The year 2002 was not a stellar year for health care reform.
In Oregon, a single-payer health care ballot initiative received only 21 percent of the vote. In Congress, the Health Care Access Initiative fell four legislators short of its goal of 100 cosponsors. And across the country, big money, especially from business and insurers, helped frame the health care debate in ways that did not favor consumers or patients.
Nevertheless, the more than 100 participants at the National UHCAN (Universal Health Care Action Network) Conference were not discouraged. The conference, held in Baltimore Nov. 15-17, attracted health care activists from 30 states, mostly from health care reform groups, labor unions and churches.
"Big change can take a decade or more, and we are taking the long view," Rachel DeGolia, UHCAN operations director, told The Wall Street Journal. She added that health care reformers will continue to move forward with universal health care measures in states including Illinois, Maine, Maryland and Vermont.
As participants debated different strategies for working for universal health care, three different tensions emerged: incremental vs. total reform, states vs. national focus, and separate efforts vs. building strategic alliances.
"We are not going to get universal health care all at once," the Rev. Jackson Day of the United Methodist Church told the group. "The crucial question is whether half a loaf is better than one –– or is that half really a moldy loaf that we need to reject?"
"We have to advocate for incremental changes if we are to be successful," he said, "because the chances of passage of any comprehensive program are remote. Increments are those reforms that move us toward the goal."
Day mentioned two other areas of challenge for the faith community. The first concerned theological education.
"Churches have a specific mandate to deal with the state of fear since 9/ 11," he said. "Over the last 20 years there has been a tremendous move to undermine the theological under-girding of social programs. Now there is a hunger for theological support for things people need to be done."
The second concerned global monitoring.
"Radical changes in world governance are taking place because of the World Trade Organization," he said. "The WTO can impose penalties on state and national governments whose health policies and environmental policies may be a hindrance to a corporation’s profit-making abilities. Governments everywhere are under tremendous pressure to cut back."
Separation of groups
Patricia Dowds, vice president of the National Coalition of Mental Health Professionals and Consumers and a UHCAN board member, pointed out that in most states there is a separation of groups that fight the immediate health care battles from the organizations that work for universal health care. "Is this the best way to organize for health care justice?" she asked.
She also noted that although UHCAN had begun to develop relationships with national organizations, often this did not translate into new relationships at the local or state level.
Steve Schear of Health Care for All-California pointed out that in California a good relationship exists between that organization, as it works for single payer, universal health care, and Health Access, which organizes California’s incremental health care justice work. "This division of labor works well," he said. "We have very cordial and supportive relations."
The coalition is now consulting with key interest groups to try to produce a consensus bill to be introduced early this year.
Major policy initiatives without either serious financial support or strong coalition backing are not like to be successful, said UHCAN national director Ken Frisof, M.D.
"We must ask the right questions in order to move our agenda," he said. "Whom do we ally with? How do we build these alliances?"
By the end of the conference, four conclusions emerged:
Although activity is necessary at both the state and national levels, at this time organizations dedicated to universal health care should build and work at the state level.
Organizational development is a priority.
Groups working for universal health care should build strategic alliances.
UHCAN needs to develop national unifying campaigns. Possibilities include "process bills" that define principles as yardsticks or a method to arrive at universal health care without specifying the policy outcome in advance, and specific policy proposals for achieving universal health care.
Patricia Dowds had one parting word for the religious groups there. "History shows," she said, "that no major social justice changes have happened in this country without the support of the faith community."
"Faith groups move slowly, but they make a big impact when they get there," said the Rev. Linda Hanna Walling, who heads up UHCAN’s Faith Project. "Religious values are a basic foundation of health care justice."