Part of the Media Blackout series on underreported labor stories

By David Swanson, ILCA Media Coordinator

Single-payer health care is, according to numerous surveys, supported by a majority of Americans.i Few public policies are inspiring more activism and advocacy in the United States right now than single-payer health care at the national and state levels.ii Organizations are holding marches across major city bridges. Think tanks and foundations and labor unions are generating studies. Doctors, patients, and labor and community organizations are rallying for the cause. Bills have been introduced in Congress and various state legislatures. Polls by the media consistently rank health care as one of the public's biggest concerns when considering political candidates.iii

Labor unions on strike and negotiating contracts usually cite health care as a primary point of contention. Numerous Congressional and state candidates advocate single-payer health care, as did a third of the presidential candidates during much of the run-up to the Democratic primaries. And the media gives extensive, though rarely substantive, coverage to health care. Yet, the media marginalizes single-payer health care, omitting it from discussion, failing to cover mass movements in support of it, misrepresenting what it means, falsely reporting that it is unpopular, and labeling it with scary names intended to make it inadmissible for consideration.

Single-payer health care means private health care publicly paid for. Under such a system, patients would choose their own doctors but be insured by the government rather than being covered by an HMO or private insurance company or not being covered at all.iv The United States would join nearly every other industrialized nation in covering all of its citizens fully, from cradle to grave, with no individual bills, co-payments, or deductibles. Vast amounts of waste in the private insurance industry would be eliminated, so that, according to countless analyses, the nation would spend less to cover everyone than we now spend to leave 45 million uncovered and tens of millions more insufficiently covered.v In effect, Medicare would be enhanced and expanded to cover all patients and to cover all necessary and preventive medicine. But doctors would remain in private practice and would not become government employees.

October 3rd to 10th was "Health Care Action Week" and witnessed numerous public forums and protests. As part of this largely unsuccessful effort to get the media's attention, Jobs With Justice released a report funded by six labor unions and developed by the Center for Economic and Policy Research. The report covered new ground with national data and, for the first time, provided state level data on the funds that could be saved by cutting out waste in the health insurance and pharmaceutical industries. The report, titled "Waste Not, Want Not," showed that approximately $245 billion is wasted on private insurance red tape, patent protection sheltering drug companies from competition, and subsidies to private insurance companies in George W. Bush's recently enacted Medicare bill. That's more than enough money to insure all Americans who lacked coverage all or part of last year.

Jobs With Justice and other organizations promoted this report ahead of its release date in many states. Often reporters enjoy nothing better than the ease of covering a report that provides them with new information on a major story and includes both national and state angles. Not this time. New York Times reporters either didn't return calls or said they were too busy, according to Jobs With Justice National Organizer Rand Wilson. A Boston Globe reporter told him the study was "biased." Various labor and progressive web-based publications covered the report, including the Union Advocate, Press Associates Inc.,, and But the corporate media was less interested. Marketplace Morning Report on public radio was the only national outlet to report on the study.

Six local newspapers covered it, the largest being the Boston Herald, which devoted about 100 words to the report and another 100 to the opinion of a "pro-business" institute that called the report "naïve." To its credit, the Herald printed a 160-word letter from Rand Wilson responding to the article. While no national newspapers, magazines, or broadcast news outlets covered this story as news, USA Today did cover it as opinion, printing a column by the report's primary author, Dean Baker.

The media's handling of this report is in many ways typical of its handling of single-payer health care. An unusually high percentage of the items found when searching in the Nexis database for "single-payer" are letters to the editor, almost all of them in support of single-payer and written in response to articles or columns that opposed it. Other than letters, many of the items found in Nexis are articles listing positions that a political candidate supports or opposes. "Single-payer health care" is listed in these articles but not explained.

Of 205 items containing "single-payer" in the past two months in Nexis, I was able to find only two articles that gave any substantive explanation of what it was. Equally rare are articles explaining that national health care is a solution already arrived at by almost every other wealthy and some much less wealthy countries in the world. Much more common are articles giving the impression that this is a uniquely Canadian idea.

Even opinion pieces explaining single-payer are rare: a total of seven in the past two months in Nexis, one of them by United Auto Workers President Ron Gettelfinger. Only one of the seven was by a staff columnist, Paul Krugman of the New York Times, who "supports" single-payer but says it's not politically feasible right now. In contrast to his usual care, Krugman offered no evidence for this assessment but said he was deferring to the wisdom of others.

Many, if not most, discussions of single-payer in the U.S. media falsely, and without making claim to any evidence, dismiss it as unpopular. During the past two months, false claims that single-payer is unpopular could be read in many "mainstream" Often the same articles or commentaries argue that this alleged unpopularity will prevent passage of single-payer through Congress.vii Mainstream outlets are towing the very same line on health care as outlets commonly labeled right-wing.viii As documented in a recent study by FAIR, the media almost never mentions insurance industry contributions to Congressional campaigns. This gap makes it easier for a false unpopularity to fill in as an explanation for Congress's failure to pass single-payer.ix

The fact that the media's own polls find popular support for a position that the media keeps telling us is unpopular suggests that there are limits to the media's ability to create reality. When people see their loved ones dying for lack of health coverage, apathetic is the last word in the dictionary that could be applied to their behavior. People in these situations try everything and find information anywhere they can. Many people have obviously found their way around the media to useful information about single-payer.

But the media knows how to play rough and is nowhere near finished supporting the private insurance industry. The right-wing Investor's Business Daily in a September editorial claimed that Canada's health care system is "a disaster." Ted Koppel tried this same lie in 1993, when he told Bill Clinton that Canadians were saying to America "Whatever you do, don't exchange what you've got for what we've got." It would have been hard for Koppel to find an actual Canadian to say that, since only 2 percent of Canadians believed that the U.S. health care system was better than their own, according to a Gallup poll taken only a few days earlier.x

A more creative lie is the one that holds that people simply CHOOSE not to have health coverage. An example of this one was found in the Journal News of Westchester County, N.Y., on September 20th in an interview with Michael Stocker, President and CEO of WellChoice Inc. and Empire Blue Cross Blue Shield, who said: "I believe that we need a universal coverage solution but that such a solution should not be a single-payer, government-run system. People are uninsured for many reasons, some by choice and some by circumstances, and we need to ensure universal coverage through a variety of targeted programs in which both the private and the public sectors participate."

When the media finishes lying about single-payer, it likes to call it names, including "extreme." Often, the current system is depicted as a moderate middle road between single-payer and some unspecified other "extreme."xi One of the media's favorite names for single-payer is "socialized medicine." In searching Nexis, I found, in the past two months, 141 items mentioning "socialized medicine," the vast majority of them using the phrase pejoratively, and virtually none of them offering any explanation of what it meant or why it was so undesirable. "Socialized medicine" is also a common reason for opposing John Kerry's candidacy for president, despite the fact that Kerry opposes single-payer, and despite the fact that not a single American politician that I'm aware of supports making doctors and nurses state employees.xii

State-level candidates also come under attack. The Worcester (Mass.) Telegram & Gazette reported on a local candidate's view that safe staffing levels for nurses is "socialized medicine": "Ms. Blute labeled one of the ideas -- to recruit and retain nurses -- as a step toward 'socialized medicine,' because it is apparently based on legislation backed by the state nurses union to mandate 'safe' nurse staffing levels." The Florida Times-Union reported that a local candidate's proposal "offers a modern, free-market solution as an alternative to the tired, old remedy of socialized medicine being proposed by others." How something never implemented can already be a tired and old remedy was not explained.

The St. Louis Post-Dispatch this month ran an article attempting to chronicle the fate of national health care proposals since Truman, which included this analysis: "Princeton University professor Uwe Reinhardt, an expert on the politics and economics of health care, said at a forum on universal health care in April that 'Americans fear American government even more than weapons of mass destruction.' With each failure, the task gets harder. The private insurance system becomes more deeply rooted, the political interests more powerful, the public more resistant to dramatic change."

The same article blamed labor unions' resistance to compromise for Congress's failure to pass national health care under Nixon, even while quoting an analyst who blamed Nixon's impeachment proceedings. Next, the Post-Dispatch blamed Hillary Clinton for resistance to compromise, even though her proposal was so corporate and compromised from the outset that many called it oxymoronic: "managed competition." The Post-Dispatch article cited criticism of the Clinton plan as "socialism," "big government," and "stupid." But the Post-Dispatch, to its credit, quoted an analyst to the effect that simple single-payer health care would have been an easier sell.xiii

The Post-Dispatch's chronicling of national health care closed with this false description and baseless crystal ball reading:

"Some advocates of universal care now say the best hope is at the state level; others still want a federal plan. The politics of it won't change anytime soon. 'It's a deeply divisive matter,' Marmor said. 'It divides the country into broad blocs concerning basic values and basic understandings of what government ought to do.'"

How does this fit with all the polls showing that, despite every effort of the media, a strong majority of Americans favor universal health insurance?xiv

The forecast that "the politics of it" won't change anytime soon should be taken with the same grain of salt as the pronouncement by the New York Times in an October 10, 1992, editorial that "the debate over health care reform is over. Managed competition has won," an outcome that the Times found "delicious" and "wondrous."xv

The argument, which I've heard more than once, that the media doesn't cover single-payer health care as a viable option because our elected representatives don't treat it as one is undone by the media's own cursory reporting on Congressional candidates favoring single-payer. In the early 1990s, when 100 members of Congress co-sponsored a single-payer proposal, it received little coverage, even at a time when health care reform was one of the media's top issues. ABC World News Tonight, for example, mentioned the bill only once in all of 1993.xvi The case that the media opposes single-payer for its own reasons was made quite starkly during the 2003-2004 Democratic presidential primaries. Substantive coverage of issues was sparse, but where it existed, it covered the positions of those candidates who did not step outside the range of debate that the media preferred.xvii

In Warren Beatty's 1998 political comedy, "Bulworth," a straight-talking candidate who bad-mouths the insurance industry and makes fun of people who fear the word "socialism" is embraced by CNN's Larry King and skyrockets to electoral victory, after which the insurance industry assassinates him. Back here in reality, Larry King tries to shut down any movement toward single-payer health care by dismissing it as socialism. This is from the transcript of the February 26, 2004, debate that included Kerry, Edwards, Sharpton, and Kucinich:

"KUCINICH: I agree with my friend John Edwards about we need to do something about poverty. And that's why I'd like you to join me in this proposal to have a universal single-payer, not-for-profit health care system, because that would lift tens of millions of Americans out of poverty. And, Larry...
"KING: By the way, Harry Truman proposed that in 1948.
"KUCINICH: Well, and you know what? John Conyers and I introduced the bill in this Congress. And that would provide all coverage for everyone, all medically necessary procedures, plus vision care, dental care, mental health care...
"KING: In other words, socialism?"

End of discussion.

But I prefer to give the last word to Jared Bernstein, senior economist at the Economic Policy Institute, who wrote this letter, published by the New York Times, in response to Krugman's column:

"To the Editor:

"Paul Krugman (''America's Failing Health,'' column, Aug. 27) argues convincingly for a single-payer health care system, but then cites health economists who claim such a goal is politically unrealistic.

"With all due respect to those, like me, in that profession, economists don't always have the best political antennas. Especially where health care is concerned, many economists still believe that markets can save the day, despite the lesson from international comparisons that the best way to provide health care is to take it out of the market.

"Perhaps we need to turn to the political scientists to help us figure out how to build a movement that can alter the political realities that are supposedly blocking the way to universal health care."

The article can be reproduced with or without the endnotes if credit is given to the ILCA and this link to the full text is included:

The International Labor Communications Association, founded in 1955, is the professional organization of labor communicators in North America. The ILCA’s several hundred members produce publications with a total circulation in the tens of millions.

Bullet Points for Legislators

  • Single Payer saves money.  For the past 20 years, states have commissioned studies on different types of health care systems.   In EVERY case, single payer was shown to be the only way to cover everyone and the only system that saved money and controlled costs.

  • Publicly financed does not mean government run health care.  YOU have publicly finance health coverage, but the government does not make decisions regarding your health care.

  • Cost conscious patients often don't get the care they need.   Most decisions are made by the doctor in concert with the patient, but the patient relies on the doctor's knowledge to make a decision.  Expensive tests and treatments cannot be ordered by the patient, only the doctor.

  • Lifestyle choices are not what is fueling high costs in health care.   The United States ranks low in general health indicators, but high in good health habits.  We smoke less, drink less and consume less animal fat that many other countries with better health indicators and much lower health care costs.

  • Businesses can accurately determine their health care costs and are not subject to unanticipated large premium increases.

  • It will reduce labor costs due to a more efficient way of financing health care, eliminating much wasteful administration.

  • Workers' Compensation costs will be reduced, likely by half, due to the fact that everyone has health coverage and there is no need for the medical portion.

  • It reduces the need for part time employees and provides easier recruiting.  There are no pre-existing conditions or Cobra issues.

  • Eliminates the oversight of health benefits and bargaining health coverage with employees.

  • It creates healthier personnel and more stable employees, reduces absenteeism and eliminates employer health coverage complaints.

  • It reduces employee health related debt and personal bankruptcies.

  • It frees up family income that can be spent on other goods and services, thus stimulating the economy.

Tips for Writing Letters to Editor

Follow guidelines for your local paper (word count, submission instructions, etc.)

Frame your letter in relation to a recent news item Use state specific data whenever possible (let us know if you need help finding some!)

Address counter arguments

Be aware of your audience and emphasize how Medicare for All is good for ALL residents of the state

Criticize other positions, not people Include your credentials (especially if you work in the healthcare field)

Avoid jargon and abbreviations

Don’t overload on statistics and minor details

Cover only one or two points in a single letter

Avoid rambling and vagueness


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