Single-payer health care: dead in Washington, but alive in the states

President Obama delivered a stirring address to Congress last night, but the federal government's inability to truly overhaul our broken healthcare system – which now leaves more than 46 million uninsured – is becoming all the more apparent.

Speaking before a joint session of Congress, Obama declared that a public option to compete with private insurers, considered vital by many liberals, was merely a "means to an end," and not essential to healthcare reform. Earlier this summer, a New York Times/CBS poll showed that 72 percent of Americans support a government-run healthcare plan. But Obama's speech last night indicates that while a bill will probably pass, prospects for comprehensive reform – the kind millions of Americans voted for – have dimmed rapidly. Insurance companies, which have given large donations to both political parties, are winning the fight in Washington.

The inability of a popular president with substantial majorities in Congress to pass a progressive health bill is immensely frustrating to healthcare activists, and to all who gave Obama a mandate for change.

But their cause is not lost – they just need a new strategy.

Given the corporate world's disproportionate influence over Washington, it is time to take the fight for public healthcare away from Congress and into statehouses across the country.

State governments are typically far more democratic that the federal government and the public has a much greater ability to penetrate the debate. Moreover, in some states there are already legislatures and grass-roots movements that are working to make a statewide "single-payer plan" – similar to Canada's national health coverage – a reality.

Two state legislatures – Vermont and California – have, in fact, passed single-payer legislation in recent years only to have them vetoed by Republican governors. But California Gov. Arnold Schwarzenegger (R) is ineligible to run for a third term and Gov. Jim Douglas (R) of Vermont has decided not to seek reelection. Either of these states could soon become the first to pass a statewide, public healthcare system that covers everyone.

"I think it makes sense to push for single-payer on a state-wide level," says Dr. Deb Richter, founder of Vermont Health Care for All. "It looks pretty grim in Washington ... so we are mobilizing our forces."

Healthcare activists in Vermont are now advocating for single-payer bills in the Senate and the House and plan to highlight the issue for the 2010 gubernatorial campaign. The Vermont Workers' Center is more than a year into a "Healthcare Is a Human Right" campaign that is releasing reports and organizing rallies all over the state.

"We think this could really happen here," says James Haslam, director of the Vermont Workers' Center. "There is a lot of excitement around this issue. Vermont could become a model for the rest of the country."

Indeed, Vermont may be the state best suited to tackle single-payer. According to a study commissioned by the Vermont Legislature in 2006, Vermont would save $51 million a year if it switched to single-payer. The state is also home to a supportive congressional delegation. Sen. Bernie Sanders, an independent who caucuses with the Democrats, has introduced legislation in the Senate that would enable states to have single-payer systems of their own.

There are also strong prospects for single-payer healthcare in California, where the legislature has twice passed single-payer, only to have it vetoed both times by Governor Schwarzenegger.

But Schwarzenegger has served two terms and will be replaced in 2010, a fact that has emboldened grass-roots activists. "The governor's race is the next stage for the single-payer battle in California," says Chuck Idelson, a spokesman for the California Nurses Association, which has been fighting for single-payer for years. "We need to elect a candidate that is open to single-payer."

The California Nurses Association was also instrumental in lobbying for an amendment, added by Rep. Dennis Kucinich (D) of Ohio to a House version of the federal healthcare reform bill, that would remove potential legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans from the federal Employee Retirement Income Security Act (ERISA).

"Even if we passed single-payer tomorrow, there would still be a protracted legal battle due to ERISA," Idelson said. "That is why this amendment is so important as we push for single-payer."

But whatever obstacles to statewide single-payer exist, they are small compared to the barriers faced in Washington, where the option was taken off the table before the national conversation began. And with vibrant single-payer movements taking place, not only in Vermont and California, but also New Mexico, Illinois, Pennsylvania, Montana, and elsewhere, it is clear that as long as Washington is impervious to change, the fight for public healthcare must be waged one state at a time.

Michael Corcoran is a journalist who focuses on business, media, and public affairs. He has written for The Nation, The Boston Globe, Extra!, Alternet, Campus Progress, and other publications.