Kip Sullivan
The rapid deterioration of the American health-care system, and the debate about what to do about it, is generating a maelstrom of news stories, magazine articles, and books. But the average person finds it difficult to make sense of this blizzard of information. Because the health-care system is large and complex, and because the symptoms of its decline are numerous, comprehensive reports about the health-care crisis are extremely rare. Comprehensive reports in everyday language are nonexistent.
The Health-Care Mess was written to fill that void. It assumes the reader knows nothing about health policy. As Kip Sullivan puts it, The Health-Care Mess is the book he wishes someone had given to him in 1986 when he, a community organizer, jumped into the cold, choppy waters of the health-care reform debate. At that time, he had no training in health policy. But in the course of studying the health-care system and explaining its problems to thousands of people, he discovered that health policy is not only accessible but fascinating.
The book resembles a textbook in that it treats a complex subject comprehensively, and it is meticulously documented. But it doesn’t read like a textbook. The author speaks in an informal, conversational style, he makes minimal use of jargon, and explains what jargon he has to use. And he is not coy about expressing his opinions. He believes the health-care reform debate has been unduly influenced by big corporations, especially those in the insurance and drug industries. He concludes that the health-care crisis will be solved only when America adopts a “Medicare-for-all” system, a system in which universal coverage is implemented by expanding a reformed Medicare program to all Americans.
The Health-Care Mess explains the debate about what’s wrong with the health-care system, and how to fix it, in terms everyone can understand.
Kip Sullivan has been teaching and writing about the American health-care crisis since 1986. His articles on this subject, which now number over 100, have appeared in the New York Times, the Los Angeles Times, The Nation, the Washington Monthly, the New England Journal of Medicine, and Health Affairs.
Mr. Sullivan is a graduate of Pomona College and Harvard Law School. With the exception of a three-year stint with the New York Legal Aid Society, he has spent his entire adult life working for citizen organizations. From 1980 to 2000, he was an organizer, researcher and lobbyist for Minnesota Citizen Organizations Acting Together (COACT), an organization that teaches citizens how to work together for social justice. In 1986, COACT endorsed universal health insurance and appointed Mr. Sullivan as the campaign director for that issue. This assignment required Mr. Sullivan to develop a thorough understanding of the health-care crisis – not just its obvious symptoms, but its origins and the various proposals to solve it – and to explain the crisis to the average person. Since 1986, Mr. Sullivan has explained the health-care crisis and the debate about it to thousands of people, including members of religious organizations, unions, farm groups, political organizations, and legislators.
Mr. Sullivan’s background makes him unique among those who write about health policy. Unlike most health-policy experts, he has had to explain health policy to everyday people as opposed to other health-policy experts or students interested in becoming health-policy experts. Unlike most health-policy experts, Mr. Sullivan has no financial connection to the health-care industry. He has been completely free to seek a solution to the health-care crisis that will benefit the average person as opposed to health insurance companies, pharmaceutical manufacturers, and other powerful interest groups that dominate the debate about how to solve the health-care mess.
In the summer of 1986, John Musick, my boss at Minnesota COACT (Citizen Organizations Acting Together), asked me if I would like to direct a citizen campaign for universal health insurance. At that time, I knew almost nothing about health policy. I couldn’t have told you how much the U.S. spent on health care, how many uninsured Americans there were, or what a carotid endarterectomy was. All I was sure of was that the health-care system was complex, the U.S. did not guarantee health insurance to all its citizens, and the opposition to universal coverage by the U.S. health insurance industry and the American Medical Association (AMA) was the main reason why. As I would learn later, the insurance industry and the AMA had thwarted four previous attempts to establish an American universal health insurance program – once just before World War I, again during the Depression, a third time after Harry Truman was elected president in 1948, and again in the early 1970s when Richard Nixon was supporting a universal health insurance plan.
Despite my gross ignorance of health policy, my gut reaction to John’s question was excitement. It excited me to think about building an army of people to take on the insurance industry and the AMA. The unaffordability of health insurance and medical care affected all Americans – deeply and personally. It would be three more years before the media began talking about the “health-care crisis,” but the staff and members of COACT were already well aware that a crisis was upon us. So too, it turned out, were citizen groups around the country.
COACT’s leaders and staff were aware of the problem because we had been organizing low- and middle-income Minnesotans on a variety of economic issues since COACT’s formation in Duluth in 1975. By 1980, which is when I went to work for COACT as a community organizer in the southern Minnesota town of Mankato, the problem of unaffordable health insurance was becoming more visible, especially in rural Minnesota where COACT’s offices were concentrated. Rural Minnesota had been especially hard hit by the 1980-81 recession. Many farmers, small business owners, and rural citizens were telling us they were coping with hard economic times by, among other things, scaling back the level of insurance coverage they had (for example, they were buying insurance with $500 deductibles for each member of the family), or, worse, dropping insurance altogether.
I had no doubt, then, that a campaign to make health insurance available to all Americans would excite COACT’s membership and staff and help us attract even more members. But my excitement at John’s question was tempered by what I perceived to be two big obstacles to a successful people’s campaign to establish universal insurance in this country.
The first obstacle was the power of our opponents. I did not know at the time that the U.S. health-care system absorbed almost one-eighth of every dollar Americans earn (today we spend almost one-sixth of our income on health care), but I knew the players in that industry, including the insurers, the doctors, the hospitals, and the drug industry, had a lot of money and political power and would use it against any proposal they saw as a threat to their welfare. I assumed that it would take an unusually strong movement – something at least as strong as the civil rights and anti-war movements of the sixties – to beat these guys. Even though COACT represented 20,000 Minnesotans and had an annual budget of about $700,000, we were minnows compared to the whales that dominated the health-care industry.
The second problem I perceived was the complexity of the U.S. health-care system and the difficulty COACT’s leaders and staff would have in explaining the problem and the solution to the citizens we would have to mobilize. Within a few years, I would not feel this way. Within a few years I would realize that most people can understand health policy – even enjoy it – if it’s introduced to them in bite-sized pieces, free of jargon or, if jargon is unavoidable, with jargon explained.
Despite my concern about the complexity of health policy and the power of our opponents, I told John I would be happy to direct a campaign for universal coverage if the COACT board decided we should undertake it. John agreed that the opposition would be intense and that we would have to work in coalition with other organizations.
Things moved very quickly after that conversation. COACT’s board endorsed the health-care campaign that fall, and, in November 1986, officers of Minnesota COACT and the Minnesota Senior Federation (another citizen group representing tens of thousands of citizens) sent a letter to several dozen Minnesota organizations, including religious organizations, farm groups, and unions, inviting them to a meeting to discuss creating a coalition to fight for legislation at the state and federal level to extend health insurance coverage to all citizens. In April 1987, the coalition, subsequently known as the Health Care Campaign of Minnesota (HCCM), was formally created. Within two years, it had grown to 30 groups. I worked closely with HCCM for 11 years, and then, beginning in 2002, with its successor, the Minnesota Universal Health Care Coalition.
Climbing the learning curve
My knowledge of the health-care system grew in stages that corresponded to the positions that COACT and HCCM adopted. During the last three years of the 1980s, when we were attempting to create new public programs that would make it easier for the uninsured to buy insurance, I learned about the impact the high cost of health insurance was having on people’s pocket books and the effect that not having insurance was having on people’s health. Between 1990 and 1992, when COACT and HCCM were lobbying state and federal legislators to sponsor legislation creating a “single-payer” health insurance system, I concentrated my studies on why insurance companies are so inefficient compared with Medicare, why the U.S. health-care system is so expensive compared with other countries, and what could be done to reduce America’s health-care costs. After 1993, I focused on the consequences of America’s ludicrous experiment with “health maintenance organizations” (HMOs). Nineteen-ninety-three was the year politicians, led by Bill and Hillary Clinton, endorsed HMOs as the solution to the health-care crisis. Thanks to that endorsement and to the power of the HMO industry, which by then had taken over most of the health insurance industry, health reform proposals that did not propose a prominent role for HMOs were kept off the American political agenda for the rest of the nineties.
