Is national health insurance “socialized medicine”?
No. Socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. Examples also exist in Great Britain and Spain. But in most European countries, Canada, Australia and Japan they have socialized financing, or socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage their medical practices or hospitals.
The term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance. It does describe the interference by insurance company bureaucrats in our health system.
Won’t this raise my taxes?
Currently, about 64% of our health care system is financed by public money: federal and state taxes, property taxes and tax subsidies. These funds pay for Medicare, Medicaid, the VA, coverage for public employees (including teachers), elected officials, military personnel, etc. There are also hefty tax subsidies to employers to help pay for their employees’ health insurance. About 17% of heath care is financed by all of us individually through out-of-pocket payments, such as co-pays, deductibles, the uninsured paying directly for care, people paying privately for premiums, etc. Private employers only pay 19% of health care costs. In all, it is a very “regressive” way to finance health care, in that the poor pay a much higher percentage of their income for health care than higher income individuals do.
A universal public system would be financed this way: The public financing already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any and all other out of pocket payments. For the vast majority of people a 2% income tax is less than what they now pay for insurance premiums and in out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. It is also a fair and sustainable contribution. Currently, over 41 million people have no insurance and thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but they would receive health insurance for the same low rate as larger firms. Many small employers have to pay 25% or more of payroll now for health insurance – so they end up not having insurance at all. For large employers, a payroll tax in the 7% range would mean they would pay less than they currently do (about 8.5%). No employer, moreover, would hold a competitive advantage over another because his cost of business did not include health care. And health insurance would disappear from the bargaining table between employers and employees.
Another consideration is that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance that is almost worthless if they were to have a serious illness.
Won’t this result in rationing like in Canada?
The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.
If there is this much rationing why don’t we hear about it? And if other countries do not ration the way we do, why do we hear about them? The answer is that their systems are publicly accountable and ours is not. Problems with their health care systems are aired in public, ours are not. In U.S. health care no one is ultimately accountable for how it works. No one takes full responsibility.
The rationing that takes place in U.S. health care is unnecessary. A number of studies (notably the General Accounting office report in 1991, and the Congressional Budget office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are far higher in the U.S. than in other countries’ systems. These inflated costs are directly tied to our failure to have a publicly-financed, universal health care system. We spend at least twice more per person than any other country, and still find it necessary to deny health care.
Who will run the health care system?
There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.
In a public system the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.
The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.
What about medical research?
Much current medical research is publicly-financed through the National Institutes of Health. Under a universal health care system this would continue. A great deal of drug research, for example, is funded by the government. Drug companies are invited in when it comes to marketing successful new drugs. AZT for HIV patients is one example. All the expensive clinical trials were conducted with government money. When it was found to be effective, marketing rights went to the drug company. (This is a controversial practice because it means pharmaceutical companies enjoy significant profits on the back of taxpayer-financed research.)
Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries that have national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The new treatment to cure juvenile diabetics by transplanting pancreatic cells was developed in Canada.
It is also important to note that studies show that the number of clinical research grants declines in areas of high HMO penetration. This suggests that managed care increasingly threatens clinical research. Another study surveyed medical school faculty and found that it was more difficult to do research in areas with high HMO penetration.
Won’t this just be another bureaucracy?
The United States has the most bureaucratic health care system in the world. Over 24% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, and other non-clinical costs. Because the U.S. does not have a system that serves everyone and instead has over 1,500 different insurance plans, each with their own marketing, paperwork, enrollment, premiums, rules, and regulations, our insurance system is both extremely complex and fragmented. The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO.
It is not necessary to have a huge bureaucracy to decide who gets care and what care they get, if and when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save nearly $150 billion per year.
How will we keep costs down if everyone has access to comprehensive health care?
People will seek care earlier when diseases are more treatable (and affordable). We know that the uninsured delay or avoid seeking care because they are afraid of health care bills. This will be eliminated under such a system. Undoubtedly costs of taking care of the medical needs of people who are currently doing without will cost more money in the short run. But we will be spending proportionately less on administration to compensate.
In the long run, the best way to control costs is to negotiate fees and budgets with doctors, hospitals, and drug companies and to set and enforce an overall budget.
How will we keep doctors from doing too many procedures?
This is a problem in systems that reimburse physicians on a fee-for-service basis. In today’s health system, another problem is physicians doing too little for patients. So the real question is, “how do we discourage both overcare and undercare”? One approach is to compare physicians’ use of tests and procedures to their peers with similar patients. A physician who is “off the curve” will stand out. Another way is to set spending targets for each specialty. This encourages doctors to be prudent stewards and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from other physicians in the same specialty. Another way is to continue to develop expert guidelines by groups like the American College of Physicians, etc. to shape professional standards – which will certainly change over time as treatments change. This really gets to the heart of “how do you improve the quality of health care” which is a longer topic . Suffice it to say that universal coverage is a pre-requisite for quality improvement.
What will happen to physician incomes?
On the basis of the Canadian experience, average physician incomes should change little. However, the income disparity between specialties is likely to shrink.
The drop in income that a physician might experience under a single-payer system could be mitigated by a drastic reduction in office overhead and malpractice costs. Billing would involve imprinting the patient’s national health program card on a charge slip, checking a box to indicate the complexity of the procedure or service, and sending the slip (or a computer record) to the physician-payment board. This simplification of billing would save thousands of dollars per practitioner in annual office expenses.
How will we keep drug prices under control?
When all patients are under one system, they wield a lot of clout. The VA can purchase drugs for 40% discounts because they are a bulk purchaser. This is called monopsy buying power and it is the main reason why other countries’ drug prices are lower than ours. The same could happen with medical supplies and durable medical equipment.
Why shouldn’t we let people buy better health care if they can afford it?
Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. One need only look at the example of the nation’s health insurance program for the poor, versus the Walter Reed Hospital in Bethesda, MD, that serves members of Congress. Access to care for the poor is deteriorating because Medicaid is a grossly underfunded health care program. Because it doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. D.C. General Hospital in D.C., which serves the poor, is always on the brink of bankruptcy. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered to be politically important. On the other hand, members of Congress have completely free access to care at Walter Reed where the quality of care couldn’t be better.
What will be covered?
All medically necessary care, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care.
What about alternative care, will it be covered?
Alternative care that is proven in clinical trials to be effective will be covered. For example, spinal manipulation for some back conditions. Other treatments will be decided by the health care planning board or other public body. New kinds of treatments will be added to the benefits package over time as they are shown to be effective, including “alternative” treatments. Similarly, ineffective, harmful, or wasteful care can be removed from the benefits package, such as funding for a costly medication that is no better than aspirin for arthritis.
Isn’t a payroll tax unfair to small businesses?
The payroll tax is more costly to businesses who are not currently insuring their workers. However, it is much less THAN what they would pay for good private insurance for themselves and their workers. For most of the small businesses already providing coverage, the payroll tax will be much less expensive than what they are paying now.
Ideally, the payroll tax will be replaced in the future by a tax that doesn’t charge an administrative assistant making $17,000 a year the same percentage of salary as a CEO earning $175,000 a year.
Can a business keep private insurance if they choose?
Yes and no. Everyone has to be included in the new system for it to be able to control costs, reduce bureaucracy, and cover everyone. However, business and anyone who wants to can purchase additional private insurance that covers things not covered by the national plan (e.g. cosmetic surgery, orthodontia, etc.).
Insurance companies will no longer be needed to decide who gets medical care and what kind of medical care, and would not be allowed to offer the same benefits as the universal health care system. Any allowance for this would weaken and eventually destabilize the health care system. It would undermine the principle of pooling the risk. Health care systems act as universal insurers. At any one time the healthy help pay for those who are ill. If private insurers are allowed to cherry pick the healthy, leaving the public health care system with the very sick, the system cannot help but fail. This is part of what is happening in U.S. health care now.
Another reason is that, if allowed, patients would enroll in the private system while they were healthy (and their premiums were low), and enroll in the public system when their care (and private premiums) became expensive. This, in fact, is what we saw happen to Medicare and HMOs. There, patients needing expensive care, e.g., a hip replacement, were encouraged to drop out of their HMO so traditional Medicare would pick up the tab. However, while they are healthy they enroll in the HMO for the modest additional dental and drug benefits.
What will happen to all of the people who work for insurance companies?
The new system will still need people to administer claims. Administration will shrink, however, eliminating the need for a large bureaucracy. The focus will shift to those who deliver health care. More health care providers, especially in the field of long-term care and home health care, will be needed, and many insurance clerks can be retrained to enter these fields. Many people now working in the insurance industry are, in fact, already health professionals (e.g.nurses) who will be able to find work in the health care field again.
How will we contain costs with the population aging and the advent of expensive technology?
Japan and Europe are already facing this problem head-on and doing fine. They have a much higher percentage of elderly than we do, and still spend less on health care by far.
The best way to approach this is to regard it as a societal problem, one that needs a solution with everyone in mind. Germany and Japan recently adopted single-payer long-term care systems to cover the long-term care needs of the elderly at home and in specialized housing. Germany is pioneering a program that pays family members to care for the elderly at home. That’s family values!
What about ERISA? Doesn’t it stand in the way of implementing a universal health care plan?
No. ERISA (the Employees Retirement Income Security Act) prevents a state from requiring that a self-insured employer provide certain benefits to their employees. However, a single payer plan would not mandate the composition of employer benefit plans – it would replace them with a new system that would essentially be “Medicare for All”. The state would require employers to pay a payroll tax into the health care trust fund. This is legal and is done now with taxes levied to pay for Medicare.
How will the Health Planning Board operate?
In Vermont, it would work something like this: The health planning board (the Health Care Administration) would be a public body with representatives from every legislative district. The representatives would be appointed by each member of the state house of representatives. The state would be divided into 7 regions. The appointed members from each region would elect one person among them to serve on the health planning board. The board would consult regularly with a medical expert advisory committee. The latter would advise the regional board members on what treatments, medications and services should be covered, decisions supported by medical science.
Since we could finance a fairly good system , like the Norwegian, Danish or Swedish system with the public money we are already spending (60% of health costs), why do we need to raise the additional 40% (from employers and individuals)?
There are three reasons why the U.S. health care system costs more than other systems throughout the world. One, we spend 2-3 times as much as they do on administration. Two, we have much more excess capacity of expensive technology than they do (more CT scanners, MRI scanners, mammogram machines than we need). Three, we pay higher prices for services than they do. There is no doubt that we do not need to spend more than we currently spend to cover comprehensive care for everyone. But it would make the transition to a universal system very difficult at first if we spent less. That is because we have a tremendous medical infrastructure, some of which would likely retain its slightly larger than necessary capacity during the transition phase. Secondly, we would likely retain salaries for health professionals at their current levels. Thirdly, we would cover much more than most other countries do by including dental care, eye care, and prescriptions. And for these reasons we would need the extra 40% that we are already spending – but NOT more. We could cover all the uninsured for the same amount we are currently spending!
How much of the health care dollar is publicly financed?
Previous calculations of the percentage of the health care dollar that is publicly financed were estimated to be around 50%. That was from federal and state taxes to fund Medicare, Medicaid and the VA. 30% was out-of-pocket and 20% from employers.
Estimates differ depending on how they factor in certain costs. For example, recent studies put the tax subsidy offered to employers into the public spending column. A tax subsidy to help employers buy health insurance for employees means the public helps pay the bill. Another factor is that many employees pay the full cost of the premiums for their health insurance at work – not the employer. Newer analyses of these factors put the public financing estimate at 64%, out-of-pocket at 17% (for uncovered services, premiums not paid for by an employer) and employers’ contributions at 19%. (Health Affairs 1999;18(2):176.
Why not MSAs?
Medical savings accounts (MSAs) and similar options such as health reimbursement arrangements are individual accounts from which medical expenses are paid. Once the account is depleted and a deductible is met, then medical expenses are covered by a catastrophic managed care plan, usually a restricted PPO plan. Individuals with significant health care needs may rapidly deplete their accounts and then be exposed to large out-of-pocket expenses. They would tend to select plans with more comprehensive coverage. Since only healthy individuals would be attracted to the MSAs, higher-cost individuals would be concentrated in the more comprehensive plans, driving up premiums and threatening affordability. By placing everyone in the same pool, the cost of high-risk individuals is diluted by the larger sector of relatively healthy individuals, keeping health insurance costs affordable for everyone. Also, since healthy individuals cannot possibly predict whether or when they would develop significant health care needs, they would eliminate that potential financial risk by being included in the comprehensive pool with everyone else.
Why not use tax subsidies to help the uninsured buy health insurance?
The major flaw of tax subsidies is that they would be used to help purchase plans in our current fragmented system. The administrative inefficiencies and inequities that characterize our system would be left in place, and we would continue to waste valuable resources that should be going to patient care instead. In spite of tax subsidies, moderate and lower income individuals would be able to afford only those plans with very modest benefits, and with higher cost sharing that might make health care unaffordable. Instead of perpetuating our current inequities, tax policies should be used to create equity in contributions to a system in which everyone is assured access to comprehensive beneficial services.
If the tax subsidies are granted to individuals, employers would be motivated to drop their coverage, and most individuals covered would have merely rotated from employer coverage to individual coverage. The net reduction in the numbers of uninsured would be close to negligible. If the tax subsidies are granted to employers, a major shift in funding passes from employers to taxpayers without significant improvements in the inefficiencies and inequities of our current system. We can use the tax system to create equity in the way we fund health care, but we should also expect equity and efficiency in allocation of our health care resources. That is possible only if we eliminate the private health plans and establish our own publicly administered system.
Won’t competition be impeded by a universal health care system?
Advocates of the free market approach to health care claim that competition will streamline the costs of health care and make it more efficient. What is overlooked is that competitive activities in health care under a “free market” system have been wasteful and expensive and can be blamed for raising costs. Not only have they NOT contained costs, they have raised costs. In fact it has been shown that in some states where competition among insurers and HMOs is fiercest, such as California, costs are higher than the national average.
There are two main areas where competition exists in health care. Among the providers, and among the payers. When, for example, hospitals compete they often duplicate expensive equipment in order to corner more of the market. This drives up overall medical costs to pay for the equipment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of the public.
Competition among medical care providers can be beneficial in terms of improving the quality of medical care. Take for example, three primary care doctors in a certain area “competing” for patients for which they will receive equal reimbursement from every patient. The doctor who is most competent in different areas will attract the most patients in that area. One doctor may make house calls to see the elderly. Another may be very good at mental health care. This is competition based on quality not on price. Competition among insurers (the payers) is not effective in containing costs either. Rather, it results in competitive practices resorted to by private payers such as avoiding the sick, cherry picking, denial of payment of expensive procedures, marketing, etc.
Why not make people who are Higher Risk pay Higher Premiums?
Experience rated insurance requires higher risk people to pay higher premiums. This approach says that people who have had cancer or other problems in the past, or who have chronic conditions like diabetes and hypertension, must pay more because they are at higher risk of getting cancer again or having a stroke or other health problem. Experience rating allows insurance companies to “cherry pick” the healthiest people and either refuse to insure the sickest or, what amounts to the same thing, charge prohibitively high rates.This approach makes no sense. The whole point of insurance is to spread the risk so that everyone is covered. If you raise premiums – and thereby exclude from coverage – those people unfortunate enough to have been sick in the past, you defeat the point of both insurance and the health care system. Genetic conditions, childhood diseases, accidents, injuries and income distribution (or how much equality there is in a society) play a much bigger role in people’s health than so-called “lifestyle” factors. It costs much less to care for a smoker than a driver who has a paralyzing accident. (Of course, we need public health and education programs to try to prevent both!).
Community rated health insurance is the socially fair approach. It spreads the risks evenly among all the insured. It removes the punitive element. It does not discriminate against the very sick, nor against those of us who are at higher risk because of our age (say, over 50) or our gender (females have higher health expenses in their 20’s and 30’s than men do).
It appears that for what should be a broad social service an insurance-based approach does not work. For it to work at all society is asked to surrender all control of the system and what is left is both discriminatory and unaccountable to anyone. At some point in our lives all of us without exception have needed or will need some level of health care. Health insurance is unlike any other form of insurance. We all are involved in it. It is profoundly intertwined with social principles of decency and fairness. A system that punishes the sick is neither. Any reform of the health care system must begin from a principled approach.
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." - Martin Luther King, Jr.
Physicians for a National Health Program
Endorsers of the campaign sponsored by Single-Payer Action Network Ohio (SPAN Ohio) to achieve an expanded and improved Medicare for All type health care system in Ohio:
HEALTH CARE COMMUNITY
James W. Agna, M.D.
Mary A. Agna, M.D.
American Medical Student Association, Case Western Reserve University
American Medical Student Association, Ohio State University
Gina Angiola, M.D.
Chris Babcock, R.N.
Holly Barrows, M.D.
Barbara T. Baylor, MPH, CHES
Stephen Beck, M.D.
Michael Bissell, M.D., Ph.D, MPH
Renee Bohannon, R.N.
Trudy Bond, Ed.D. (Consulting Psychologist)
Jeanette N. Boraby, R.N., B.S.N.
Michaela Brennan, R.N.
Daniel J. Brustein, M.D.
Brendan T. Carroll, M.D.
Wendy Cicek, M.D.
Pamela K. Cobb, M.D.
Brad Cotton, M.D.
Joseph Daprano, M.D.
Barbara I. Delarwelle, R.N.
Clarence A. DeLima, M.D., D.A.B.P.N., D.P.M.
Teri Dew, R.N.
Cynthia L. Dilauro, M.D.
John Ditraglia, M.D.
Frances Dostal, R.N.
John Egar, M.D., Ph.D.
Gaby El-Khoury, M.D.
Alice Faryna, M.D.
James Foley, L.P.T. (Physical Therapist)
Amasa B. Ford, M.D.
Constance Fox, M.D.
Eric Friess, M.D.
Elizabeth Frost, M.D.
Thomas A. Fuller, M.D.
Edward Goldberger, M.D.
Rakesh Gupta, M.D.
Christopher T. Haas, M.D.
Robert W. Hamilton, M.D., FACP
Eric Hasemeier, D.O.
B. Mark Hess, M.D.
Karl W. Hess, M.D.
Margaret Houlehan, PA-C
Marilyn Huheey, M.D.
Wendy Johnson, M.D.
Erick A. Kauffman, M.D.
Kristopher Keller, DC, DABCO
John H. Kennell, M.D.
Heidi Kreidler, R.D., L.D.
Sophia Kwiatkowski, R.N.
Lorenzo S. Lalli, M.D.
Jerome Liebman, M.D.
Dena Magoulias, M.D.
Jan Maiocco, C.R.N.P., Associate Medical Director
Joy Marshall, M.D.
Charlotte Masserant, R.N.
Catherine Mauser, C.N.M.
Jack Harvey Medalie, M.D., M.P.H.
Edward D. Miller, M.D.
James Misak, M.D.
Susan Louisa Montauk, M.D.
Bill Myers, M.D.
Mary Nichols-Rhodes, L.P.N.
Pamela Oatis, M.D.
Annette Opfermann, R.N.
Mary Ostendorf, R.N.
Clifford Packer, M.D.
Halesh M. Patel, M.D., FACP
Eleni Pelecanos-Matts, M.D.
Brenda Pettus, L.S.W.
Physicians For a National Health Program
Harry W. Pollock, M.D.
Amy Prack, M.D.
Eric Prack, M.D.
Thomas G. Pretlow, M.D.
Patrice Rancour, M.S., R.N., C.S.
George A. Randt, M.D.
M. Edith Rasell, M.D., Ph.D.
Ann B. Reichsman, M.D., Medical Director
Susan Righi, M.D.
Johnie Rose, M.D.
Johnathon Ross, M.D.
Kathleen Ross-Alaolmolki, Ph.D., R.N.
Donald L. Rucknagel, M.D., Ph.D.
Michael Joshua Seidman, M.D.
Gabriel E. Sella, M.D.
Mary Louise Shaw, M.D.
Susan B. Shurin, M.D.
Marcia Silver, M.D.
David E. Smith, M.D.
Gabriel Stanescu, M.D.
Sul Ross Thorward, M.D., F.A.P.A.
Joan E. Trey, M.D.
Laurel A. Twardzik, R.N.
Eugene J. VanLeeuwen, M.D.
Lisa Vantrease, M.D.
Aaron E. Villaba, M.D.
Heather A. Ways, M.D.
Paul Webb, M.D.
Joan B. Webster, M.D.
Cheryl Ermann Weinstein, M.D.
Meredith Weinstein, M.D.
Robert S. Weiss, M.D.
Molly M. White, C.R.N.P.
George L. Wineburgh, M.D.
Anne S. Wise, M.D.
Richard Wyderski, M.D.
American Federation of State, County & Municipal Employees (AFSCME) Ohio Council 8
American Federation of State, County & Municipal Employees (AFSCME)
Asbestos Workers Union Local 3
Ashtabula County AFL-CIO
Ashtabula County AFL-CIO Retirees Council
Boilermakers Local 900
Building Laborers Local 310
Chicago & Midwest Regional Joint Board affiliated with Workers' United
Cincinnati AFL-CIO Labor Council
Cincinnati Federation of Teachers
Cleveland-Akron Allied Printing Trades Council
Communications Workers of America District 4
Coshocton Firefighters IAFF Local 216
Cuyahoga-Medina UAW CAP Council
Farm Labor Organizing Committee (FLOC)
Franklin County AFL-CIO
Graphic Communications Conference/International Brotherhood of Teamsters Local 128N
Graphic Communications Conference/International Brotherhood of Teamsters Local 508 O-K-I
Graphic Communications Conference/International Brotherhood of Teamsters Local 544C
Graphic Communications Conference/International Brotherhood of Teamsters Local 546M
Greater Columbus-Franklin County UAW CAP Council
International Alliance of Theatrical Stage Employees (IATSE) Local 160
International Brotherhood of Electrical Workers Local 8
International Chemical Workers Union Council/UFCW
National Association of Letter Carriers Branch 385
National Production Workers Union
North Shore Federation of Labor
Ohio Association of Public School Employees, American Federation of State, County and Municipal Employees Local 419
Ohio Civil Service Employees Association, American Federation of State, County and Municipal Employees Local 11
Office & Professional Employees International Union Local 1794
Ohio State Legislative Board, Brotherhood of Locomotive Engineers & Trainmen/Rail Conference IBT
Ohio United Auto Workers Community Action Program (CAP) Council
Ohio Valley Council of Sheet Metal Workers
Operative Plasterers Local 80
Plumbers & Steamfitters Local 50
Portage/Summit United Auto Workers Community Action Program (CAP) Council
Professionals Guild of Ohio American Federation of Teachers Local 1960
Richland County AFL-CIO
Roofers Local 42
Service Employees International Union Local 627
Sheet Metal Workers' Local Union No. 24
Sheet Metal Workers’ Local Union No. 33
Toledo Council of Newspaper Unions
Toledo Newspaper and Printing Graphics Union Local No. 27N
Toledo Port Council
United Auto Workers Local 420
United Auto Workers Local 658
United Auto Workers Local 1050
United Auto Workers Local 1250
United Auto Workers Local 2075
United Auto Workers Region 2-B
United Food and Commercial Workers Local 7A
United Food and Commercial Workers Local 17A
United Food and Commercial Workers Local 880
United Food and Commercial Workers Local 911
United Food and Commercial Workers Local 1059
United Food and Commercial Workers Local 1099
United Food and Commercial Workers Ohio Council
United Food and Commercial Workers Region 4
United Steelworkers of America District 1
United Steelworkers of America Local 1375
United Steelworkers of America Local 5724
United Steelworkers of America Local 5760
United Steelworkers of America Local 14964
Utility Workers Union of America Local 270
POLITICAL ENTITIES & INDIVIDUALS
John Agenbroad, Mayor of Springboro
Brook Park City Council
Sherrod Brown, U.S. Senator
Cleveland City Council
Cleveland Heights City Council
Clinton County Board of Health
Danny Colonna, Brook Park Councilman-at-Large
Columbus City Council
Dayton City Commission
Mike Foley, Ohio State Representative
Green Party of Ohio
Robert F. Hagan, Ohio State Representative
Sandra Stabile Harwood, Ohio State Representative
Mathias H. Heck Jr., Montgomery County Prosecutor
Jefferson Village Council
Dennis Kucinich, U.S. Representative
Lakewood City Council
Debbie Lieberman, Montgomery County Commissioner
Mahoning County Commissioners
Dale Miller, Cuyahoga County Council
Montgomery County Democratic Party
North Olmsted City Council
Ohio Progressive Action Coalition
Ohio State Labor Party
Painesville Township Board of Trustees
Portage Democratic Coalition
Progressive Democrats of America, Ohio Chapters
Seven Hills City Council
Michael Skindell, Ohio State Senator
South Euclid City Council
Struthers City Council
Village of Newburgh Heights
Warren City Council
Windham Village Council
FAITH & SOCIAL ACTION AND COMMUNITY ACTIVISTS
Rev. Colin Bossen, Minister, Unitarian Universalist Society of Cleveland
Rev. Melissa Carvill-Ziemer, Minister, Unitarian Universalist Church of Kent
Christ Episcopal Church Vestry, Dayton, OH
Church of the World, Western Reserve Association
Cincinnati Interfaith Committee for Worker Justice
Cleveland Jobs with Justice
Community Partners for Affordable, Accessible Health Care (CPAAHC)
Consumer & Family Advocacy Council - Franklin County
Contact Center - Ohio Empowerment Coalition
CORE: Concerned Ohio Retired Educators
First Unitarian Universalist Church of Marietta
Rev. Dr. Joseph W. Goetz, Retired, Roman Catholic Archdiocese of Cincinnati
Greater Cincinnati Coalition for the Homeless
Hard Hatted Women
Justice and Witness Ministries, The United Church of Christ
Warner Mendenhall, Attorney-At-Law
NAACP Cleveland Branch
Northeast Ohio American Friends Service Committee
Northeast Ohio Poor People's Economic Human Rights Campaign
Northeast Ohio Coalition for the Homeless (NEOCH)
Rev. Dr. John S. Paddock, Rector, Christ Episcopal Church, Dayton
Rev. Gordon S. Price, Rector Emeritus, Christ Episcopal Church, Dayton
RESULTS — Columbus Group
Rev. Richard L. Righter, Pastor Emeritus, Congregation for Reconciliation
Single-Payer Action Network Ohio (SPAN Ohio)
Social Justice Committee, First Unitarian Universalist Church of Columbus
South Park United Methodist Church, Dayton
Rev. Dr. Leslie E. Stansbery, President, Interfaith Association of Central Ohio
Stop Targeting Ohio’s Poor
The Empowerment Center of Greater Cleveland
The National Poor Peoples Economic Human Rights Campaign (PPEHRC)
The Peace With Justice Project
Toledo Area Jobs with Justice Coalition
Toni K. Mcbroom, International Association of Machinists & Aerospace Workers - Ohio State Council of Machinists - Trustee of Local Lodge 956; union delegate to Coalition of Labor Union Women (CLUW)
Tri-County Independent Living Center
Universal Health Care Action Network of Ohio (UHCAN Ohio)
Wake Up Ohio
Rev. Maurine C. Waun, Minister, Ohio Valley Unitarian Universalist Congregation
West Shore Unitarian Universalist Church Social Action Committee
Women for Racial and Economic Equality
Women Speak Out for Peace and Justice
Workmen’s Circle Educational Center
Action Septic Service
Bullock's Framing Ltd.
Cleveland Food Co-Op
Dexter City Auction Gallery
Hock's Vandalia Pharmacy
Hood and Hoover Jewelry
McCutcheon Information Services
Mosyjowski & Associates Engineers
Nightsweats & T-Cells Co.
Skyview Auction House
The Honey Barn
Touch of Elegance
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Operating Expenses & Lobbying
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Donations to SPAN Ohio help cover operating and lobbying expenses and are NOT tax deductible. To donate, click the DONATE button below. On the page that appears, type in the amount of your donation. If you want your donation to be recurring, check the box where it says "Make this a monthly donation." If this is a one-time donation, leave that box blank.Then click either "Donate with PayPal" (if you have an account) or."Donate with a Debit or Credit Card." Complete the transaction on the page that follows.
Donations to HCFAO go to our education fund and ARE tax deductible. To donate, click the donate button below. On the page that appears, type in the amount of your donation. If you want your donation to be recurring, check the box where it says "Make this a monthly donation." If this is a one-time donation, leave that box blank.Then click either "Donate with PayPal" (if you have an account) or."Donate with a Debit or Credit Card." Complete the transaction on the page that follows.
OTHER WAYS TO DONATE
Recurring donations are most helpful — having a regular income stream allows us to plan and organize our activities most efficiently. If you do not wish to use your credit card through PayPal, consider asking your bank to deduct a specified amount from your account each month and send a check, payable either to SPAN Ohio or to HCFAO, to the address shown below.
Of course, a single personal check in any amount is always welcome. Please make check(s) payable to either SPAN Ohio or HCFAO and send to:
c/o Barbara Walden, Treasurer
31100 Cedar Road
Pepper Pike, OH 44124-4433
Thank you for your support.
When the Clinton health care plan collapsed in 1994, many people active in the movement to reform the system concluded that national health care was way off in the remote future and that the emphasis should be on attempting to win "small victories" and incremental reforms.
Actually, the Clinton plan never called for true universal health care. It specifically rejected eliminating the private health care insurance companies from the system. It was basically a plan for managed care or, more accurately, managed costs.
A broad coalition of forces actively fighting for a single-payer system in the early 1990s disappeared after the 1994 debacle. By the year 2000, increasing numbers of people had come to understand that an incremental approach could not solve the country's health care crisis and that only a fundamental reform of the system would. Indeed, when Clinton left office, there were eight million more people without health care insurance than on the day he was inaugurated. The single-payer movement began to experience a revival.
In February, 2001, six people met at a union office in Cleveland and constituted themselves the Single-Payer Universal Health Care Organizing Committee (SPUHCOC). Their goal was to educate the public about the advantages of a single-payer plan and to build a movement at the grass roots calling upon the Ohio General Assembly to establish such a system.
The founding group was diverse in composition and included unionists, a physician, community activists and retirees. SPUHCOC decided as its initial function to organize a public meeting to be addressed by Claudia Fegan, a Chicago physician who was a past president of Physicians for a National Health Program (PNHP) and co-author of Universal Health Care: What the United States Can Learn From the Canadian Experience. The meeting was held April 10 and drew an audience of 130 at Case Western Reserve University.
In subsequent months, SPUHCOC concentrated on drafting a model single-payer resolution and getting political bodies, other health care groups, health care providers, unions, community organizations and faith groups to endorse it. In relatively short order, the Cleveland City Council approved the model resolution with only minor modifications and other cities and town councils followed suit. Many physicians, nurses, local unions, and a variety of others endorsed a statement which simply said, "We endorse the campaign to get the Ohio General Assembly to act without delay to pass publicly funded universal health care guaranteeing coverage for all Ohioans." This statement was unanimously approved by the Cuyahoga County Commissioners, three members of Congress — Sherrod Brown, Dennis Kucinich and Stephanie Tubbs-Jones — and a number of state legislators.
In November, 2001, at the insistence of growing numbers of activists, SPUHCOC changed its name to Single-Payer Action Network Ohio (SPAN Ohio). Meanwhile, single-payer groups in Toledo and Cincinnati had begun to form and they affiliated with SPAN.
In early 2002, thousands of steelworker retirees from LTV in the Greater Cleveland area lost health care benefits they thought had been guaranteed for life. They were among 600,000 steel retirees confronted with the same drastic loss. The anguish of this situation and the constantly growing numbers of the uninsured from all walks of life created further disillusionment with the market-driven, for-profit system and much greater openness to the single-payer alternative.
By mid-2002, SPAN had become the established organizing center for the single-payer movement in Ohio. By then, SPAN had established a web site at www.spanohio.org
, which to date has received over 10,000 hits.
It became clear that SPAN needed to branch out and become a genuine statewide coalition. In the summer of 2002, SPAN activists began discussing the possibility of organizing a statewide conference which could be the springboard for forming an Ohio coalition that could mount an effective campaign for single-payer. In September, 2002, the Ohio AFL-CIO, representing 850,000 workers and meeting in convention in Cleveland, voted unanimously to endorse SPAN's campaign for a single-payer health care system in Ohio. The UAW, on a statewide basis, had also endorsed. These developments helped propel momentum for the state conference, which was held in Columbus on January 18, 2003.
This conference was a great success with keynote speeches by Dr. Claudia Fegan and Dan Martin, representing Steelworkers District 1, a panel discussion and workshops for constituency groups. The upshot of the conference was a call for a March 1 meeting to formally launch a statewide single-payer coalition.
The March 1 meeting brought together organizations representing a million Ohioans and a number of dedicated individuals. It was agreed that "Single-Payer Action Network Ohio (SPAN Ohio)" would be the name of the coalition formed at the meeting. An Interim Steering Committee of 29 was elected, pending the adoption of bylaws.
While SPAN continued to gather endorsements for its campaign, the March 1 meeting exhibited increasing interest in the idea of an initiative petition ballot campaign to put the single-payer issue on the ballot. Bob Smiddie, of Pomeroy, had long been urging an initiative and, now that SPAN Ohio had the affiliation of major forces, the idea seemed eminently reasonable, despite Ohio's highly restrictive constitutional provisions on initiatives.
In the months following that meeting, SPAN fleshed out its structure, approved bylaws, changed the name of its governing body to State Council (retaining as members on that body those previously elected to the Interim Steering Committee while adding others), convened periodic meetings of the State Council and moved forward in the drafting of the initiative petition. After months of meetings, discussions and plain hard work, a petition upon which all could agree was finalized and approved by a statewide meeting of SPAN supporters. The petition summary and 201 signatures were filed with the Attorney General's office on July 14, 2004. (The state requires that 100 or more qualified electors sign to begin the process of proposing a law to the Legislature.) On August 5, 2004, the Attorney General certified the petition, and by August 20, five thousand copies, each accommodating 65 signatures, had been printed for distribution. Within five days, nearly 2500 had been picked up by chapters, unions, and individual supporters, all volunteering to help SPAN reach its goal of 140,000 signatures.
SPAN State Council meetings are often characterized by robust debate, reflecting the internal democracy and diversity of views within the coalition. Throughout, it has maintained unity and continues to attract more and more organizations and individuals fed up with the current system and wanting a new one guaranteeing quality and comprehensive health care coverage for all Ohioans. The formation of a Columbus Chapter of SPAN on July 26, 2003 and a Southeast Ohio Chapter on July 24, 2004 were important steps forward. The goal of establishing additional chapters around the state remains a key SPAN priority.
If you are interested in organizing a SPAN chapter in your area, please call 216-736-4766 or email firstname.lastname@example.org
. Also take a look at "Forming Chapters of the Single-Payer Action Network Ohio (SPAN Ohio)" which is also posted on this website.
Article 1: Name
The name of the coalition shall be Single-Payer Action Network Ohio (SPAN Ohio), hereafter referred to as SPAN Ohio.
Article 2: Purpose
SPAN Ohio is a statewide coalition of individuals and organizations in Ohio that seeks fundamental health care reform in our state and country so that every resident is guaranteed full and comprehensive coverage for illness or injury, including work-related illness or injury. Under the plan we advocate, all medically necessary services are covered, including primary care and prevention, inpatient care, outpatient care, emergency care, prescriptions, durable medical equipment, long term care, home care, mental health services, the full scope of dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services, and basic vision care and vision correction (other than laser vision correction for cosmetic purposes). We advocate the establishment of a public fund that would pay all health care bills without co-payments or deductibles. The plan we call for is sometimes referred to as a single-payer health care system.
Article 3: Membership
Effective June 1, 2016 and forward, SPAN Ohio shall become a membership organization where membership is defined as timely payment of applicable dues, based on a rolling 12 (twelve) month membership period (from the date of membership initiation or renewal through the end of the same month of the following year) with the following categories of membership – Individual (Regular/Senior/Student) and Organization. Active membership (membership in good standing) entitles a person or an organization representative to vote in SPAN Ohio State Council elections, to nominate and hold SPAN Ohio State Council office and to receive any other benefits offered to members.
Article 4: Structure
a. State Council: The State Council shall meet at least quarterly and shall guide the work of the coalition. The State Council shall be composed of the following: (1) the SPAN Ohio Executive Committee; (2) seven regional coordinators; (3) representatives from each of the following constituencies: labor, health care community, community organizations, faith groups, business community, and other organizations and individuals not fitting into the preceding five constituencies. An equal number of seats shall be set aside for each constituency and in the event a constituency does not fill its allotted number, seats shall remain open for that constituency until that number is filled by vote of State Council members who represent that constituency. Members of the State Council elected to serve on the Council in more than one capacity (for example, as regional coordinator and constituency representative) shall have only one vote. Members of the State Council shall be elected for a one-year term at the annual meeting of single-payer supporters referred to in Article 5, at which time the seven regions shall caucus for the purpose of electing regional coordinators, after which the constituencies shall caucus for the purpose of electing their representatives, with no more than one representative coming from any one organization. The State Council shall be empowered to establish additional constituencies, if necessary, preserving parity among all constituencies. Members of the State Council may be represented by alternates of their choosing, who are members of SPAN Ohio, at State Council meetings and such alternates shall be accorded full voice and vote. State Council meetings shall be open to all supporters of SPAN.
b. Quorum: A quorum of 34% of State Council members shall be required to conduct business, and decisions shall be by simple majority of those present and voting. In the absence of a quorum, any decisions made must be ratified by the State Council either by e-mail or at the next State Council meeting.
c. Executive Committee: At the annual General Meeting referred to in Article 5, the State Council shall elect an Executive Committee which shall be composed of the SPAN Ohio State Director, SPAN Ohio Secretary, the SPAN Ohio Treasurer, and five at-large members, four of whom shall be elected and, by virtue of their election, be members of the SPAN Ohio State Council. The fifth at-large member shall be appointed as set forth in Article 4(h). The Executive Committee shall serve as the governing authority between State Council meetings. The business of the Executive Committee shall be conducted by simple majority of those present and voting, where a majority of the Executive Committee will constitute a quorum. In addition, the Executive Committee shall be responsible for monitoring and supervising the work of any consultants or professionals employed by the State Council. A member of the Executive Committee shall chair any meeting of the State Council in the absence of the State Director.
d. State Director: The State Director shall be elected by the State Council and shall chair all meetings of the State Council. The State Director shall work with SPAN Ohio supporters and Constituency groups to develop and expand education and worksite programs, work with the State Council and the Constituency groups to develop strategies for outreach and growth, work with the State Council to develop and implement legislative strategies and/or initiatives geared to promote the single payer solution and health care for all Ohioans, work with the State Council to develop and implement a fund raising strategy, work with other key coalition partners in Ohio (and nationally) promoting single payer legislation and function as the key media spokesperson for the organization. Commensurate with these responsibilities, the State Council may approve reasonable financial compensation (including expenses) to the State Director which could be adjusted relative to achievement of fund raising targets.
e. Secretary: The Secretary shall be elected by the State Council. The Secretary shall maintain records, take minutes of State Council meetings, conduct correspondence, and keep the State Council informed of SPAN Ohio activities and developments in coordination with the Executive Committee.
f. Treasurer: The Treasurer shall be elected by the State Council. The Treasurer shall receive all contributions, pay all expenses, maintain records of all financial activity, and give financial reports to State Council meetings. Payment of ordinary administrative expenses shall not require prior approval by the State Council, but payment shall not be issued to anyone absent written documentation supporting the expenditure, such as an invoice or paid receipt bearing the date of the purchase, a description of the item or service purchased, and the reason for the purchase.
g. Regional Coordinators: One Coordinator for each of the seven geographical regions corresponding to the seven Ohio Department of Health regions shall be elected at a caucus of the attendees from each respective geographical region at the annual General Meeting. The Regional Coordinators are responsible for the recruitment of SPAN Ohio supporters, maintenance of supporters lists and development of contacts among the various constituency groups within each respective region of the state. In addition, the Regional Coordinators are to work in coordination with the SPAN Ohio State Director in the development and implementation of education, outreach, petitioning and legislative action programs in their respective regions. Also, the Regional Coordinators are expected to regularly submit reports of their activities at State Council meetings.
h. Membership Committee: A Membership Committee shall be composed of three (3) members appointed by the Executive Committee for one (1) year terms and the Chairperson of the Membership Committee shall be an at-large member of the Executive Committee. The Membership Committee, in cooperation with the Treasurer, shall be responsible for recruiting new members, developing membership materials and notifying members when their dues are up for renewal.
i. Audit Committee: An Audit Committee of three members in good standing shall be appointed by the Executive Committee, excluding Executive Committee members. The Audit Committee members shall audit the Treasurer’s books and records at year’s end and report their findings to the State Council at its first meeting of the year. However, nothing shall preclude the Audit Committee from conducting more frequent audits should it deem it prudent to do so.
j. Special Committees: The State Council or the Executive Committee may establish special committees as needed.
k. Removal from Office: Any person elected or appointed to serve in any position within SPAN may be removed from office for misfeasance, malfeasance or nonfeasance in office. No representative may willfully misrepresent the mission and policies of SPAN, or use the SPAN Ohio name/logo to promote other activities not approved by SPAN. "Willfully" means that the person has received written notice of the violation and continues the unapproved activities or has refused to desist. The issue will be presented at the next scheduled meeting of State Council and submitted for a vote in case of elected positions. A 2/3 majority vote is required for dismissal.
l. Termination of Membership: The membership of a member shall terminate upon the occurrence of any of the following events:
1. Upon the member’s notice to the Secretary that he or she wishes to terminate membership.
2. Upon the member’s failure to renew his or her membership by paying dues on or before their due date.
3. Upon a determination by the State Council, after providing the member with reasonable written notice and an opportunity to be heard either orally or in writing, that the member has engaged in conduct materially and seriously prejudicial to the interests or purposes of SPAN Ohio.
All rights of a member in SPAN Ohio shall cease on termination of membership as herein provided.
Article 5: General Meetings:
SPAN Ohio shall convene an annual meeting in Columbus in the month of April or May, open to all Ohio supporters of a single-payer health care system, and in addition the State Council shall be authorized to call special general meetings when in its judgment they are warranted. The purpose of General Meetings shall be to provide Ohio single-payer supporters with an update on SPAN Ohio’s activities, programs, and campaigns, and to encourage their input, suggestions and evaluations with respect to SPAN Ohio’s work. The annual General Meeting shall also serve as the occasion for convening caucuses of the seven regions for the purpose of electing regional coordinators, and caucuses of the respective constituencies for the purpose of electing members from each constituency to the State Council, as described in Article 4(a). An agenda will be made available two weeks in advance of the General Meeting.
Recommendations for agenda items for General Meetings should be made to the Executive Committee within two (2) weeks of the General Meeting. Voting rules at the General Meetings will be governed by Article 4(a) above.
Article 6: Vacancies in Elective Positions
In the event of a vacancy in any elective position the SPAN Ohio Executive Committee may designate a temporary replacement who shall serve until the next SPAN Ohio Annual Conference, at which time a replacement can be elected.
Article 7: Amendments to the Bylaws
These bylaws may be amended by a two-thirds vote of the State Council. Notice of proposed changes to the bylaws must be mailed to State Council members at least two weeks in advance of the State Council meeting at which the amendments are to be voted upon.
Bylaws as adopted 6/21/03 and amended 8/16/03, 10/11/03, 12/4/04, 7/9/05, 6/2/07, 12/15/07, 8/22/09, 7/9/11, 2/8/14, 2/6/16 and 4/6/16.
COMPREHENSIVE LIFETIME HEALTH CARE FOR ALL OHIOANS
WHEREAS every person who lives or works in Ohio is entitled to quality health care as a fundamental human right; and
WHEREAS there is an escalating crisis in access to health care in the State of Ohio as massive layoffs and plant shutdowns cause alarmingly high numbers of workers and retirees to lose health care benefits; and
WHEREAS existing for-profit insurance plans often fail to deliver adequate, timely coverage to the insured and fail to provide any coverage at all to more and more Ohioans; and
WHEREAS inefficiency and unnecessary overhead and profits inherent in the existing failed system divert hundreds of millions of dollars from the taxpayers of Ohio, from Ohio businesses attempting to provide employees with health benefits, and from state and local government entities and taxpayers, and impede the efforts of health care providers to deliver quality health care to their patients; and
WHEREAS individual Ohioans and Ohio businesses continue to be subjected to large, unchecked increases in insurance premiums, prescription drug prices and other medical costs, imposing hardships on millions of individual Ohioans and driving many businesses and individuals to eliminate or curtail desperately needed coverage and benefits; and
WHEREAS a comprehensive, publicly-funded not-for-profit program will provide higher quality care for all Ohioans at much lower cost (as is the case in all of the nine largest industrialized countries except for the United States, according to the World Health Organization); now, therefore, be it
1. That the Ohio General Assembly enact without delay the Health Care For All Ohioans Act (HCFAOA), which is HB 186 and SB 168, and which provides comprehensive lifetime coverage for all Ohioans;
2. That pursuant to the HCFAOA, every person covered by it would have the same uniform schedule of benefits, including inpatient and outpatient hospital care, preventive care, doctors' visits, prescription drugs, vision, hearing, mental health, dental, home care, emergency care, medical devices, and all other necessary medical services determined by any state licensed medical provider;
3. That pursuant to the HCFAOA, an independent elected agency of State government be created to implement and administer the HCFAOA;
4. That pursuant to the HCFAOA, any person displaced from employment as a result of implementation of the Act shall be eligible to receive up to $60,000 for two years for subsistence and training, with the understanding that many of such displaced persons will find alternative employment administering the HCFAOA;
5. That pursuant to the HCFAOA, funding will be provided by the mechanisms specified by the Act, with the understanding that any claimed inequities will be subject to change by the Ohio General Assembly.
Sponsored by the Single-Payer Action Network Ohio (SPAN Ohio). For copies write us at 3227 West 25 Street, Cleveland, OH 44109 or call 216-736-4766. Please send endorsements of this resolution to the above address or email email@example.com
If you're not yet convinced that something needs to be done about access to health care in the USA, click here to read Barbara Ehrenreich's commentary: A Society That Throws the Sick Away.
A lengthy but enlightening article by Morton Mintz appeared recently in The Nation magazine. It is well worth your time to read: Single-Payer: Good for Business.
Ohio Attorney General Jim Petro has certified our petition to get the Health Care For All Ohioans Act on the ballot, opening the door for us to start collecting signatures. Click to see full text of the Petition. For a handy guide to the most important provisions of the Petition, click INDEX. For commentary that clarifies and expands upon the Act's funding formula, click FUNDING FORMULA.