Last Friday evening I visited with John R. Battista, MD at his office in the outskirts of New Milford. Dr. Battista is a practicing psychiatrist who has been instrumental in the writing of proposed legislation that would provide health care based on a single payer model to all Connecticut residents.

G: How did the Connecticut Health Care Insurance Act come about, and how did you become involved?

J: I am a member of the Connecticut chapter of Physicians for a National Health Program, which is a large, nationwide organization with over 8000 health care providers as members, all of whom are in favor of single payer health care. Our Connecticut chapter wrote this single payer bill, as have other chapters in our organization. For example, the Massachusetts chapter has written a single payer bill that has received good support in that state legislature. I was involved in the writing of this bill, having been told a year ago by Representative Chris Donovan of Meriden that he would support such a bill in the state legislature if it was responsibly researched and written. So he and Representative Nancy Beal of Hamden have co-sponsored this bill, which is now formally called Proposed Bill No. 6034: An Act Concerning the Connecticut Health Care System, and it is now before the Public Health Committee in the legislature.

G: I have read the Findings and Declarations section of the bill, and the arguments for a single-payer health care system seem to be overwhelming. It certainly seems that this is an idea whose time has come.

J: The United States is the only industrialized nation in the world that does not have single payer health care. Canada, Germany, France, Italy Britain, Japan—these countries all have single payer. Furthermore, the United States spends more per patient than any other country, by far! We spend something like 30-40% more per patient in the US than other industrialized countries do. And to make matters worse, everyone thinks the United States has the best health care in the world, but this is completely bogus! We have poorer health care statistics than any other industrialized country in the world. For example, what do you imagine our ranking is for longevity in relation to the rest of the world? We're ranked 20th in the world; Japan happens to be ranked first. In infant mortality we rank 18th. We rank something like 66th in immunization, and although this is not a direct indication of the quality of our care, we do know that immunization and prevention are ways to keep down costs. We have simultaneously the most expensive health care system, with the best trained physicians and health care providers—which no one will argue with, I certainly don't—and more health care facilities than anyone else in the world, yet we have these horrible statistics. The reason for this is that we don't have access to all this high quality care that is available. Access is about money, and people can't afford it! It's as long and short as that. Single payer takes the opposite approach to what we have been doing. It says, hey everybody, you all have access. You don't have to worry about the cost. We'll figure out the cost of it by a series of checks and balances between the health care providers lobbying for more money and benefits for their services, and the consumers lobbying for more coverage or different types of coverage, and the willingness of the insurer—which is really you, the taxpayer, the voter—to pay for it.

G: How exactly will these decisions on coverage, providers' fees, and the ultimate cost to the taxpayer be made?

J: Providers' fees will be negotiated between a provider advisory group and the insurer, which would be the Connecticut Health Care Trust, an independent entity which will be set up to be reportable to the State of Connecticut. The Trust will also be in negotiation with consumer advisory groups. The Health Care Trust then is stuck with the task that they should be stuck with—deciding what benefits to cover, how much it is going to pay for these benefits, and how it is going to pay for it all.

G: So where will the money come from?

J: All of the start-up costs for this system will come out of the tobacco settlement, which is where it should come from. All of the ongoing costs will come from three different sources. We will levy excise taxes on activities which are detrimental to health, such as cigarette smoking, air and water pollution, and alcohol. We're not out to tax these things arbitrarily, or tax them out of existence, but only tax them to the extent that they can reasonably be shown to contribute to health care costs. For example, how much chronic lung disease can reasonably be attributed to air pollution coming from automobiles or other sources, how much lung cancer can be attributed to smoking cigarettes, how much will levels of infectious disease increase because of water pollution? Those who are polluting the environment or who are buying or selling these products should bear the costs of the illness that they cause. Then there will be some kind of individual income tax, and we know that no one likes taxes. But we guarantee by law that the average person's tax will be less than he or she would pay for comparable private health care. In other words, you won't be paying health care premiums or doctors' bills any more, and the money you save will more than cover the new tax you will be paying. The third source of revenue will be employers, who will be taxed a percentage of payroll. Again, the average business will pay less in this new tax than they would have paid for employees' health care premiums. A huge factor in accomplishing these savings is that we will be reducing the overhead of administering health care from 15% to 5%, which is enough of a savings to also cover all those people who don't have health care now, but who will be covered under this plan. And remember, it's not me who's saying this, but the state and federal governments who have said that single payer would save enough money to do all this. It's right there in their own reports, which are public information—read them if you don't believe me.

G: You sound like you've run into some people who question the facts and figures you're throwing out.

J: Well, yes. For example, just the other day I went with some of my colleagues to the State Capitol to meet with various legislative leaders about the bill. Of course, we met with the co-chairs of the Public Health Committee, Senator Toni Harp and Representative Mary Eberle. Their committee is the first stop in the legislative process for this bill; their committee has the decision as to whether this bill will receive a public hearing and whether it will be passed on for consideration by other committees and ultimately the full legislature. They have the power to kill this bill without it ever being considered or debated by anyone else, merely by deciding not to act on it. This happens all the time—bills die in committee for various reasons, some better than others. Anyway, we gave our presentation, and these are sophisticated politicians, we're not telling them anything they don't already know. After all, some of the studies we're relying on were done right here in Connecticut by our own government. Anyway, Mary Eberle happens to be a lawyer with a longstanding relationship with the insurance industry—she's represented and worked for the industry—and we knew this going into our meeting with her. In fact, there are some people who feel that her appointment this year to co-chair the committee, which has had a reputation in the past for being pretty progressive, was a signal that no progressive legislation was going to get through the Public Health Committee. Even though we knew all this, her reaction absolutely shocked and amazed me. In the face of all this data, all the studies—by the way, the US health care system is the most studied and catalogued in the world, it's pretty scary how much information sits in files and computers in Washington and elsewhere—Mary Eberle was able to argue that privately-run managed care is the only way to control health care costs. She understood and didn't deny the problems with our current system that single payer would address—covering the uninsured and under-insured; the issue of patient confidentiality, which is becoming a larger problem all the time with managed care, because a physician has to provide detailed information about patients on a routine basis in order for the patient to receive coverage; and the large administrative expenses of private sector managed care, which eat up about 30% of health care dollars that pass through it. Managed care administrative expenses in the US are roughly equivalent to the total amount paid to all health care providers in the country—it's amazing the amount of money that gets diverted to pay for people to sit in offices and feed information into computer programs that will determine whether or not your extra day in the hospital will be paid for. Not to mention the money that goes to paying the salaries of the people at the top of these managed care corporations—Fortune magazine has reported that the highest paid CEOs in the US are those of the HMO industry, with average yearly salaries of $20-$30 million, including stock options and all that . Yet Mary Eberle can say that she "has her finger on the pulse" of the people of Connecticut, and in the face of poll after poll which say otherwise, claims that the people prefer corporate-run managed care to the supposed horrors of a state-run single payer system.

G: So what happens next?

J: It's not clear right now whether this bill will even receive a hearing, let alone get out of the Public Health Committee to make its way through the various other hoops it will need to pass through before could become law. When you look at why we don't already have single payer health care, you begin to see how politics really works in our country. Rationality and common sense are not what control how decisions are made. There's some long and hard work that needs to be done to overcome the enormous power that the insurance industry has to crush legislation of this type.

G: Is there anything that someone reading this can do to help?

J: They can contact their state senator and representative to let them know that they support Proposed Bill No. 6034, and it wouldn't hurt to put your legislator on the spot—tell them you want to know their position on this. If you want to do even more, you can contact The Connecticut Coalition for Universal Health Care, PO Box 771, Simsbury, CT 06070, phone 860-651-3989. We could use help contacting legislators and the press, making phone calls, following up on requests for information. Like any other social movement, those of us who are involved with this become deeply passionate as we see the problems and roadblocks more clearly, but it also can be exhausting and overwhelming. We welcome more people to lend a hand!

G: Thanks for your time, and for all the hard work you're doing.

J: You're welcome. I enjoy talking about this—maybe sometime we can talk more about how this is playing out, and what I'm learning about how our government operates.